Whimsical, queer exploration of all things gender.

Archive for the ‘The gender binary’ Category

Non-binary genders have Thousands of Years of Precedent

The enormous extent to which the binary gender system has been enforced – which claims everyone can only be male or female –  has left many people unaware of the existence of anything (or anyone) else. A lot of this has to do with a phenomenon that sociologists understand as the ‘medicalisation’ of sex. Differences in gendered behaviour (whether that be a man doing ‘women’s things’ or vice versa), sexual attraction, or clothing choice became understood as sicknesses, best left to the expertise of a doctor -when before you would’ve called for a priest, or even more likely, not actually been all that bothered. Anthropologists in the 19th century gave fantastical reports of ‘exotic’, ‘alien’ cultures. These social models regarding gender and sexuality were unintelligible to people bound by the western model: that you could be a man (who was attracted to women), or a woman (who was attracted to men). And that’s that. Such ancient and enduring social systems which involve a third gender (or more!) and other ways for understanding sexuality that aren’t readily analogous to ‘gay’, ‘lesbian’, or ‘bisexual’ can be found all over the world, but it isn’t even these that I’m referring to in the title of this article. One doesn’t need to travel far to find hugely mainstream historical precedent for the concept of a third gender. How about one of the most important and influential civilisations in the western world? Ancient Greece.

I want to talk about a particular text, written by Plato. Student of Socrates, teacher of Aristotle, it’s fair to regard him as a founding father of philosophy. The text is a collection of speeches by different important Greek thinkers, written to reflect  each man delivering his speech to the others at a drinking party. This is Plato’s Symposium.

One of the speeches was given by Aristophanes, who was a comic playwright. He asks why is it that when in love, many people report feeling ‘whole’, as if previously incomplete? The explanation, he says, is due to how mankind used to be.

Humans were, according to Aristophanes, originally beings with two heads, four arms and legs, and two hearts, who were very powerful. Each head (and corresponding genitals) could be male or female – so there were three possible sexes! Male, where both were men, female, where both were women, and ‘androgynous’, where you had one male and one female. These powerful double-people decided to storm Mount Olympus, so to stop them Zeus smote them, tearing everyone in half. Each person then desperately tried to find their original pairing – which positions the male and female double-people as gay men and lesbian women, with the third gender representing what we would now label heterosexuality. This comic illustrates perfectly.

aristophanes

This importantly demonstrates how a two gender system hasn’t always had the total monopoly one might assume it has. Whilst this doesn’t say anything about the thoughts had about gender by the everyday ancient Greek, it simply shows there was recognition of a third gender through stories, and there wasn’t any strangeness or moral failure or sickness associated with it. The same culture gave us Hermaphroditus, the neither-male-nor-female divine child, and root of the word hermaphrodite, often historically used to describe intersex people.

SONY DSC

 

Whilst the identity labels are new (the word ‘homosexual’ only being created in the late 1860s for example), all evidence shows that the rich human variation of gender identity and sexuality have been around for as long as people have  thought about themselves and who they are.

 

Facebook Gender Categories Explained

In case you didn’t know, Facebook allows for a user to fill in their own gender identity, rather than be forced to select ‘male’ or ‘female’. This is great news for everyone, including many people who ARE male or female. But what is meant by many genders can leave some people puzzled.

gender options

Oliver Haimson et al. has gathered some data which shows what people who use the custom gender option actually define themselves as:

facebook gender options

 

Whilst the numbers total over 100%, that’s due to there being no restriction on how many gender identity labels a person can hold. It’s a good graph to get a rough sense of the identity categories that people are using. There’s also many categories where the differences may not be clear. What’s the difference between transgender and transsexual? What’s the difference between ‘trans’ and ‘trans*’?

Of course, the meaning of a label can differ depending upon who you’re talking to – different terms resonate differently with different people, and two people’s understandings may easily contradict, so there is never going to be an easy ‘factual’ list that can be referred to. Identity is a highly personal thing, and can only be defined by an individual. This post simply acts as a guide to give some basic explanation of these categories. Some labels may seem to overlap completely in one person’s eyes (say, trans man and trans male) whilst highlighting an important difference to someone else. I’ll be grouping some identities together due to similarity, but it’s important to bear this in mind and that of course, much variation can exist between people who may identify with the same gender identity. I’ll also explain some of the differences between some of the labels.

It is important to remember – gender identity is not sexuality! A person of any gender identity may associate themselves with any sexuality (though of course some may be more common than others. Whilst a cisgender man would not identify as a lesbian, a transmasculine person may have a more complex relationship with this identity for example).

This list is not intended to be authoritative or exhaustive. No-one knows your gender identity better than you yourself! If anyone wishes to expand or add in the comments section, please feel welcome.
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 Genderqueer/Non-binary

Often used as umbrella categories, these terms both refer to gender identities other than simply ‘man’ and ‘woman’ – people who exist outside of the gender binary. Neither tells you much about a person’s gender besides that they’re not (exclusively) male and not (exclusively) female. Some genderqueer or non-binary people may embrace or express masculinity, femininity, both, neither, a mix, or vary depending on time, place, or people – regardless of the gender that person was assigned at birth. The possibilities are practically endless.

Gender fluid/Bigender

Being gender fluid can mean that a person sometimes identifies as male/man, sometimes as female/woman, or sometimes as androgynous other non-binary identities. Similarly, people identifying as bigender may experience two differently gendered personas, typically ‘masculine’ and ‘feminine’ which may change. Whilst not frequent enough to come up on the Facebook chart, the identity of trigender may be used by people who can change between male, female, and non-binary identites too. Note that someone may potentially have more than two gender identities and still identify as bigender – a person cannot ‘identify wrongly’. It is simply what a person feels fits with their sense of themselves.

Agender/Neutrois

Sometimes also described or understood as ‘neutral’ or ‘null’, some people may experience these identities as an absence of any gender, or, subtly different, as a neutral gender identity that isn’t male or female. This doesn’t tell you anything else, such as whether a person identifies as transgender, or has any wish to engage with a transition.

Gender nonconforming/Gender variant

These gender identities are quite self-explanatory, and broad. These labels don’t share information about the person’s relationship with maleness, femaleness, masculinity or femininity – but that their gender expression may not fit with cultural expectations of their gender assignation. Someone identifying as gender nonconforming or gender variant may identify as trans, or may not.

Two spirit

A non-western gender identity, two spirit is an umbrella term for gender identities associated with the cultures of some indigenous North Americans, such as the Oglala Lakota (note: I say ‘cultures’ rather than culture to avoid conflating different tribes and groups, which are distinct). There isn’t a simple way to generalise, though historically two spirit people often engaged in work or cultural practices not associated with their assigned birth sex. Called ‘Berdaches’ (a problematic term no longer used, and considered a slur) by western anthropologists, two spirit people may identify with both male and female gender roles and thus be recognised as a third gender within indigenous American cultural contexts.

Transmasculine/Transfeminine

A transmasculine person identifies more with maleness than with femaleness, but may not necessarily identify entirely as ‘a man’ (some however, might – and use this label as an indicator of their position regarding masculinity). Likewise a transfeminine person vice-versa – identifies more with femaleness but not entirely as ‘woman’. In accordance with the ‘trans’ aspect of this identity, transfeminine people are assigned male at birth and transmasculine people are assigned female at birth.

Androgynous/Androgyne

This is an identification with the mixture of masculine and feminine presentation so as to be a mixture of the two, and ambiguous in gender presentation. The terms can be used quite broadly, however.

Other

What can be said here? Other. Something else. Gender unknown space unicorn. Being deliberately vague is often a deliberate political decision.

Neither

Not male or female. If you know the person well you may know more detail (though you probably shouldn’t ask out of idle curiousity). The individual themselves may not have a clearer definition than this – sometimes it’s easier to know what you aren’t than exactly what you are, and that’s completely fine.

Intersex

Intersex people, by arbitrary medical definitions, may not physiologically fit into the gender binary in one way or another (most commonly, through having what are termed ‘ambiguous genitalia’ at birth). Intersex infants may be surgically altered without their consent, in order to assuage the  gendered anxieties of parents and doctors. Some people who may be ‘diagnosed’ as intersex may identify as men, women, or other gender identities, whilst some may feel their intersex status is something they identify with.

Pangender

Whilst pangender may imply an identification with all genders, more usefully it can be understood as fluidly experiencing a multiplicity of genders. A FAQ can be found here – where it is also clarified that appropriation of gender identities from other cultures (such as two spirit, or hijra) isn’t okay.

Gender questioning 

This is the process of questioning or working out one’s own gender, and may not be a permanent identity – though there’s no set amount of time someone might do this for! A questioning person may not be sure of what they identify with, and might not come to an answer – which is absolutely fine.

Transgender/Trans/Trans Person/Transgender person/Trans woman/Trans female/Transgender female/Transgender woman/Trans man/Trans male/Transgender male/Transgender man

Transgender people are people who do not identify with the gender they were assigned at birth. Trans is a shortening of transgender. The differences between ‘man’ and ‘male’, and ‘woman’ and ‘female’ may be something an individual has a solid opinion on, or they may feel unconcerned about the implied difference, or not see one. By specifying ‘person’ in a Facebook gender identity, someone may be iterating that whether they identify as male or female or otherwise isn’t something they want to share there.

