The Medical and Academic
Oppression of the Sexuality of Sex and Gender Diverse People
Paper
presented by Dr Tracie O'Keefe DCH at the Australian Society of Sex Educators,
Researchers & Therapists (ASSERT) National Sexology Conference, University
of Sydney, Lidcombe, 5-6 December 2004.
Abstract
This discussion
paper examines the oppression and exploitation of sex and gender diverse
people by the medical and academic establishment. Many people identify
as intersex, transsexual, transgender, androgynous or without sex and
gender identity. These groups of people over the past 20 years have often
been swallowed up and encompassed by the greater label of the queer culture.
The material for this discussion is taken from literature, reports from
the sex and gender diverse community and from the author's 30 years' experience
in helping sex and gender diverse people.
Sex diverse
people are those who are atypically male or female in their biological
primary and secondary sex characteristics. Gender diverse people can be
fluid in their sociological gender presentation. People may present with
either sex and gender diversity or dysphoria, or a combination of both.
For some people, sex and gender presentation does not influence their
sexuality or vice versa but for others it might.
Due to the
fight that sex and gender diverse people have had and continue to have
throughout the world to claim their human rights, they often have to forgo
their sexuality in order to avoid being pathologised as suffering from
a form of paraphilia. Most societies have also sublimated the emergence
of sex and gender diverse people's sexuality in order to allow them a
gradation of negotiated human rights.
There is
pressure on sex and gender diverse people to present socially as heterosexual,
thereby pandering to homophobia and transphobia. Sexuality identity is
an integral part of a person's ego state, allowing them to enjoy the full
spectrum of the human experience. To oppress the sexuality identity of
sex and gender diverse people is nothing less than an act of violence
against them, which the academic and medical communities currently propagate,
disseminate and profit from.
Background
In the book
Gender Reversals Gender Cultures (Lang, in Ramet (ed), 1996, p193) wrote:
"Within
the majority of North American Indian tribes, there existed - and, in
a number of instances, still exists - a cultural construction of more
than two genders, allowing the individuals to either take up the gender
role of the 'other' sex completely, or to mix the culturally defined men's
and women's roles to varying degrees."
She went
on to say:
"Due
to the cultural construction of two or more genders, Western concepts
such as 'transsexual' and 'homosexual' can also not be applied to Native
American women-men and men-women: a sexual relationship, for example between
two individuals of the same sex, yet not of the same gender is not necessarily
considered homosexual in a gender system that provides four or more genders
to accommodate individuals who do not feel comfortable with the gender
and gender roles assigned to them at birth, the concept of transsexualism,
which was developed in a culture that only recognizes and values two genders
and sexes, is not applicable."
In Hermaphrodites
and the Medical Intervention of Sex (Dreger, 1998, p177) there is an intersexed
person's story that reports:
"It
took months for me to obtain…[all] of my medical records. I learned
that I had been born, not with a penis, but with intersexual organs: a
typical vagina and outer labia, female urethra, and a very large clitoris.
Mind you, 'large' and 'small,' as applied to intersexual genitals, are
judgments which exist only in the mind of the beholder. From my birth
until the surgery, while I was [considered a boy], my parents and doctors
considered my penis to be monstrously small, as well as lacking a urethra…Then,
in the moment that intersex specialist physicians pronounced that my 'true
sex' was female, my clitoris was suddenly monstrously large."
This child
was then involuntarily subjected to a clitorectomy for no other medical
reason than the clinician's ideas of aesthetics. The operation resulted
in a less than satisfactory sex life and that person felt permanently
disturbed that they were involuntarily assaulted.
Dreger comments
(p 201):
"In
the last two hundred years, scientists and medical doctors have come to
know a tremendous amount about hermaphroditism. They know much about why
some babies arrive in this world with parts that look different from other
babies' parts, and they know of [and employ] a wide variety of techniques
designed to change bodies to make them look more 'typical'. But the accumulation
of this knowledge has not taken away the perception that hermaphrodites
are strange and troublesome"
In his book
As Nature Made Him, John Colapinto (2000) tells the story of David Reimer.
