The Gender Binary & LGBTI People: Religious Myth and Medical Malpractice

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Designated as disordered rather than just different, LGBTI people have been and continue to be victims of medical malpractice purely because they are neither Adams nor Eves. Psychiatrists, surgeons, endocrinologists, pediatricians, and other medical experts have subjected LGBTI people to bogus and horrific treatments with reckless disregard for patient health and well-being―all the while ignoring the basic tenets of medical ethics and the ever-growing scientific evidence showing LGBTI people to be natural variations. Beyond this, medical stigmatization of LGBTI people has contributed to their oppression in the world at large. This treatise will contrast the scientific evidence with the ongoing medical (mis)treatment of LGBTI people to vividly illustrate the insidious effect of the biblical creation myth.
This presentation is from Chapter 12 of the anthology Christianity Is Not Great: How Faith Fails. John W. Loftus (editor), (Amherst NY: Prometheus Books, 2014).
Paperback or Kindle version of the book here.
http://www.amazon.com/Christianity-Is-Not-Great-Faith/dp/1616149566

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The Gender Binary & LGBTI People: Religious Myth and Medical Malpractice

  1. 1. The Gender Binary & LGBTI People Religious Myth and Medical Malpractice by Veronica Drantz, PhD Excerpted from Chapter 12 of Christianity Is Not Great: How Faith Fails John W. Loftus (editor), Prometheus Books, 2014. for Northern Illinois University, April 9th, 2015 Thanks to the sponsors: NIU Secular Student Alliance NIU LGBT Studies Program NIU Gender & Sexuality Resource Center
  2. 2. Religious Myth: The Gender Binary  Only two sexes (male, female)  Sex = Gender (male = man, female = woman)  Only one kind of sexual attraction (heterosexual)
  3. 3. LGBTI People L = Lesbian G = Gay B = Bisexual T = Transgender I = Intersex This diverse collection of sexually different people shares one feature—they innately defy the gender binary, not clearly fitting into either the “Adam” or the “Eve” categories.
  4. 4. Public Views About Human Evolution
  5. 5. The Medicalization of LGBTI People SIN to SICKNESS This shift from religion to the medical domain was accompanied by an important development, the creation of a category of person ― the “homosexual” Homosexuality was no longer just a behavior; it was now a kind of identity ― a type of person
  6. 6. Medical (Mis)treatment of LGBTI  Designated as disordered rather than just different  Subjected to bogus and horrific treatments  Reckless disregard for patient health and well-being  Basic tenets of medical ethics ignored  Ever-growing scientific evidence showing LGBTI people to be natural variations ignored  Contribution to LGBTI oppression in the world at large This presentation will contrast the scientific evidence with the ongoing medical (mis)treatment of LGBTI people to vividly illustrate the insidious effect of the biblical creation myth
  7. 7. The Scientific Study of Sexual Behavior  Alfred Kinsey  C.S. Ford and Frank Beach  Evelyn Hooker
  8. 8. Alfred Kinsey  Criticized scientists’ portrayal of homosexuals as “inherently different types of individuals”  Devised a scale from zero to six to represent the continuum along which human sexual behavior or fantasy can be classified from “exclusively heterosexual” to “exclusively homosexual”  Kinsey’s work showed that homosexuality was more common than previously thought 1948 1953
  9. 9. Ford & Beach  Integrated information on sexual activity from 191 cultures representing Oceania, Eurasia, Africa, North America, and South America  Significantly, homosexual behavior was accepted in 49 of the 76 cultures for which the relevant data were available  Homosexual behavior in other mammals was reported as well  This work indicated that homosexuality was widespread and natural C. S. Ford Frank Beach1951
  10. 10. Evelyn Hooker 1957  Exploited data from several projective tests, including the Rorschach, that many clinicians believed to be the best method of assessing total personality structure and that was employed for the diagnosis of homosexuality at the time  The failure of expert psychologists to distinguish nonpatient homosexuals from nonpatient heterosexuals showed that homosexuality occurs in persons who demonstrate normal psychological adjustment, seriously challenging the view that homosexuality was always associated with psychopathology Evelyn Hooker, “The Adjustment of the Male Overt Homosexual,” Journal of Projective Techniques 21 (1957): 18–31.