Trans*/Trans* Person/Trans* man/Trans* male/Trans* woman/Trans* female

Some people use the asterisk to specifically highlight they are using ‘trans’ as an umbrella term, rather than to refer specifically to (binary identified) transgender people. There have been discussions both for and against the use of the asterisk, further indicating how personal comforts are a big part of identity label choice.

FTM/Female to male/MTF/Male to female

Often used by binary identified transgender people, these identity labels are used as a shorthand way of indicating the gender the individual was assigned at birth, and what they currently identify as. The terms don’t necessarily imply ‘I was a man and I am now a woman’ for example, as many MTFs would also say that they were always women, simply assigned incorrectly at birth based on their genitals. Thus the implication of having changed from one thing to another is something some trans people have a problem with, whilst others still find the identity label useful.

Transsexual/Transsexual person/Transsexual female/Transsexual woman/Transsexual male/Transsexual man

Transsexual is now quite an old-fashioned term, most associated with medical language and discourses of the mid-20th century. Many trans people don’t like the term or may find it offensive, but others may embrace it, particularly older trans people. The term is also typically used in a binary fashion.  Transsexual females/women are women who were assigned male at birth. Transsexual men/males are men who were assigned female at birth. Some people make a distinction between transsexual and transgender based on whether gender affirming surgeries have been undertaken, but this isn’t very common and can problematically create some artificial distinction between men and women who have certain medical procedures and those who don’t.

Cis/Cisgender/Cis female/Cis woman/Cisgender female/Cisgender woman/Cis male/Cis man/Cisgender male/Cisgender man

Cis is simply short for cisgender. Cisgender is the ‘opposite’ of transgender, and is used to indicate that a person identifies with the gender they were assigned at birth. So if at birth the doctor exclaimed ‘it’s a girl!’ and that person grew up to say ‘yes, I identify as female’ – that person is cisgender. Some individuals have claimed this is a slur, which is nonsense – the term exists as a neutral way to talk about people who are not trans, without positioning cisness as ‘the normal’ gender identity, or that ‘man/woman = cis man/cis woman’, which is the product of cissexism.

The 32 Problems I Found with this Gender Identity Service FAQ Guide.

Transgender people have, as a group, an enormous amount of awareness of the problems with accessing gender related support through the NHS. This post will highlight some of these problems. Below is a letter received in February 2015 from the Leeds Gender Identity Clinic, copied verbatim (including all errors, down to mis-spacings and grocer’s apostrophes). The quality of this letter is pretty dreadful, and prompted my critique and questions, to be found below the letter.

The numbers in square brackets are references for my points. Some numbers will repeat, indicating the same response to a repeat of a problem.

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Leeds Gender Identity Service

Frequently asked questions August 2013 [1]

Leeds Gender Identity Service is well established, around 20 years old and has evolved over the years. It is a dynamic process. Below are some frequently asked questions and our answers as they stand in 2013.[1]

1) What are the team’s views and commitment to the client group?

The service has a very committed multi disciplinary team. Fortunately all members of the team (Consultant Psychiatrists, Medical Practitioner[2], Endocrinlogist, Clinical Nurse Specialist’s[3], Occupational Therapist, Prescribing Pharmacist, Clinical Team Manager, Clinical Service Manager and the Team Administrators) Share the belief in the bio psycho social model[4] and its application within physical, mental, social and general health and Gender Dysphoria in particular. All members of the team believe in the recognition of Gender Dysphoria[5] and the need to facilitate and co ordinate gender reassignment in the safest and most effective manner.[6]

The service believe in mutual respect between service provider and service user, informed consent, capacity ,[3] guidelines and a flexible application accordingly[3] to individual needs are paramount to the success of an agreed outcome.

2) What standards of care are followed by the service?

The Harry Benjamin International Standards of Care have a well established and historical influence on standards of care which are considered worldwide, over recent times these have evolved into the WPATH, version 7, and standards of care for the health of transsexual, transgender, and gender nonconforming people. As a team we are mindful[7] of this guidance. The team are guided by the National Royal College of Psychiatrist standards; however these have not been ratified[8] are recognised by NHS England. The Gender Act, ICD10, DSM IV, Nice guidelines, Act of parliament 2004 and the policies of the trust including First Do No Harm all guide our practice.

The service has an active involvement in the development of the National standards of care professionals group. This includes other leading, NHS, Gender Identity Services in the UK. The purpose of the group is to define agreed, UK, baseline standards of care.

A proposed DSM V is due for publication; however this is still in draft format.[9]

The DOH[10] published guidance for G.P.’s[3] and other health care staff in May 2013. Leeds Gender Identity Service along with other NHS teams[11] were involved in the preparation of this document.

3) What is included within the care pathway?

The care pathway is guided by the standards of care which are stated above however has the ability to be flexible to meet individual needs. It includes all the stages of Gender reassignment, assessment, hormone treatment, social gender transition and surgery[12]. The service initiates the 2nd opinion and surgical referral but these are completed outside of the Leeds Gender Identity Service[13] therefore any waiting times associated with these are outside of our control.

4) What is the assessment?

The assessment stage takes up to 4 sessions (4 months) however a minimum of 2-3 sessions completed over a 2-3 month period could be agreed according to individual needs.

The criteria of the assessment is confirmation of the diagnosis of gender Dysphoria and exploring aspects of physical, mental and social health. Issues of eligibility and readiness to move into the next stage would be evidence based.

5) What is the social gender transition (SGT)?

Social gender transition is in its entirety approximately 2 years[14]. In order to complete an assessment of social gender transition the information gathered during this stage of social gender transition needs to be evidence based, this would include:

Living in role full time[15]

Change of name[16]

Some form of occupational activity[17] this could include voluntary work, paid employment, further studies or evidence of engagement/ daily living in the new role[18]. The service looks at occupational activity in the most flexible way and will agree with each service user how they will meet this requirement depending on their individual circumstances. If extra support is required by the service user a referral to the occupational therapist is available.

It is the service user[3] responsibility to collect this evidence. The team’s responsibility is to document it [19].

The hormone stage describe3d in question 6 would also fit into the SGT and will last 12months this would include a surgical referral once a positive 2nd opinion has been received.

Leeds Gender Identity Service is keen to learn from our experiences, working safely and flexibly within the care pathway to meet the changing needs of the client group.

For those clients who feel they are unable to live in full time SGT or do not wish to live in role at all in a specified area of their life e.g. employment ‘special circumstances’  this can be discussed with the clinician. If ‘special circumstances’ is agreed the following criteria must be met:

The client will be assessed as fitting the diagnostic criteria of Gender Dysphoria with a high level of confidence[20]. (In accordance with ICD 10)[3]

Psychotherapy opinion / treatment will be accessed and a detailed report provided to the Gender Identity Service supporting a referral for hormone treatment.

A 12 month plan will be agreed if appropriate to identify additional objective evidence for all other aspects of SGT can be ‘agreed between client and clinician.

6) What is involved in the hormone stage?

The service has an appointed Medical Practitioner, Consultant Endocrinologist and a prescribing pharmacist they are responsible for this stage of the pathway. The lead professional remains involved throughout the stages including the hormone stage. Close liaison with General Practitioner[3]/other professionals are a must. This stage could last for 12-18 months or significantly shorter in individual cases. While attending the hormone clinic Clients[3] will receive regular blood test[3] from their GP and blood test monitoring by the gender service, until such a time that it is safe to transfer all hormone treatment care to the GP including appropriate prescriptions.

7) What is the surgical stage?

Surgery stage:  2nd opinion is a prerequisite to a surgical referral. Once we receive a positive 2nd opinion a referral to the appropriate surgeon is initiated.  Any delays within this stage would be due to delays in variables[21] totally outside the control of the team.

The service will be responsible for referring clients to an NHS Gender Specialist for a 2nd opinion appointment however if individual clients wish to access private 2nd opinion appointments to speed up waiting times it will be the responsibility of the client to self refer or negotiate[22] this with their GP.

Leeds Gender Identity Service is happy to receive and act upon a positive, private 2nd opinion from a reputable[23] Gender Specialist at the appropriate time within the care pathway.

The service usually refers clients to specific identified surgeons however will consider referral to other areas if a client has a specific request and the CCG[24] are willing to fund surgery in the requested area.

Clients will need to have completed 12months,[3] full time, SGT before receiving a mastectomy and have received 6 months hormone treatment[25].

Breast Augmentation is not currently a core treatment[26] commissioned through Leeds Gender Identity Service; however clients can apply for this following completion of 18 months on hormone treatment[27] if there is clear failure[28] of breast growth. This treatment can be applied for through individual CCG’s via individual funding requests.

On occasions clients have requested orchidectomy surgery without a penectomy, the service will work collaboratively with clients to ensure the treatment provided is in line with supporting client choice and within the safety of clear clinical boundaries.

This would include:

Confirmation from the endocrine clinic that current hormone levels are safe, stable and within range.

And

A ‘one off’ appointment from an independent NHS gender Specialist is obtained.

8) How long will it take me to move through the care pathway?

The service follows a care pathways which can be adapted to individual circumstances taking into account transition which has already taken place before attending the service and specifically for those clients holding a Gender Recognition Certificate. An illustration of the pathway could be represented as follow:

The full process from start to finish around 3-4 years[29]

The shortest flexible process depending on individual needs could be condensed to 18-24 months; this has to be realistic taking into account waiting times for second opinions and surgery which are outside of the services[3] control[30].