After a botched circumcision as an infant, surgeons decided to try and
surgically turn Reimer into a girl. John Money, a clinician in America,
then convinced Reimer's parents to force him to be brought up as a girl.
After much maladjustment Reimer eventually began to live as a male again
in his teenage years.
Money, knowing that the child was very maladjusted as a female, continued
to report academically that he was fine all the way through Reimer's childhood
in order to support Money's own theory that gender performance is socialised
and not genetically determined. Reimer found life very difficult as he
tried to deal with what had physically and mentally been done to him and
the loss of his penis, eventually committing suicide in 2004 (Colapinto
2000), (Chalmers 2004).
J Michael
Bailey, Professor of Psychology at Northwestern University USA, in his
book The Man Who Would Be Queen (2003), proposes that women of transsexual
origin were simply misguided homosexual males. His poorly-written book,
printed with the support of the academic system in the USA, outraged the
sex and gender diverse community and upon investigation it was found that
his research was fraudulent (Conway 2003). He had posed as a clinical
psychologist whilst not being registered to do so during the research.
He had also promised letters of referral for surgery to transsexual people
in order to obtain their personal stories, printed those stories without
their permission, and sourced his study participants largely from bars.
This book
was hailed as an academic revelation but it was in fact a form of transphobia
from a man ill-qualified to investigate in the field and who fraudulently
produced research to fit his own theories. This book, which was printed
by the National Academic Press, was very quickly exposed as unethical
and fraudulent research, but the publisher failed to order its withdrawal.
Germaine
Greer, a seasoned academic, in her book The Whole Woman (1998) sought
to disempower sex and gender diverse people in a chapter she entitled
Pantomine Dames. As the author of The Female Eunuch (1970), a pivotal
piece of literature in the development of feminism, one would have expected
her to make an effort to understand and appreciate the disenfranchisement
that sex and gender diverse people can experience. Instead she sought
to exploit them as a group to ridicule in order to propagate her own theories
of how women's history is developing.
Her ridiculing
and chastising of transsexuals was done from an evident place of lack
of knowledge on the subject, particularly when it came to basic biology.
She still, however, seemed to think her academic status allowed her to
propagate her own prejudices without having to put in research into the
subject. This behaviour is typical of many academics that seek public
exposure at the expense of sex and gender people's reputations, and seek
to pigeonhole them as misguided sexual perverts (O'Keefe, 1999).
We live in
dangerous times as the world's politics in many places are moving to the
right. With a rise of religious influences, the law, medicine, politics,
psychology, and cultural norms set back the cause of sexual freedom for
many. George Bush Jr. is now in office for the second term of his American
presidency, a confirmed homophobe and transphobe (CNN.com, 2004). In differing
American states legal gay marriages are being dissolved by political bigots
with extreme religious views. Sex and gender diverse people have little
continuity throughout America of what sex they really are, with this varying
from state to state. They can be regarded legally as and are often treated
as homosexuals of their original birth sex; which gives them no real footing
to explore their real sexuality.
With no social
healthcare system, America is a place where many sex and gender dysphoric
people frequently end up in the sex industry to finance their hormones
and surgeries. Many get stuck in the poverty trap, being perceived as
social misfits, mentally disturbed, and sexual deviants (Blumenstein 2003).