  11. 11. Homosexual Behavior in Animal Kingdom  Homosexual behavior has been found to be widespread in the animal kingdom—from worms, insects, and frogs to mammals and birds
  12. 12. http://www.pbs.org/independentlens/two- spirits/map.html More Than Two Genders!  Not just gay people but other gender-diverse people also are found all over the world  Worldwide the variety of gender expression is almost limitless, and hundreds of societies have long-established traditions of three, four, five, or even more genders A Map of Gender-Diverse Cultures
  13. 13. North America  Two-spirits – Native American  Berdache – Illiniwek (Illinois)  Muxes – Zapotec People, Oaxaca, Mexico Two-spirits Muxes
  14. 14. South America  Travestís – Brazil  Bichas  Viados  Guevedoche – Dominican Republic  Quariwarmi – Incan Viados Travestís
  15. 15. Europe  The Sworn Virgin – Balkans  Catamites – Ancient Greece  Mollies – Modern England  Tertium genus hominum (a third human gender) “eunuchs” – Ancient Eastern Mediterranean Sworn Virgin Sworn Virgin Catamites
  16. 16. Africa  Ashtime – Maale culture of Southern Ethiopia  Mashoga – Swahili-speaking areas of the Kenyan coast, particularly Mombasa  Mangaiko – The Mbo people, Democratic Republic of the Congo  Sḫt (”sekhet”) – Middle Kingdom of Egypt (2000- 1800 BCE) Mashoga
  17. 17. Middle East  The Kurgarûs – Sumer  Zenanas – Arab  Xanith or Khanith – Oman
  18. 18. Asia  lyha – Mohave  Hijras – India, Pakistan & Bangladesh also known as: Aravani/Aruvani or Jogappa Hijira (alt. sp.) – India  Sādhi  Kotis  Sadhin – The Gaddhi in the foothills of the Himalayas Hijras
  19. 19. Asia continued  Basivi – Madras (area of India)  Tritiya-prakrti (third-nature) – Indic culture of premodern India  Ubhatobyanjanakas – Buddhist Vinaya Pandakas  Kathoey – Thailand  Pandaka – Ancient Buddhist Societies Kathoey Kathoey
  20. 20. Asia-Pacific Polynesia  Fa’afafine – Samoa Polynesia  Fakaleiti – Tonga  Mahu Wahine – Hawaii  Mahu Vahine – Tahiti  Whakawahine – Māori  Akava’ine – Cook Islands Fa’afafine
  21. 21. Indonesia  Waria Kwolu-aatmwol – Papua New Guinea  PHILIPPINES Bakla – Tagalog Bayot – Cebuano Agi – Ilonggo Bantut – Tausug Binabae Bading Lakin-on Waria Bakla
  22. 22. The Scientific Study of Sexual Development  How does this sexual diversity develop?  Do we learn our core sexuality?  Can core sexuality be changed?  Answer – from the physiologists – “Organization-Activation” mechanism – Mechanism of sexual development in mammals
  23. 23. Organization-Activation Mechanism  Sexual “organization” before birth – Genetic control (XX, XY) – Hormonal control (the presence or absence of testosterone or other androgenic substances during critical periods of fetal development)  Sexual “activation” at puberty – Sexual maturation and functioning – Caused by hormones from ovaries or testes
  24. 24. Sexual Development in Mammals Figure 25-4 Embryonic differentiation of male and female internal genitalia (genital ducts) from wolffian (male) and müllerian (female) primordia. Figure 25-5 Differentiation of male and female external genitalia from indifferent primordial structures in the embryo.
  25. 25. Sexual Development in Mammals Figure 25-6 Diagrammatic summary of normal sex determination, differentiation, and development in humans. MIS, müllerian inhibiting substance; T, testosterone; DHT, Dihydrotestosterone
  26. 26. Mechanism of Androgen Hormone Action Figure 25-18 Schematic diagram of the actions of testosterone (solid arrows) and dihydrotestosterone (dashed arrows).