9) How do the team keep abreast of new developments and ensure client safety and satisfaction?

The service is part of a wider governance group which include most other UK, NHS Gender Identity Service’s[3]. This group meets on a 6 monthly basis and shares views, takes learning’s[3] and discusses standards and guidelines within the area of Gender Identity.

The team are also part of the Specialist Services Clinical governance group within Leeds and York Partnership NHS Foundation Trust who meet on a quarterly basis and also have a team monthly Clinical Governance meeting where issues can be discussed in more detail. Clinical audits, rigorous clinical supervision, evidence based practice are all essential parts of our practice.

Service user feedback is an area which we have worked particularly hard on over recent years. We always provide clients with feedback forms following any new developments and we also ask service users to complete satisfaction questionnaires. Information taken from these forms is used to develop and inform practice in the service[31].

10) Will I get funding to access the service?

The service is commissioned by NHS England therefore potentially we could accept referrals from around the country. Individuals are funded for assessment and if appropriate core treatments which are funded by NHS England.

11) How will I know what is happening in the service?

The team have a specified lead in service user involvement she works alongside service user volunteers to produce a six monthly newsletter. The Newsletter will update all readers on any new developments within the service, will provide feedback on any completed service user feedback form and how this has informed practice and provide service users with an opportunity to display thoughts, feelings, poems or information to others!

The newsletter is posted out to all service users and is available in the waiting area.

You can also access the News letter via Leeds and York Partnership NHS Foundation Trust website.

12) What if I am discharged from the service but am experiencing a Gender related problem?

The service offers “one off” appointments to clients experiencing an issue they need to explore within the specialist service. To access this you will need support from your GP[22] so they can write to the team and ask us to see you. Again this will be funded by NHS England. The “one off” appointments may cover issues which are stated below:

“One off” assessment lasting for an hour n order to advise GP about outstanding problems and submit a medical (psychiatric) opinion.

A “one off” assessment lasting for an hour carried out by our Medical practitioner who is able to advise GP’s on endocrinology issues.

GP’s can also request “one off” extended full day assessment in complex referrals where specialist advice / recommendations are required.

13) How long will I need to wait to be seen once I have been referred?

The service is commissioned to see a specified number of new clients each year by NHS England[32]. Once we have seen these clients a waiting list will start to form for the next financial year. NHS England are kept informed on the waiting list on a monthly basis and will use this information to help identify new assessments to be funded on each rolling year.

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trans_symbol

…And now my bit.

[1] – Well, at least this makes it easy to identify as out of date. Major changes have occurred in the provision of gender based care (such as the release of the DSM V – an important diagnostic tool which actually redefined gender related diagnoses). An update is essential.

[2] – Wait. Only one medical practitioner? For the whole practice? This is alarming not only because of how understaffed it makes the practice appear, but also if any service user has a bad experience with that doctor, there is no-one else. The implication is that access to services all go through this one person.

[3] Grammar is hardly the most important issue here, but when I read an official document providing medical guidance, and it reads as if it was thrown together and not given a second glance, that translates into an uncertainty about the meticulousness and professionalism of the institute being represented. Such primary-school-level errors simply give an unprofessional air, and are easily avoided.

[4] Even with a biology degree I needed Google here, so they could really rephrase to be more user-friendly. How about ‘we understand that personal, social, and psychological factors play a vital part in experiences of gender, and do not seek to reduce service user’s needs to something purely biological’?

[5] – Um. Whilst this is clearly meant to be reassuring, it’s so basic as essential as to come off as alarming at the idea that anyone possibly might not recognise Gender Dysphoria in a Gender Identity Service. If I went to the GP for a vaccination and they said ‘don’t worry, I believe in these!’ I really wouldn’t feel better. There is a history of medical practitioners failing to respect transgender people’s agency, but this statement is hardly an effective way to gain trust.

[6] – I’m so relieved they clarified they wouldn’t do things an unsafe and ineffective manner. Pointless waffle.

[7] – ‘Mindful’ – this is so vague as to be useless. It implies they don’t actually have any external code they’re bound to follow, and can choose to ignore any guidance as and when they see fit. I’m not an alarmist, and I don’t for one minute think guidance would be actively rejected. But not referred to, in preference of one’s own considerations? I can see that happening. Especially as they go on to blanket name six other sets of policies, as if trying to universally appease without actually committing to anything.

 [8] – If not ratified, why chosen/used? I couldn’t easily verify whether this has changed since 2013, but practising with unratified standards seems like it requires explanation, at best.

[9] – This is simply out of date. The DSM V has been published, and this is a really important point. The service is potentially then misinforming service users who may not have much knowledge on the topic.

[10] – Explaining what an acronym is when you use it is widely regarded as a good idea – Department of Health. Should also get a [3] tag for not being ‘DoH’.

[11] – If they’re going to say this, they might as well say who.

[12] – This demonstrates how practice is still quite focused on a model of transgender care that emphasises the gender binary, heavily implying ‘one state of being to another’. It of course is fine for individuals who do feel this way about their gender, but is an approach that fails some of those trans people who are most invisible and marginalised within society.

[13] – Why?

[14] – It doesn’t ‘take’ any time at all, because this is an arbitrary and artificial measure created by the medical establishment. This functions as a method of restriction and control, again policing gender identity along arbitrary and binary boundaries. See here, here. and here for some further considerations, though it’s fair to say it’s a point of contention and much discussion, but lacking much research, especially that which emphasises trans voices.

[15] – Further absolutist, binary conception of gender. The very existence of bigender people blows this out of the water.

[16] – If a person is happy with their name, why should they have to change it? Once again ignoring non-binary people, this also ignores unisex names even amongst binary trans people (Alex, Charlie, etc.)!

[17] – The argument for this is to essentially force trans people into being exposed to the world, again to demonstrate a performance of seriousness and sincerity for medical gatekeepers. Whilst this is argued to provide time within which to learn about oneself and gendered practices, it is highly problematic. Not only the danger this puts people in who wish to and may not pass (before being given access to hormones and procedures that can significantly aid in this) but also for those trans people who may experience mental or physical conditions which makes these demands difficult or impossible. The validity of an individual’s gender identity is not dependent upon how that individual is viewed by others in society.

[18] – ‘new vs. old role’ – a dated, binary based requirement and phrasing that doesn’t work for many trans realities.

[19] – And judge what can or can’t count as ‘acceptable’ evidence, which is coloured by binary and cissexist positionality.

[20] – I went into the ICD (International Classification of Diseases) 10. As it was endorsed in 1990, it was no surprise that it still included ‘transsexualism’ and ‘duel-role transvestism’, and used wince-inducing terms like ‘the opposite sex’. There was no obvious mention of ‘confidence levels’ in relation to diagnoses. Therefore what this actually means, I have no idea and I don’t see how anyone else could readily be expected to either.

[21] – ‘Variables’. Nice and vague there. Such as?!

[22] – The expectation to do this is problematic if someone has a GP who is cissexist or transphobic. Which isn’t as rare as one would hope or expect.

[23] – What defines reputable? Obviously this isn’t easy, but such vagueness only serves to emphasise the position of power which the Gender Identity Service occupies. Obviously it’s vital that standards of care are maintained in private practice as well as state funded, but this wording doesn’t help anyone.

[24] – Clinical Commissioning Group. But everyone knows that, apparently.

[25] – No explanation as to why this is. Further relates to problems with the Real Life Test/Social Gender Transition (SGT) as it stands. Fails to account for those trans people who are very knowledgeable, secure, and stable in relation to their needs.

[26] – More unanswered questions. Why? Estrogen does stimulate breast development yes, but frequently produces small or even unnoticeable development. To create a hierarchy of gendered traits/procedures seems inherently nonsensical as what different trans people value and need for their well-being is obviously variable.

[27] – An excessive, arbitrary, and under-justified restriction. Whilst one can appreciate that with change being stimulated by estrogen, an immediate surgery around that time may risk complications, this absolutism runs contrary to the pledge to individual service user needs and desires.

[28] – And a further restriction. Who decides what, and at what size, ‘failed’ breast development is?

[29] – In true cissexist fashion, prioritising the intensely small minority of individuals for whom gender affirmation procedures are not appropriate, to the disproportionate suffering of a very large number of trans people.

[30] – It’s not the first time, but the service has very clearly distanced itself from responsibility for delays. Obviously this is a recurring problem which has invoked complaints and righteous demands for explanations. Are all of these interactions outside of the service strictly necessary? Could the system be made more transparent so that service users can see what aspects of the pathway causes delays? These are questions that trans people deserve answers to.

[31] – Might it be prudent for the service to also engage with transgender groups, so as to get informed guidance from members of the transgender population who aren’t in the (often stressful) process of accessing these services? Of course the feedback from service users is essential, but by no means the only resource available to them for the optimisation of their services.

[32] – This is of particular note. The idea that only a certain number can be seen, in a way that isn’t dictated entirely by resources (as different individuals require different amounts and types of time and care) but is decided upon in advance doesn’t make sense. It also emphasises one of the biggest problems at the heart of the insufficiencies of NHS Gender Identity Services – lack of funding. The number of individuals seeking aid is growing exponentially, and this remains unrecognised by funding bodies. This isn’t a criticism of the document per se, but highlights one of the more important frustrations with the larger system.