In Australia
on 30 June, 2004, Mission Australia, a Christian organisation that receives
government funds to provide short-term stay facilities for the homeless,
obtained an exemption under section 126A of the Anti-Discrimination Act
of 1977 to refuse service to non-operative transsexual women. This exemption
affected three women's refuges in Sydney: Woman's Place, Lou's Place and
Women in Supported Housing (WISH). The Anti-Discrimination Board (ADB)
received requests for consultation by the Gender Centre, Australia's largest
assistance centre for sex and gender diverse people, and from Sex And
Gender Education (SAGE), a civil rights organisation for sex and gender
diverse people to be consulted on any exemption in the law. (Mission Australia
2004). The Attorney General granted the exemption on the recommendation
of the ADB without community consultation. The legal representative of
the ADB told the author that the ADB had no legal obligation to consult
any community no matter who they were (Meeting between SAGE, a representative
of the Aids Council of New South Wales (ACON), the Gender Centre and the
ADB, NSW, Australia, 2004) (Telephone conversation between author and
legal representative of the ADB November 2004) .
Mission Australia
put its case to the ADB that it believed some of its female service users
would fear that they would be raped by sex and gender diverse female persons,
namely non-operative transsexuals. The exemption was railroaded through
by the ADB in secret, not informing leaders in the gender community. After
the exemption was in place leaders in the gender community were told by
the president of the ADB that the department was short of funds and it
probably would not have funds to invest reversing the decision (Meeting
between SAGE, a representative of the Aids Council of New South Wales
(ACON), the Gender Centre and the ADB, NSW, Australia, 2004).
Mission Australia,
with one of its patrons being a female psychiatrist, demonised transsexual
people by refusing service to the most vulnerable of any of society's
unfortunates: the homeless, non-operative, probably jobless transsexual
women who may have drug problems or even HIV issues. They took sex and
gender issues of transsexual clients living as women and turned them into
the characterisation of being potential rapists because of their own religious
prejudices.
Elizabeth Riley, the manager of the Gender Centre and Norrie May-Welby
of ACON, described relations between the ADB and the sex and gender diverse
community as being the worst they had been for a decade (Meeting between
SAGE, ACON, the Gender Centre and the ADB, NSW, Australia, 2004).
Also in Australia John Howard as the Prime Minister has almost a carte
blanche manifesto with a political majority where he seeks to push the
rights of heterosexuals over the rights of all other people (World Socialist
Website 2004). His government seeks to prohibit gay couples from marrying
their partners and adopting children from aboard, and this will include
sex and gender diverse people who identify as gay in any form; however
if they identified as heterosexual they would be allowed to marry and
adopt (Wearing 2004).
The New Gender Recognition Bill (McNab 2004) in England only allows heterosexual
transsexuals to marry after transition. Should a sex and gender diverse
person refuse to divorce a pervious married partner after transition then
they will be unable to change their birth certificate. The government
fears the danger that they may appear to be gay and married after transition
- all this from a government headed by Tony Blair who proposes to support
the family establishment (Hartley-Brewer, 2000).
Discussion
The acquisition
of any liberty and equality is always accompanied by stereotyping. The
Jew in occupying Israel to escape displacement became the enemy of the
displaced Palestinians. The wild silverback mountain gorilla in being
listed as an endangered species became a zoned amusement for tourists
to domesticate. Women in becoming wage-earners of the world have also
become the slaves of capitalism. And so, sex and gender diverse people,
in asking for free medical care from governments and insurance companies,
have become medicalised and pathologised as psychiatric freaks and dysfunctional
human beings.
Governments
and insurance companies never give medical funds without first seeing
evidence of disease. Sex and gender dysphoria are indeed very debilitating
experiences that can render a person deeply unhappy and unable to function
and they may even lead to suicide. Sometimes they can be resolved with
psychotherapy and for the cases where that does not happen, the person
may wish to undergo medical procedures to change their body to express
partly or wholly another sex and gender expression. Some sex and gender
diverse people may see their condition or state of being as illness, but
many do not, seeing it as sex and gender diversity. The problem now, however,
is that the price that sex and gender diverse people have to pay is that
they are being asked to define themselves by mainly medical validation.
This has come about for three main reasons:
Firstly the
medical profession got wind of a money earner - that is, treating transsexuals
became very profitable and was also able to offer a considerable amount
of kudos to many who sought to define themselves as experts in the field.