  27. 27. Males are Altered Females!  Everybody is a variation on the female theme FemaleIntersexMale (Unaltered) (Partly altered) (Fully altered)
  28. 28. More Than Two Sexes!  Intersex people differ physically from the “standard” male or female Curtis Hinkle - Founder Organization Intersex International
  29. 29. Intersex People  There are many different kinds of intersex people  Intersex people demonstrate that the organization-activation mechanism works in humans as it does in other mammals
  30. 30. Androgen Insensitivity Syndrome (AIS)  XY chromosomes  Testis secrete testosterone  No internal genitalia  Partial AIS (2-5)  Complete AIS (6/7)
  31. 31.  XX chromosomes  Ovaries  High production of androgen hormones from adrenal glands Congenital Adrenal Hyperplasia (CAH) Classical Type
  32. 32. Sexual Identity & Orientation – Nature or Nurture?  We don’t learn or choose our genitalia. What about sexual behavior?  Evidence for Organization-Activation Mechanism in the brain – Nonhuman mammals – David Reimer story – Sexuality of intersex people – Human brain work (trans vs. cis, gay vs. straight)
  33. 33. Development Of Sexual Brain – the “Animal Work”  Brain-organizing action of fetal testosterone discovered C. H. Phoenix et al., “Organizing Action of Prenatally Administered Testosterone Propionate on the Tissues Mediating Mating Behavior in the Female Guinea Pig,” Endocrinology 65 (1959): 369–82.  Over the years, evidence for the “determining influence” of prenatal hormones has accumulated in numerous mammals
  34. 34. Hypothalamus  Instinctive Drives & Behaviors – Hunger – Thirst – Sleep – Body rhythms – Sexual function  Interconnected with amygdala (emotion)  Similar in all mammals  Ancient Netter, Frank H. The CIBA COLLECTION OF MEDICAL ILLUSTRATIONS. Vol I. Nervous System. Part I. Anatomy & Physiology. New York: CIBA (1983)
  35. 35. Sexual Behavior Requires Anterior Hypothalamus  Sexually-dimorphic nuclei in this region  Neurons have sex hormone receptors Figure 25-28 Loci where implantations of estrogen in the hypothalamus affect ovarian weight and sexual behavior in rats, projected on a sagittal section of the hypothalamus. The implants that stimulate sex behavior are located in the suprachiasmatic area above the optic chiasm (blue area), whereas ovarian atrophy is produced by implants in the arcuate nucleus and surrounding ventral hypothalamus (red). MB, mamillary body
  36. 36. Mesolimbic Reward System and Social Behavior Network Are Found in All Vertebrate Brains  Note: AH and BSNT  AH and BSNT of mammal brain have homologs in fish! Figure 3. Evidence for homologies by hodology. Sagittal view of the projection patterns of a social decision-making circuit are presented for each major vertebrate lineage. Arrows imply directionality of the connection. Brain regions within the social behavior network are colored yellow, brain regions in the mesolimbic reward system are colored blue, and brain regions shared by both networks are colored green. The Journal of Comparative Neurology Volume 519, Issue 18, pages 3599-3639, 17 OCT 2011 DOI: 0.1002/cne.22735 http://onlinelibrary.wiley.com/doi/10.1002/cne.22735/full#fig3
  37. 37. Do We Learn Our Core Sexuality? “Sexuality-at-Birth” Theory “Organization-Activation Mechanism” -Evolutionary view -Began challenging Money when only grad student “Psychosexual Neutrality-at-Birth” Theory “Optimal Gender of Rearing policy” -Requires conventional genitalia -Requires patient deception about sexual status at birth John Money Milton Diamond
  38. 38. David Reimer Story (“John-Joan” Case)
  39. 39. Phall-O-Meter  Only an Adam or an Eve  Never both, or neither, or in between
  40. 40. Sexuality of Intersex People  Consistent with prenatal hormonal hypothesis – CAIS: female sexual identity – PAIS: sexual identity unpredictable – CAH: majority are heterosexual women but incidence of bisexual and lesbian orientations is above controls and correlates with degree of prenatal androgenization – Cloacal exstrophy: genetically and hormonally male-born children may identify as males despite being raised as females and undergoing feminizing genitoplasty at birth
  41. 41. Cloacal Exstrophy Reiner, William G. and Gearhart, John P. Discordant Sexual Identity in Some Genetic Males with Cloacal Exstrophy Assigned to Female Sex at Birth. THE NEW ENGLAND JOURNAL OF MEDICINE, 350:333-341 (2004)
  42. 42. Biology of Gender Identity Fa'afafine A broadly accepted social class in Samoa
  43. 43. Bed Nucleus of the Stria Terminalis (BNST) Figure 2: Representative sections of the BNSTc innervated by vasoactive intestinal polypeptide (VIP). A: heterosexual man; B: heterosexual woman; C: homosexual man; D: male-to-female transsexual. Bar=0.5 mm. LV: lateral ventricle. Note there are two parts of the BST in A and B: small sized medial subdivision (BNSTm), and large oval-sized central subdivision (BSTc)  Necessary for sexual behavior in animals  Size of BNST - not influenced by sex hormones in adulthood  Connects amygdala with anterior hypothalamus
  44. 44.  Male-to-female transsexual has BNSTc in the female range  S7: male, lifelong female identity, never “treated”- within female range  FMT: number of neurons is fully within the male range 2nd Study on BNST Heterosexual Male Heterosexual Female Homosexual Male Male-to-female Transsexual
  45. 45. Genetics of Transsexuality  MtF – linked with longer version of gene for androgen receptor that weakens testosterone effect  FtM - linked with gene variant for an enzyme that causes higher concentrations of androgens and estrogen in developing brain