Have you heard of this Trans riot that pre-dates Stonewall?

In the spirit of the international Transgender Day of Remembrance (20th November), I’ll be looking at one of the earliest 20th century events which helped to nucleate the organisation of LGBTQ movements and rights as we know them today.

Plaque_commemorating_Compton's_Cafeteria_riot

The occurrence I’m referring to was the Compton’s Cafeteria Riot of 1966. A full three years before the much more famous Stonewall riots, this riot occurred in August but the exact date is lost to history. The cafeteria was located in the Tenderloin district of San Francisco, known in part as a rough patch – so unsurprisingly, had large populations of drag queens, prostitutes, and other marginalised members of society. The cafe was open 24 hours a day, which made it a popular spot for the queer underworld to frequent in the small hours. This didn’t mean the management were sympathetic to their queer customers however. The management is said to have called the police to remove a group of queens from the premises, under the pretext of noisiness, and hanging around too long without spending very much. At this time, it was extremely common practice for the police to stop people visually judged as gender variant, as it would be most likely such individuals wouldn’t match the name or appearance of any ID they might have, allowing for easy arrests. There had previously been a history of laws in the US prohibiting cross-dressing, and whilst struck down in Chicago there was still a strong association culturally with perceived cross-dressing as being associated with fraud and ‘anti-social conduct’ – so-called nuisance crimes that were often used to arrest queer people.

So, the police were called, and they were used to dealing with ‘people like that’. But when trying to arrest the queens, one of them threw her cup of coffee in the officer’s face. This sparked full scale resistance – everyone started throwing everything they could get their hands on, and so the police called for backup. Chairs and tables started being thrown. The plate glass windows of the cafeteria were smashed. The fear and rage that the queer community had experienced a build-up of in response to long term, systematic abuses at the hands of the police finally overflowed. A police car was vandalised. A news stand was burned to the ground.

One would think that fighting of this scale would be easy to date when it’s still within living memory. However police recording isn’t archived that far back, and more tellingly there was no newspaper coverage of the riot. One of the earliest references to the riot was 6 years later, in the program of the first San Francisco gay pride parade, in 1972.

The night after the riot, the cafeteria would not allow anyone judged to be transgender (or a queen, or ‘people like that’) in to be served. This resulted in the new plate windows installed in the daytime to be smashed again.

So what was the impact (beyond chairs into windows)? The queers who rose up weren’t actually completely disorganised when this riot took place. Only a couple of months earlier an organisation called Vanguard had been founded by activist ministers of Glide Memorial United Methodist Church, a very liberal church (for the time in particular) who tried to help all marginalised members of the community. Vanguard was ‘an organisation of, by, and for the kids on the streets’ – a detailed revisit of Vanguard can be found here. Vanguard’s meetings were held at Compton’s, and many of the rioters were most certainly Vanguard members. The networking and sense of urgency that the riot engendered (pardon the pun) amongst the community took activism forward. 1966 was an important year in transgender history because of the publication of the book The Transsexual Phenomenon by Harry Benjamin, which argued from a medical position that transsexuality wasn’t something that could be ‘cured’, and that doctors had a responsibility to help trans people feel happy with the gender they identified with. Such post-riot networking and in the context of this publication led to the set-up of the National Transsexual Counselling Unit by 1968, which was peer-run.

Much of the work that exists on Compton’s was put together by Susan Stryker, author of the book Transgender History (an important reference for this article) and director of the 2005 film Screaming Queens: The Riot at Compton’s Cafeteria. In these works a great deal more social and political context is provided. However it is crucial to remember the impact of past struggles for basic rights and respect, along with the victims and warriors who have fallen on the path towards transgender liberation.

The Inequality of Civil Partnerships and Marriage Persists

In the UK that is. I want to talk about that.

So let’s start by going back to 2004, when the Civil Partnership Act was brought about (well, gained Royal Assent anyway. The first actual UK civil partnership happened on 5th December 2005). I’m not going to talk about why it was a bad thing for there to be nothing in place for LGBTQ people before this (and all the rights it gave), but I will outline why it still wasn’t good enough. This isn’t necessarily all that obvious for a lot of people and deserves making clear. I’ll then move on to what the problems are that STILL remain with the new marriage set up! This is one of those rare instances when I hope that the contents of this post don’t age all that well. I hope I’ll be able to look back on this and think about how things have changed for the better. There’s all sorts of finickity angles this article could’ve taken, and a lot more to say. But it’s long enough as it is. I’ve tried to stick to what I see as core issues.

Many of the problems with the old Civil Partnership Act and the Marriage (Same Sex Couples) Act 2013 are due to their inability to account for transgender people, but we’ll get to that.

One of the most obvious ways in which the ‘separate but equal’ claim regarding civil partnerships vs. marriage is the disservice done to any LGBTQ person who might be religious. It was prohibited for civil partnerships to contain religious readings, music (such as hymns) or symbols. This is still the case actually, which is interesting given that not every organised religious practice (or even every organised Christian practice) opposes ‘same sex’ marriage – just certain major ones such as the Catholic Church, and the Church of England. Reformed Judaism and (some) churches following Quakerism for example were supportive of same-sex unions, but the government still deemed it a matter of law to decide how a civil partnership could be conducted in terms of religious content.

Okay, okay. So the government (eventually) recognised this was bad, so in 2011 after the Equality Act of the previous year, civil partnerships could now take place in religious venues – though in accordance with the protection of (homophobic) religious freedom, places of worship could not be compelled to conduct civil partnerships. However, the costs and administration created large and unequal barriers for willing places of worship to be positioned to legally conduct civil partnerships, even when they already did marriages, which makes… no sense.

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Credit to: https://www.flickr.com/photos/carbonnyc/ (under creative commons)

Arguably more serious though was the financial inequality that civil partnerships allowed. This video explains this very eruditely – how a widow or widower of a marriage was able to get significantly larger pensions as a result of their deceased partner, in comparison to survivors of a civil partnership ended by death. It also highlights that civil partnerships may not be recognised abroad in some countries, regardless of whether they have gay marriage or their own civil partnership equivalence, or not. Andrea Woelke (the chap in the video) also makes the valuable point that being in a civil partnership could put people in a position where they have to ‘out’ themselves when required to declare their marital status, which carries the potential to experience fear, or harm.

Whilst there are other bits and bobs that made marriage and civil partnerships fundamentally different experiences under the law, (such as the potential criteria for ending each type of union), the ugly problem of the gender binary within law is starkly revealed when looking at how the government chose to deal with marriage and civil partnerships in relation to trans people. Christine Burns talks about this, and also gives attention to the context of and interplay with the Gender Recognition Act of 2004 as well.

Up until the Gender Recognition Act (so pre-2004), trans women were still legally classified as men, and trans men were legally classified as women. The fact that people still are until dealing with the gauntlet of the Gender Recognition Certificate is not a discussion for here. What I mean to say is simply that until this time, there was no possibility of a trans person’s gender identity to be recognised under the law. This meant that a trans woman could legally marry a cis woman, because it was technically an ‘opposite sex’ marriage (and vice versa, with a trans man marrying a cis man). Many transgender people also would remain married after transitioning – rendering them legally married, yet for all visible social and personal purposes, a same-sex couple. However, the Gender Recognition Act coming in gave the government a problem – if these married transgender people could have their genders legally recognised (and therefore changed), marriages would start to exist between two men, or two women. Therefore it was made law that before a transgender person could receive a Gender Recognition Certificate, they had to divorce their partner. They could then get the GRC as a single person, and then get a civil partnership again afterwards.

It’s not like this is an immense hassle in terms of logistics? Or that it is deeply insulting or upsetting to have to do this to attain legal rights? Or that both individuals have to put the legal safety nets that marriage grants at risk in order to do this process? Except they do. And I say ‘do’ because this is still the legal status quo. Unlikely though it might be, if one partner died during the period of not being married or civilly partnered, it could quite obviously screw just about everything up. Especially if children, a co-owned or shared residence, life insurance, and pensions are involved. Whilst in theory that conversion process can happen within a day, this depends upon, as Burns puts it: “Lengthy meetings on the logistics of such a tortuous process indicated that if everyone had read the instructions and followed them to the letter, it would be possible”. But that’s a fairly sizeable ‘if’.

This is all also true the other way around. If say, you have a trans woman (legally considered male), who is straight (attracted to men), she could legally be civilly partnered. But in order to gain legal gender recognition, that would have to be dissolved first because heterosexual civil partnerships are still banned in the UK. As for how easy it might be for a trans person to have a religious marriage (rather than a civil one), within the Church of England this is apparently okay – though clergy do have the right to refuse to conduct such marriages as long as their church is still made available.

So this has brought us to where things are now. Yes, they introduced civil marriage, so now same-sex couples can get around the above stuff. Unless you’re trans where you still have to do that ridiculous get-divorced-to-get-recognised-and-get-remarried-again thing. HOWEVER. They have introduced a way for a member of a married couple to get their gender recognised without separating first. The same provision allows a civilly partnered couple involving a transgender person to simply ‘convert’ that civil partnerships into a marriage without separating first. This comes into effect on 10th December 2014. The big problems are first: if you are civilly partnered, you HAVE to change it to a civil marriage or split before anyone can get a Gender Recognition Certificate. Because no heterosexual civil partnerships, remember? Second: before a married trans person can have their gender legally recognised, their spouse has the right to veto this. Sarah Brown says:

So basically, if your spouse can’t, or won’t sign the consent form, you have to divorce them to get your rights. This creates what is possibly the most passive-aggressive legally sanctioned way to initiate a divorce ever, i.e. “I don’t want to divorce you, but I’m going to veto your human rights until you divorce me”.