A similar thing happened when the medical profession started to dominate
the reproductive lives of women in the second half of the 19th century.
Freud and his counterparts pegged women's mood changes as hysteria and
a form of pathology. Surgeons sought to cure the natural process of the
menopause by the introduction of mass hysterectomies (Pope, 2001). And
women's reproductive rights were overruled by the unethical prognoses
of male doctors. Women were seen as neither intellectually nor morally
capable of deciding their own fates. So In parallel the sex and gender
diverse community has become the highly paying dysfunctional patient and
both clinician and patient collude in a folie a deux that uses pathology
to excuse choice.
Secondly
feminism and masculinity studies sought to define, redefine, claim and
reclaim what it was, is and should be to be male or female. Consequently
the bridge of unisexism, that rose in the 20th century to find commonalities
between men and women, as we move into the 21st century wavers. Fanaticism
and the right wing seek to re-polarise the sexes. Governments prostitute
themselves for votes by allowing religious persecution against sex and
gender diverse people. Whilst governments may accept that sex and gender
diversity may be due to a medical condition in some cases, the persecution
they allow is on the grounds of proposed immorality.
In cases
where the issues of the persecution of the sexuality of sex and gender
people comes up, governments retreat into the Pontius Pilot position of
we know it's wrong to crucify you but it's popular. Issues on sexuality
are one of the greatest difficulties for any government because they fear
right-wing backlashes at the ballot box and there are few votes in sexually
liberated sex and gender diverse people's rights. So committees and quangos
are concocted to make sex and gender diverse people medicalised or immoral
in order to make them manageable, but rarely sexually liberated.
Thirdly the
sex and gender diverse political freedom lobby has blindly in desperation
thrown itself into the medical model as a refuge from persecution. The
cry of "We can't help it we have a medical condition" is the
stock-in-trade phrase used by some gender freedom lobbyists to ask for
health funds for hormones and surgery. The phrase is also used to escape
the criticism of being seen as anything other than normal. It is an acquiescence
of "fitting in" by the means of a medical condition: a doctor's
note that excuses the individual's behavior that might challenge male
and female stereotypes and offend bigots.
Every month
I get people coming into my consulting rooms talking about medical doctors
and practitioners of psychological and psychotherapeutic therapies who
have tried to dissuade the client from their desired course of sex and
gender identity. These practitioners are often noted academics with outdated
models of sexuality. Invariably they are driven by either philosophical
exclusivity or by religious beliefs that see anything other than a bipolar
model of sex, gender and sexuality as illness or moral bankruptcy. They
are profoundly unaware of their ignorance and in denial about their bullying
and malpractice.
Dangers
for Clinicians
In the climate
of today Western medical and psychological practitioners are faced with
ever increasing threats of being sued for malpractice. Therefore helping
people who present themselves to health practitioners with a sense of
sex and gender dyphoria often becomes a process of treating by numbers
according to the Harry Benjamin International Gender Dysphoria Association
(HBIGDA) Standards of Care (2004). The very name of the HBIGDA itself
is oppressive because it assumes pathology, not diversity. If a person
remains pathologised on their medical records for the rest of their lives,
it leaves them with a social stigma and little confidence to have a sexuality
of which they can be proud.
The DSM4
categorisation of gender dyshoria [302.85 Gender Identity Disorder in
Adolescents or Adults] is inept and dangerously informs a naive practitioner
about how to identify a gender variance or dysfunction. It takes no account
of variables like cultural components, ever changing sociological perspectives,
personal development and psychodynamic exploration. It ignores that sex
and gender diverse people may have a sexuality which can be something
to celebrate.
The major
stumbling block, however, is that medical and psychological practitioners
have limited ways of seeing sex and gender expression. Clinical training
does not include anthropological, cultural, and sociological perspectives
on sex and gender expression. This leaves practitioners with only pathological
windows to view their clients who deviate from the average sex and gender
expression. This ignorance leads to oppression of variance in sex and
gender expression and disempowerment of the client. It further leads to
the suppression, omission and sublimation of the sexuality of sex and
gender diverse people. Academia dramatically fails medics and healthcare
workers in their training on sex, gender and sexuality expression.