Getting a GRC is a heavily involved process, and requires that a person has lived as their identified gender for at least two years. Pretty hard to do that in most marital arrangements without working out what the future holds for the relationship. As this article highlights, some partners are not supportive of their partner’s transitions, and may throw up roadblocks to try and prevent this from happening. Selfishly and delusionally hoping that by making transition considerably more torturous, their partner might decide ‘it’s not worth it’. This misunderstands transition in the same way that the government clearly has. It isn’t a choice like going on holiday, whereby not doing so makes you disappointed. Not being able to transition can cause enormous harm, or cost lives. The partner should not have any legal right to block this. Any relationship with healthy communication going on would either have already ensured that it’s fine and they’re staying together, or have already separated or begun separations. Or made a decision one way or another. This simply creates the possibility for spiteful, transition blocking action on the part of estranged partners.

Another thing there is to understand is that in the United Kingdom of Great Britain and Northern Ireland, marriage is a devolved issue. This means that England, Scotland, Wales, and Northern Ireland get to make up their own minds on what they want to be allowed. The first same sex marriages will be able to occur in Scotland on 31st December 2014, for instance. Northern Ireland however has decided not to allow same-sex marriages, and will treat same-sex marriages from other jurisdictions as civil partnerships… hopefully from having read the above, you can see obvious problems with this. Public opinion is almost a dead even split, but this shouldn’t really matter. Human rights shouldn’t be put up for a vote, especially when the ones voting aren’t the ones affected.

For as long as the unions between two (or more…?) people are bound up in legal and religious anxieties about the genders of the people involved, we will never have true equality. Don’t forget that as regards non-binary people, there isn’t a single official word on what they can or can’t have.

For any FtM readers in the UK in particular…

Below is my PhD proposal, which has been accepted to start later this year. I am going to be looking into problems that exist within medical policy and the medical establishment that unfairly hinder transition.

I am a cis (queer, but cis) white male, and I want you to believe that I recognise how problematic it could be, me trying to do this kind of work without having directly experienced the relevant issues myself. This is why it is going to be of utmost importance to me for this project to be lead by trans* voices. Not to just go around begging for interviews and treating people like data and stats. I intend to earn and keep the trust of anyone and everyone who agrees to work with me in the course of my work over the next few years.

What’s my motivation? Other than the obvious anger anyone who knows even a little bit about systematic cissexism should experience with regards to legistlative and policy structures, my best friend was an incredible trans man who I was very close to, but tragically he took his own life. Also I have been privileged in supporting my (now ex) long term partner through his own transition some time after this.

Bottom line is: please be in touch if you have anything to say about this project. I will take all criticism/encouragement/suggestions very seriously, as my cis-privilege means I should. Do feel free to pass this on to anyone you may feel would be interested, and follow this blog for further updates on this project – most of which won’t take off until October or afterwards, but yeah. So below is my proposal, as it was accepted:

Female to Male Transgender Transitions through the NHS – Addressing Policy Problems

There is no reason why psychiatrists and other mental health professionals cannot be charged with the responsibility of recognizing gender-identity issues without the necessity of labelling them as disorders.

Gianna E. Israel and Donald E. Tarver in Transgender Care: Recommended Guidelines, Practical Information and Personal Accounts

Research Context

Transgender people often experience an urgent need for medical treatment in order to facilitate a transition in gender presentation. Whilst data is lacking, it has been estimated that suicide risk in post-operative trans people is potentially seventy times higher than the risk for the overall US population (Haas et al. 2011), and suicide risk has been estimated at 19-25% for those seeking surgical gender reassignment (Dixen, Maddever, van Maasdam, Edwards, 1984). Whilst distress for trans individuals may result from the dissonance experienced between the mental and physical self (characterised as gender dysphoria), lack of support, as with any serious personal issue, may have an extremely detrimental effect on the individual’s ability to cope with their situation. This research will address medical (and legal) policy in the UK regarding transgender transition for AFAB (assigned female at birth) individuals. The reason for this particular focus is that treatment routes and transition difficulties are extremely different depending upon the direction of transition, and this focus will allow for both a wider consideration of AFAB experiences and greater depth of analysis. This research is particularly timely due to the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) being due for release in May 2013, which should have some ramifications for how gender identity dissonance is addressed clinically.

Currently there exists no specific gender and sexuality minority training as part of UK medical degrees or clinical training. This leads to primary care physicians often being ill-equipped to deal with the needs of trans patients – and in some cases directly doubting or dismissing the patient’s needs, resulting in risk of harm. Of the knowledge of transgender issues amongst the primary care medical population, much is extensively pathologising. This is due to the historical status quo of the power dynamic between doctor and patient, whereby medical ‘expertise’ trumps lived experience and identity (Cohen-Kettenis and Friedemann, 2010). Similarities can be seen with the discourse generated by the reversal of knowledge/power relations between the medical establishment and HIV positive gay men in the 1980s, who also often had a more detailed grasp of their options and needs than their physicians did (Weeks, 1990). However, a key difference is the grassroots push towards recognition by the medical establishment that trans* identities are not inherently pathological – as reflected partially by the upcoming revisions to theDiagnostic and Statistical Manual of Mental Health Disorders (DSM-V). ‘Gender Identity Disorder’ will henceforth be understood as ‘Gender Dysphoria’, and ‘Transvestic Fetishism’ as ‘Transvestic Disorder’.

Relating to the Literature

Whilst the crux of this project will be the analysis of qualitative data generated by interview schema (as detailed in the methodology section), it will be important to further contextualise individual’s experiences in terms of queer theory. This will provide evidence of the extent of cissexist positions and behaviour within gatekeepers and other positions of social authority, and the social context of how this has come to be the case. Cissexism (the belief and treatment of transgender people as inferior to non-trans people) within society has already been considered by such important authors as Julia Serano and Riki Wilchins. It is also important to consider that in the formation of policy concerning gender and health, a binary model of gender is likely to be utilised, which may not provide recognition of the identities of all individuals who wish to transition (Bilodeau, 2005). The way in which any individual’s behaviour patterns (such as a doctor to a patient) are externally effected will depend upon the local cultures, geographies and other individuals they find to be their environment (Stevens 2004). A nuanced understanding of this may be aided by consideration of Social Identity Theory (Tajfel, 1981) and concepts such as dramaturgy – The idea that human actions are dependent upon where, when, and with whom they occur (Goffman, 1959).

Feminist epistemology will be used to address the intersection of patriarchal oppression (particularly when presenting as female) and trans identities, such as with the ‘border wars’ of butch lesbian, transmasculine and trans male identities (Halberstam 1998), transition from one group to another and how this can impact upon support networks and involvement in (for example) female-only spaces.

Research Questions

A key question of the thesis will be how and why did undesirable scenarios experienced by trans men happen? It is recognised that demand is greater than supply regarding appointments with NHS gender identity clinics, with 22% of users in October 2006 of the Charing Cross Gender Identity Clinic waiting over a year for a first appointment (Reed, Rhodes, Schofield and Wylie, 2009). Patients are required to have two meetings at such a clinic before being granted access to hormonal treatment, and the desperation and loss of morale that can accumulate in this time can result in risky self-medication using the internet to purchase hormones, self-harm, and suicide. The research will explore the space that exists between medical claims that may exist for the importance of the current framework that governs these appointments and the demands for improvement and change vocalised by the trans male population.

Other questions include asking to what extent may dissatisfaction with the medical establishment be a lack of detailed understanding of well founded (as opposed to well-intentioned but ultimately flawed) commitment to the well-being of patients? To what extent is the current medical establishment policy built on subtle cissexist assumptions and responses? A common argument for example, for the extent of hoops that need to be jumped through is that treatment with testosterone has certain irreversible physiological changes, and that protection must be offered to those who may ‘change their minds’, and be later caused distress and dysphoria by the retrospective treatments. The cisgender (to hold the same gender identity as was assigned at birth) perspective of how traumatic it would be to have one’s physiological gender markers (voice, fat distribution, breast tissue, musculature, etc.) altered in an undesirable way is arguably given a greater sense of importance than the provision to the treatment of trans people is (Taylor, 2010). It is considerably easier for a cis person to empathise with the former hypothetical scenario than it is with a trans person’s lived experience. The negative impact of undesirable physical traits is not at issue, but the insidious way in which what one is born with (or without) can be afforded a privileged position over the need for change.

 

Methodology

This project will have a multi-faceted and interdisciplinary approach, utilising both empirical data and queer theory to synergistically explore the reality of trans experiences and the political and social frameworks within which these exist and are shaped. The precedent for transgender activism leading to a revision of policy is the framework upon which I will build this thesis. Through qualitative methodologies such as semi-structured interviews and surveying, I will collect and analyse accounts of trans men’s experiences with both NHS and private medical establishments, paying particular attention to delays and dissatisfactions with prescription to testosterone and approval for surgical procedures.

Whilst the focus of this project would be the experiences of self-defined male experiences, I believe it is also important to cross-examine such data with the experiences and knowledge (or lack thereof) of both primary and secondary care medical practitioners regarding their practice and knowledge of both transgender treatment provisions and what may be termed political considerations, such as pronoun usage and the phrasing of questions, and their necessity and appropriateness. Collecting qualitative data from staff who are involved with any of the administrative processes which dictates a trans person’s trajectory through medical systems may also prove valuable, though whether this direction is taken or not may be informed by information gathered from trans reports. Recognition and treatment of those AFAB individuals with non-binary gender identities is also to be involved. Whilst medical transition processes and lived experiences do vary in a clear and divisible way based on assignation at birth (before consideration of intersexed individuals at any rate), the social model of binary genders is being increasingly recognised as a dissatisfactory lens through which to view the wide spectra of queer identities which have gained visibility over the last fifty years (Hubbard, 1996). It is a common conception by many trans people that in order to achieve the (variable) desired end-goals of engagement with the medical establishment, a favourable narrative may need to be constructed in order to be considered ‘right’ (Rubin, 2003).

Policy Implications

“I just want a therapist who ‘gets’ me. I don’t want to have to explain gender, sex, and all that other stuff. I have been to so many therapists where I have to educate them. I have to tell them first that I am not a ‘freak’. Then, I have to make sure they feel comfortable. And then we get down to my real issues.” – Luke, 21 year old transgender man

Handbook of Multicultural Counselling Competencies, Erickson Cornish J. A. et al.

The ultimate goal of the project is to offer a rigorous academic approach to both assessment of the efficacy of systems designed to alleviate suffering, whilst also exploring important questions of identities and power. The ramifications of such work would hopefully lead to policy review such that trans voices and experiences are better heard by medical establishments. Systems for recognising cissexism in policy (or where it could be enacted by free agents in positions of authority) can be created and used in protection from and prevention of cissexism, for transgender populations. This work will provide a rigorous, empirical approach to policy formation that will help provide a greater voice for an often poorly understood minority, undeniably improving lives.

References

Biloeau, B. (2005) ‘Beyond the Gender Binary: A Case Study of Two Transgender Students at a Midwestern Research University’, Journal of Gay and Lesbian Issues in Education, Vol. 3, Issue 1

Cohen-Kettenis, P. T., Friedemann, P., (2012) ‘The DSM Diagnostic Criteria for Gender Identity Disorder in Adolescents and Adults’. Archives of Sexual Behaviour, 39:499-513.

Erickson Cornish J. A. et al. (2010), Handbook of Multicultural Counselling Competencies, John Wiley & Sons.

Dixen, J. M., Maddever, H., van Maasdam, J., Edwards, P. W., (1984). Psychosocial characteristics of applicants evaluated for surgical gender reassignment. Archives of Sexual Behaviour, 13(3), 269-276.

Goffman, E. (1959), ‘The Presentation of Self in Everyday Life’. Anchor books.

Haas, A. P. et al. (2011), Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations. Journal of Homosexuality, 58:10-51.

Halberstam, J. (1998) Female Masculinity, Duke University Press.

Hubbard, R. (1996) Gender and Genitals: Constructs of Sex and Gender, No. 46/47, Science Wars, pp. 157-165.

Reed, B., Rhodes, S., Schofield, P., and Wylie, K. (2009) Gender Variance in the UK: Prevalence, incidence, growth and geographic distribution, GIRES.

Rubin, H. (2003) Self-Made Men – Identity and Embodiment Among Transsexual Men, Vanderbilt University Press.

Serano, J. (2007) Whipping Girl – A Transsexual Woman on Sexism and the Scapegoating of Femininity. Seal Press.

Stevens, R. A. (2004), ‘Understanding Gay Identity Development Within the College Environment’, Journal of College Student Development, Vol. 45, No. 2, pp. 185-206.

Tajfel, H. (1981), ‘Human Groups and Social Categories: Studies in Social Psychology’, Cambridge University Press.

Taylor, E. (2010) ‘Cisgender privilege: on the privileges of performing normative gender’, in Gender Outlaws: The Next Generation by Bornstein, K. and Bergman, S. B., Seal Press.

Weeks, J. (1990) Coming Out, Quartet Publishing.

Wilchins, R. (2004), ‘Queer Theory, Gender Theory’. Alyson books, Los Angeles.

“The analytical category of gender presents particular methodological difficulties. Discuss.”

For those who found the last post to be a case of ‘tl; dr’, sorry that I’m simply putting up another essay again. In this one I discuss scientific methodology, and tensions between this and postmodern thinking, and feminist criticism of positivism.

 

This was written by 16th March 2011.

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Every academic field has methods that are conventionally considered acceptable for use within that field. The use of unconventional methods ranges in acceptance and frequency in a field dependent manner, and broadly speaking the most ‘rigid’ research areas may be the so-called ‘hard’, or natural sciences. Here, the only acceptable methodology is the scientific method, deviation from which results in loss of scientific status. Science cannot progress without the collection of empirical data in a controlled and repeatable manner, which provides objective information on a given hypothesis or model. Models that are supported by evidence are only held with for as long as the evidence supporting it remains the best available. When better evidence becomes available, the model must be either modified or replaced. Models may exist that independently are supported well in the explanation of part of a system, but when considered together are not compatible. Two areas of physics (using this same methodology, but different methods) which blossomed during the twentieth century are quantum mechanics – the mathematical underpinnings of matter and energy on very small scales, and general relativity – which provides a description of gravity on very large scales. Whilst work done in both these fields are (now) uncontroversial and entirely embraced by the scientific community, these models of the behaviour of the universe break down when attempts are made to integrate them. The point I am making with this example is that the very nature of the knowledge we create through the use of different methods can result in total incompatibility with knowledge created in another way, even when the methods themselves are not particularly controversial – which of course is not necessarily even a stability that can always be relied upon in some areas.

Due to its multidisciplinary nature, the field of gender studies arguably attracts as many different methodologies as any given discipline can reasonably justify. There are scientists utilising quantitative methods resting on a positivist philosophy, social scientists using a range of quantitative and qualitative methods, and theorists who may use hermeneutics, discourse analysis or post-structural thought, to highlight some important examples. These different methods can be regarded as a toolbox, providing different analytical advantages and disadvantages which may be considered dependent upon both the researcher and the research question. Methodology is dependent on ideology (Keller 1985, p. 126), and thus the scientist approaching gender may completely reject the position of the poststructuralist and vice versa despite consideration of the same questions, using methods accepted within their respective fields. Such methods are both clearly used to explore questions about gender. The methodologies used within these schools of thought rest on different philosophical axioms which will be considered through the lens of gender in this essay, in order to examine their effectiveness and interplay. Consideration of the problems academic supporters of each of these methodological camps (natural sciences and post-structuralism) have with each other will be used to expose the weaknesses of each position. The defences of each position along with amalgamation of theoretical strengths will be then used to cross-examine the problematisation of methodology, using research done on gender as case studies.

Dispute over the validity of scientific methodology is not only seen when researchers use this school of thought directly to try and answer questions in the field of gender studies, but has indeed been critiqued more generally by some feminists who have argued that the scientific community, through being male dominated for centuries, is a construction of the patriarchy and that: “Traditional research contains more or less concealed expressions of sexism in its focus, its linguistic usage and its results. In this way the asymmetrical gender relations in society are legitimated and reproduced” (Alvesson and Sköldberg 2000, p. 210). Methods can therefore be problematized both when ‘science is done to gender’ and when ‘gender is done to science’. Before discussing real examples of methods used in scientific gender based research, it is worth further discussing what science actually ‘is’, what questions it can hope to answer, and how this relates to gender. This clearly involves very large philosophical and subjective questions that perhaps interestingly one doesn’t need to consider in order to do ‘good science’ (based on the fact that many successful, well published and well regarded scientists never explicitly address such questions within their careers).

The Nobel Prize winning physicist Erwin Schrödinger claimed that the two fundamental axioms of science is that ‘nature’ is both objectifiable, and knowable (Schrödinger 1967, quoted in Keller 1985 p. 141). The existence of facts or truths about the world is taken to exist independently of the consideration of any consciousness. It is understood that by collecting data in a manner that is independent from influence by the person collecting it, one does not subvert the results which arise from analysis of this data. It can be argued that for any topic on which empirical data can be collected and analysed in order to test predictions about the world, science can be done. In the natural sciences, the data that is collected is restricted to the ‘material’ (rather than the ‘social’ – this rather problematic distinction will be returned to later). Examples of two scientists who have used such a methodology related to the field of gender are Melissa Hines and Simon Baron-Cohen.

In Hines’ book Brain Gender, a large deal of scientific literature and experimentation is reviewed in order to attempt to answer whether biological factors contribute to behavioural sex differences and what the ramifications of this may be. The discussion references cognitive sex differences on measures of visuospatial abilities (Hines 2004, p. 12), and it has been shown that differences between the sexes may be large or negligible depending upon what abilities are specifically tested. Whilst this information on its own doesn’t bring us closer to answering Hines’ questions, it is possible to argue that the methods being used are indeed appropriate, and may be part of the construction of answers. Ability at particular tests done by men and women are quantifiable and analysable – objectifiable and knowable. The same can be said of doses of hormone and the physiological responses to such, which Hines also considers by studying how sex typical reproductive behaviour in the rat is affected (Hines, 2004 p. 47). The analysis of animal models is a standard and heavily used method of learning about human biological systems due to huge overlap as a result of evolutionary processes.