Recent emerging
law suits against clinicians working in the field of sex and gender diversity
using a bipolar male and female ideology closely linked to hetrosexualism
as the only true model have been inevitable. When medicine, academia and
psychology play god and try to dictate the human condition to their clients
it is a loaded gun that will always eventually go off in their faces.
When these disciplines ignore the research of anthropologists and sociologists
that teach us that there is no true sex or gender, simply an ever floating
diversity arrived at through a physical, individual and sociological perspective,
they ignore important variables and equations that make up part of the
human experiences of sexual happiness and satisfaction.
Sex and gender
diverse people often go through difficult times establishing their sex
and gender identities. Part of being able to develop a whole rewarding
life is to feel safe in being able to explore one's own sexuality. Medical,
psychological, and healthcare practitioners, alongside academics, can
cause enormous damage to the psyche of sex and gender diverse people when
they carelessly make assumptions about that client group. The denial,
sublimation and ridicule of the sexuality and sexuality development of
sex and gender diverse people by those professionals is nothing less than
an act of violence.
Recommendations
Educators
in medicine, psychology and the caring professions need to more widely
educate their students about the diversity of sexuality that is separate
from sex and gender diversity. They also need to consult the sex and gender
diverse communities to invite them into their classroom to tell trainees
about themselves, including their sexualities.
Intersex
people's genitals should no longer be mutilated after birth to fit into
the artificial aestheticism of urologists and gynecologists. Intersex
people need to be allowed to choose to have medical treatment and surgery
if that is right for them, with all the risks plainly explained to them.
The fact that surgery may result in sexual dysfunction always needs to
be stated.
Clinicians
would be wise never to diagnose and foist upon the client the label of
gender dysphoria, because such a pronunciation will inevitably come back
to haunt them at a later stage, should a client have a change of heart.
Having a psychotherapist help the client explore their issues is a wise
way to help those clients choose a path that is right for them. If a client
wishes to label themselves as dysphoric, a clinician can support what
they are describing about their own experiences. Each client needs to
be fully cognisant with the personal responsibility of those choices unless
they are non-compos-mentis.
The sexuality
of sex and gender diverse people should not be pathologised simply because
the person may have altered or is altering their body through choice.
Their sense of celebration about their sexuality should be supported and
celebrated, not ignorantly confused with sex and gender identity issues.
An emergence and development of that evolving sexuality can be encouraged,
giving the person a sense of confidence at least equal to the kind of
sexual journey that ordinary people celebrate; and there are clinicians
and academics throughout the world who help sex and gender people do just
that in a positive and affirmative way.
Sex and gender
diverse people come in many differing kinds of combinations that can include
intersexed people, transsexual, transgendered, transvestite, androgynous,
without sex and gender identity, and a continuum of ever changing and
developing linguistic descriptions of sex and gender experience. Their
exploration of their sexuality is sometimes separate from their sex and
gender issues and sometimes not, but they are often at the frontline of
exploring the infinite dynamics of sexuality and could wisely be respected
for the journey that they make.
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NWU to Discipline J Michael Bailey in Secret. Wednesday 1 December, 2004,
6.41am. To Press for Change News Distribution www.pfc.org.uk/pfclists
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Meetings
Meeting between
Elizabeth Riley, manager of the Gender Centre, Norrie May-Welby for the
Aids Council of New South Wales (ACON) and Sex and Gender Education (SAGE),
a political lobbying group for sex and gender diverse people, Tracie O'Keefe
for SAGE, and a representative of the Anti-Discrimination Board (ADB)
of New south Wales, Australia, 22.1.2004.
Telephone
conversation between Tracie O'Keefe and legal representative of the ADB
November 2004.
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