Fascinatingly, it has been shown that sex differences can be observed in non-human primates through toy preferences (Alexander and Hines, 2002). This provides evidence for a non-social component due to the animals having neither prior experience of the toys nor being influenced by peers or environment. Whilst there is clearly scope for further work to be done this has implications for a great number of gender based questions concerning the interplay of the biological and the social in men and women.

The use of scientific methods can also be constructive in disproving commonly held gender-based misconceptions. For example it is a commonly held social conception that high levels of testosterone result in increased aggression. However, in Hines’ discussion, a metaanalysis demonstrates a small correlation which may itself be overstated due to there being evidence to suggest that positive findings may be overrepresented (Hines, 2004 p. 135). This highlights a problem with the concept of peer review, which will be returned to when critiquing the use of scientific methods.

If obeying a positivist philosophy, then claims that this is so problematized as to deny useful conclusions to be drawn may be considered solipsistic. However there is great academic scope for multiple levels of problematisation as related to gender which shall now be further explored.

Methods, broadly speaking may be thought of as being systematic processes by which data are collected and then analysed. But what if your data are statements, arguments, or even other methods? Post-structuralism provides tools for doing this by the deconstruction of arguments which can allow new information to be revealed or new conclusions to be drawn, which hidden or ignored biases in the existing methodology don’t account for. Post-structural thought could potentially be regarded as anti-methodological (Alvesson and Sköldberg 2000, p. 184) however I would argue whilst being used systematically to problematize other methods; it unavoidably becomes a methodology itself with paradigmatic and syntagmatic analysis examples of methods used within semiotics and deconstruction (Prasad 2005, p. 99). The central ideas that the ‘self’ as well as elements of society (including sex and gender) are socially constructed as well as the importance of what a reader understands from a piece of work in contrast to what the writer necessarily intends are of great importance.

So why deconstruct scientific methods when the logic – that is, to control extraneous variables and not allow the quest for truth to be coloured by personal biases – may appear to be an effective way to answer questions of gender, particularly given that there are results that have independently been found to be repeatable? Because it can be argued that despite best intentions and efforts (that are never always going to be there in every piece of work), political, cultural and social influences will insidiously impact upon the scientific enterprise (Begley, 2001 p. 114). An example relevant within gender studies is how the model of human conception has changed over the past fifty years. It was once thought that the sperm was the ‘active’ and the egg the ‘passive’ agent in conception. Language used within the literature on this topic reflected this and was clearly influenced by social parallels drawn from preconceptions of the ‘male’ and the ‘female’ despite research existing which demonstrated active roles for the egg cell (Begley, 2001 p. 117). Larger scale historical examples where hindsight has demonstrated that attempts at a scientific enterprise were clearly distorted by personal beliefs and preconceptions include the damage done by the field of eugenics, and the rise of the anti-Mendelian ‘Lysenkoism’ of the Soviet Union in the 1930s (National Academy of Sciences 2001, p. 112).

Furthermore, one might argue that it is in fact impossible to separate the biological from the social. As Hines herself says “All of our psychological and behavioural characteristics, however, have a biological basis within our brain. No matter whether hormones or other factors, including social factors caused us to develop in a certain way, the hormonal or social influences have been translated into physical brain characteristics, such as neurons, synapses, and neurochemicals. Thus, the distinction between biological and social/cultural causes is false.” (Hines, 2004, p. 213-4). Given that the social must be experienced through the material in the two-pronged sense that all thought originates in the complex but materially finite brain, and all experience of the world is through biological, sensory perception. There are thus good arguments suggesting that science attempting to stand independently in the production of new information is at best hampered and at worst fundamentally flawed.

The monolithic monopoly on being able to effectively create knowledge through scientific methods is thus well challenged given that social context can change the results discovered. This may be a problem with the cognitive visuospatial sex differences discussed by Hines, as according to one of the very metaanalyses she references “partial support was found for the notion that the magnitude of sex differences has decreased in recent years…it was found that the age of emergence of sex differences depends on the test used” (Voyer et al. 1995). Given that the differential biology between men and women have not changed over this time frame, and that there has been no clear methodological upheaval in more recent studies being done, it is implicit that the change in the magnitude of the results is a result of the time and cultural attitudes the studies were performed in.

There are a number of responses that defendants of the methods used to collect the data presented in Brain Gender may argue. Firstly and most obviously, empirical results are real. Deconstruction may allow for greater understanding of problems that may be inherent in research, but the explicit results of scientific research that have been shown to accurately model elements of the world including relevant issues to gender (our understanding of physiological differences, for instance). It is important to recognise that peer review exists in order to attempt to catch such methodological problems. Also when utilising a scientific methodological approach, one is really attempting to create models that usefully reflect the world, rather than necessarily state an essentialist truth about the world which can be readily problematized.

Historical context is also important to better appreciate how gender and methodology are related, by considering past interaction and discussion that has gone on between the scientific community and post-structuralists (Oakley 1998, p. 708). The 1990s saw a series of intellectual arguments known as ‘the science wars’, involving the criticism of scientific objectivity by post-structuralists, with the rebuttal by the scientific community that their critics lacked both intellectual rigour, and an understanding of what they were critiquing. An important event was the ‘Sokal affair’, whereby a professor of physics was successful in getting an article published in a post-structural journal despite then revealing that he was testing to see if they would: “publish an article liberally salted with nonsense if it (a) sounded good and (b) flattered the editors’ ideological preconceptions” (Sokal, 1996). This clearly problematizes post-structural criticism as a method of academia with forward motion a great deal. It is commonly argued that post-structuralism has a lack of constructivity, and does not offer alternative explanations to the hypotheses which it problematizes. As a result of this, it clearly isn’t a methodology that can exist independently. In order to have meaning, the deconstruction that is posited must have a structure to act upon which is near exclusively the result of alternative methods.

By beginning a deconstructive critique with the a priori assumption that the structuralist position is inherently flawed can result in a lack of engagement with the position under scrutiny. This can lead to misunderstandings and oversimplification of the subject matter at hand leading to a far less convincing and less useful output. For example, the argument that has been put forward suggesting that ‘science is the masculine’, ‘nature is the feminine’, and that knowledge acquired by science from nature is a form of rape (Oakley 1998, p. 709) and that subsequently Newton’s Principa Mathematica can be characterised as a ‘rape manual’ (Begley 2001, p. 115) demonstrate a lack of engagement with the purpose or methodology of science, whilst simultaneously abusing the sensitive term ‘rape’ in a manner that does not empower or usefully critique. Such dramatic language use is also likely to inspire a (deliberate) reaction in readers, which is another important dimension related to all methodologies which will be returned to.

Having discussed the work of Hines, the way in which scientific methodology can be used to study gender can be better understood by a comparative examination of the work of another scientist and his work’s implications and problematisations within gender studies – Simon Baron-Cohen. The premise of his book The Essential Difference examines the theory that: “The female brain is predominantly hard-wired for empathy. The male brain is predominantly hard-wired for understanding and building systems” (Baron-Cohen 2003, p. 1). Baron-Cohen’s methodology rests upon the use of two tools which he is responsible for creating, the Empathy Quotient (EQ) and the Systemizing Quotient (SQ). These are questionnaires where points are scored dependant on answering ‘strongly agree/disagree’ or ‘slightly agree/disagree’ to a range of questions of which some are scored for positive answers, some are scored for negative answers, and some do not affect the final score of the test at all. The results that he has found show that on the SQ, people with autism score higher on average than men who score higher on average than women. On the EQ this pattern is reversed. How then, is this methodology problematized by the analytical category of gender?

Firstly, the way in which language is used to express the research is somewhat problematic. The summary on the back cover of The Essential Difference begins with “At last, leading psychologist Simon Baron-Cohen confirms what most of us have long suspected: male and female brains are different”. Then on page 8 of the book, the subtitle “Your Sex Does Not Dictate Your Brain Type” is used. If sex does not dictate brain type (in that the differences he is referring to are statistical averages, thus allowing for the existence of, within his model, women with ‘very male’ brains and vice versa) then this raises the question of why he has chosen to refer to the brain types as ‘male’ and ‘female’ given this clearly obfuscates his point. This requires him to explicitly demonstrate to his readers that he is aware of and receptive to the need of “not perpetuating the mistaken attitudes of former generations by assuming that sex differences imply that one sex is inferior overall” (Baron-Cohen 2003, p. 10). Demonstrating this is clearly no bad thing,  however it can be argued that it is at best an ‘unscientific’ (that is, obviously subjectified) approach to discuss the hypotheses in these terms. The choice of language on the back cover was clearly designed to be simple and catchy, to increase the appearance of significance and therefore readership, and status.

Baron-Cohen’s methods are also critiqued by other scientists. An alternative model has been proposed with ‘Machiavellianism’ and EQ offered as a more accurate dichotomy than EQ/SQ (Andrew, Cooke and Muncer 2007). It is argued that the EQ and SQ have “not been strongly validated”, and that “the relationship between empathising and systemizing is still unresolved”. Some of the criticisms levied against the EQ/SQ model are not particularly complex. For instance: “One would expect that if these were two contrasting cognitive styles that showed such a clear pattern then there would be a negative relationship between them. This has certainly been proposed by Baron-Cohen, but seldom strongly supported by research which has generally shown a weak negative correlation between the two styles. Furthermore, some research using other proposed methods of measuring systemizing and empathizing has found no significant correlation.” (Andrew, Cooke and Muncer 2007).

These are problems that if truly using an objective approach, one might expect Baron-Cohen to address more explicitly, however the reasons this does not happen are easy to understand. All academics clearly have a vested interested in the value of their research contribution due to impact on their reputations and by extension, career success. Discussion of further work needing to be done is common, but self-criticism of methods is very rare due to the fundamental uncertainty this then places on the value of the whole work. The process of peer review and intra-disciplinary competition does provide a policing of research to limit the impact of the avoidance of this level of self-criticism (which is not unique to natural scientists of course) however should the work being criticised have been written by someone ‘eminent’ and published in a ‘prestigious’ journal it is unlikely that the problematisation will receive as effective a voice on the academic landscape.  This may also be regarded as a problem from a feminist perspective when considering arguments that men may have more active and effective voices than women in many circumstances in society, which relates this problem directly back to gender.

What is most interesting methodologically is that whilst number of individuals taking the test, their sexes and their scores can all be quantified and analysed, how is the wording of the questions that form the main methodological tool performed ‘scientifically’? There is an implicit and unavoidable subjectivity here, and it is difficult to claim a firm authority on ability to do this. Gender further problematizes this question by the fact that all researchers are gendered, and arguably cannot disconnect their ‘selves’ from the words they choose to use in the construction of their methodological tools. Based on the discussion of post-structuralism that has already been engaged with this position may regard this only as a flaw or disadvantage; however there are potential benefits that this may also bring despite it being common that a lack of discussion occurs on such points within scientific literature. Scientists are not robots; by acknowledging that subjective traits that do not yield to rational analysis such as creativity, integrity and curiosity do influence research (National Academy of Sciences 2001, p. 111) constructive dialogue can be opened in order to create a more nuanced understanding, such that research validity isn’t jeopardised by neglect of such.

These critiques have partially alluded to an important approach in considering scientific methodology through a gendered lens – feminist epistemology. This approach (or approaches) involves examining the ways in which gender affects the acquisition of knowledge. There are a great many ways that feminist methodologies may be developed because there are a diverse number of branches of feminist theory (Rosser 2001, p. 126). An interesting dimension to the problematisation of scientific methodology are the different conflicts that can arise out of these positions, which will be related back to the work of Baron-Cohen and the potentially unavoidable subjectivity in science just discussed.

The first of these positions I shall consider is that of liberal feminism. A simple summary of this would be the belief that women suffer unjust treatment in society in comparison to men, and that this is unjust and equal consideration with regards to sex is a social ideal to be aimed for. There is no incompatibility with the hegemonic, objectivist approach to scientific research as ideally it is believed within this framework that gender biases in science can be consciously uncovered and removed (Rosser 2001, p. 129). It is not saying that science has successfully been performed in a de-gendered manner. A simple example would be a consideration of the social consideration of the hormones testosterone and oestrogen. Whilst both of these hormones are found in men and women with numerous and complex roles and effects, one is very much gendered as male and the other very much gendered as female, with a huge emphasis being placed on their roles in the development of secondary sexual characteristics. The reasons behind this could be explored, but from a social perspective it seems that due to the simplicity of this description and the fact that everyone learns this basic concept in secondary school biology, the trickle down of scientific research into education and the gendered implications this has results in a propagation of relatively ubiquitous and basic ‘engenderments’.

Sexism within the scientific community as a result of subjectivities connected to gender has been documented and studied. A paper published in the prestigious journal Science (claiming to have demonstrated that the corpus callosum in the human brain was larger in females than in males) was examined and shown to have methodological flaws by the neurophysiologist Ruth Bleier. She performed her own study, which, with conscious methodological improvements, resulted in no differences found. Her group’s paper was however rejected by Science, with a reviewer rejecting her arguments seemingly for tending “to err in the opposite direction from the researchers whose results and conclusions she criticizes” (Spanier 2001, p. 369). One might argue that whilst this may indicate problems already discussed with difficulty in criticising scientific results that have attained a position of privilege, it has been shown through empirical study and statistical analysis that nepotism and sexism exist within peer review (Wenneras and Wold 2001, p. 44). This raises the important point that it is demonstrable that both methods and methodologies that were created and near-exclusively used by men for a long period of history can be used by women to demonstrate clear evidence of need for adjustment to attain equality. I avoid saying ‘the need for the empowerment of women’ due to the potential for positive discrimination to result (in theory at least) merely an inversion of the problem. The crux of this evidence within a liberal feminist framework is the need for equality.

Baron-Cohen’s conclusions and assumptions have been faulted in detail on a methodological basis within what could be described as a liberal feminist framework (Nash and Grossi 2007). One might find it problematic that faults with work that (in theory) endeavours to remain objective is criticised on grounds that are immediately political in nature through a lack of relevant connection. However, concurrency and legitimisation are maintained by working within the same methodology as the research itself is performed under, which adds voice to the feminist position. Various books have been written which could be considered under this framework, including those which deal with Baron-Cohen’s work directly such as Delusions of Gender by Cordelia Fine, and Pink Brain Blue Brain by Lise Eliot.

Marxist feminism is markedly different in that knowledge is viewed as a construct resulting from the human endeavour of production that is tied to a proletariat/bourgeois dichotomy. This creates a methodological space for the argument that research questions about both sex differences and biological causations of sexuality or gender identity would not be valid research questions if society was free from inequality (Rosser 2001, p. 131).

Essentialist feminism provides an interesting difficulty to be resolved philosophically and politically when considering gender research. This position is compatible with positivism, and holds that biological differences may mean that men are superior in some physical and mental aspects, and women are in others (Rosser 2001, p. 133). This can arguably lead to reinforcement of a potentially harmful and restrictive binary, though by focussing on the ways in which women are believed to be ‘superior’ to men may be useful in the empowerment of women within a patriarchal system. Obviously the interactions between methodology and this interpretation of feminism may be problematic because of the argument that this constructs barriers to individual freedom based on a socially constructed categorisation. Such ideas of social construction resulting in ‘othering’ as a result of social perception of biological differences (which alone don’t necessarily imply an inequality) are found within existentialist feminism which was explored by Simone de Beauvoir: “The enslavement of the female to the species and the limitations of her various powers are extremely important facts; the body of woman is one of the essential elements in her situation in the world. But that body is not enough to define her as woman; there is no true living reality except as manifested by the conscious individual thorough activities and in the bosom of a society. Biology is not enough to give an answer to the question that is before us; why is woman the Other?” (de Beauvoir 1974, p.51).

This range of categories of feminism makes methodology a difficult area to agree on, because the underlying principles vary significantly even if the general aims (equality for women) are the same. This highlights the importance of the relationship between philosophy, epistemology and methodology when considering research through a gendered lens. This remains true whether actively attempting to answer questions that directly contribute to gendered debates (sex differences, etc.) using scientific methods, or researching topics that are not obviously directly contributing to such debate but still have subjective elements which require conscious and careful language use and analysis to avoid contributing to any level of patriarchal maintenance, repression or preconceived engendering. Some feminists believe that the use of quantified methods is not compatible within an honest and emancipated feminist research methodology. Ann Oakley discusses this in terms of objections against positivism, power and p-values (Oakley 1998, p. 710). In this discussion, Oakley deals with the unequal power distribution between the ‘knower’ or researcher, and ‘known’, the subject – who under a scientific method is properly made to be an ‘object’, arguably removing any agency. However qualitative methods which are sometimes held up as an alternative are subject to these same methodological difficulties, especially if considering any post-structural consideration of language problematisation. The underlying social reason that is given for these attitudes rather than a legitimate superiority/inferiority relationship between methodologies generally is that “Feminism needed a research method, a distinct methodology, in order to occupy a distinctive place in the academy and acquire social status and moral legitimacy” (Oakley 1998, p. 716). In other words, the field required its ‘niche’, in the same way that individual researchers require this in their field. Originality is the key to success and respect within the academy, and this must be achieved not just with subject but also with methodology to some extent.

There are therefore a great many ways in which difficulties can be encountered when considering even just quantitative methodologies and the analyses that may be applied to them in the consideration of gender. What it means to be ‘scientific’ is contentious before considering how language affects results, how unavoidable subjectivity can arguably permeate even the best controlled systems and work – but that fortunately if one can utilise a multifaceted and open approach, engaging quantitative methodology in dialogue with political and social theory can be constructive rather than irrelevant or overcomplicated. Self-expression is as much a part of science as competently collecting one’s data is.  All published academics must consider how to do this, yet this is a stage of the research process that can go relatively un-critiqued despite arguably being strengthened by a systematic element of the consideration of the implications of how and what is being said. This could potentially be regarded as the invisible element of methodology, though this provides good evidence for the usefulness of criticism of methodology from outside of the immediate community or system. Ironically enough then, despite the sometimes polemical or highly subjectively motivated attacks that have occurred on and between quantitative scientific methodologies, post-structural thought and feminist methodologies, the exchanges temper and strengthen all of these so that the complete toolbox can be used to more convincingly express understandings of the world.

References:

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