  46. 46. Biology of Sexual Orientation
  47. 47. Third Interstitial Nucleus of Anterior Hypothalamus INAH3
  48. 48. More Evidence For Innate Gayness  2nd human study confirmed INAH3 finding  Gay sheep brains – About 8% of rams are exclusively homosexual – “Duplicated” human INAH3 results
  49. 49. Anterior Hypothalamus Is Activated by Sex Pheromones  Positron emission tomography (PET scans) of anterior hypothalamus while subjects smell sex pheromones  Heterosexual – activated by sex pheromones of other sex  Homosexual – activated by sex pheromones of same sex AND = progesterone derivative 4,16-androstadien-3-one EST = estrogen-like steroid estra-1,3,5(10),16-tetraen-3-ol Subject Activation of anterior hypothalamus Heterosexual males EST Homosexual males AND Heterosexual females AND Homosexual females EST
  50. 50. Genetics of Gayness/Lesbianism  Evidence for genetic markers for gay men and their gay brothers in the Xq28 region on the X chromosome  Findings are consistent with a genetic hypothesis for lesbianism – Lesbians had significantly higher rates of lesbian sisters, daughters, and cousins through a paternal uncle than did heterosexual women – Increasing rates of concordance of lesbianism from nonidentical twins to identical twin pairs – But lesbianism is not associated with the locus at Xq28  Epigenetic mechanism also hypothesized for sexual orientation
  51. 51. Summary of the Science  “…gender identity and sexual orientation are programmed or organized into our brain structures when we are still in the womb”  “…since sexual differentiation of the genitals takes place in the first two months of pregnancy and sexual differentiation of the brain starts in the second half of pregnancy, these two processes can be influenced independently, which may result in extreme cases in transsexuality.”  “This also means that in the event of ambiguous sex at birth, the degree of masculinization of the genitals may not reflect the degree of masculinization of the brain.”  “There is no indication that social environment after birth has an effect on gender identity or sexual orientation”
  52. 52. Medical Malpractice Against LGBTI People  The medical profession has pathologized and stigmatized LGBTI people  Medical policy has been to “fix” LGBTI people - attempting to make them conform to the gender binary
  53. 53. Medical Malpractice Against Gay People  Methods used in attempt to change sexual orientation – Hormonal treatments  Castration  Administration of testosterone or estrogen – Psychoanalysis – Vomiting induced in combination with homo-erotic pictures – Psychosurgery (hypothalamic lesioning) – Electroshock treatment – Chemical induction of epileptic insults Alan Turing
  54. 54. Stonewall Riots (1969)
  55. 55. Frank Kameny & Barbara Gittings Father And Mother of the LGBT Civil Rights Movement In 1970 a group of thirty gay activists led by Frank Kameny and Barbara Gittings broke into the American Psychiatric Association meeting in Washington and turned the staid proceedings into chaos, with Kameny shouting: “We are here to denounce your authority to call us sick or mentally disordered!”
  56. 56. 1972 APA Meeting Panel of psychiatrists to discuss homosexuality titled “Psychiatry: Friend or Foe to Homosexuals: A Dialogue” ‘Dr. Anonymous’ is John E. Fryer Gittings, Kameny, & Dr. Anonymous
  57. 57. Medical Malpractice Against Gay People
  58. 58. New head of World Psychiatric Association has come out as gay  Says that psychiatry should apologize for the harm done to gay and bisexual people  Has vowed to fight reparative therapy and the notion that still prevails throughout much of the world that homosexuality is an illness. Professor Dinesh Bhugra
  59. 59. “Reparative Therapy” by Quacks Continues  Therapy involves “…counseling to acting out scenarios to in some cases shock treatment”  American Psychological Association has reported that efforts to change a person’s sexual orientation not only don’t work but cause harm (loss of sexual feeling, depression, anxiety, and suicidality)
  60. 60. Trans Activists Confront the APA Kelley Winters at 2009 Annual APA Meeting Requested that the APA (1) “affirm in public policy statements that gender identity and expression which differ from assigned birth sex do not in themselves constitute mental disorder….” (2) release “a statement clarifying the medical necessity of hormonal and surgical transition treatments for those who suffer distress with physical sex characteristics that are incongruent with our gender identities,” and (3) “encourage legal and social recognition of all people consistent with our gender identity and expression.
  61. 61. Medical Malpractice Against Trans People
  62. 62. Trans Activists’ Efforts Rewarded in DSM-5  Gender Identity Disorder has been renamed Gender Dysphoria – Gender nonconformity itself is no longer a mental disorder―just the clinically significant distress associated with the condition – New title is less pathologizing and emphasizes the importance of distress about the incongruity for a diagnosis – The work group claimed that it didn’t remove the condition as a psychiatric diagnosis, as many activists had suggested, because to do so would jeopardize access to medical care – Has “exit clause” - cured by surgery on genitalia and other nonbrain body parts! Released May 2013
  63. 63. Canada Clinic Suspends Conversion Therapy Services (March 2015) Dr. Kenneth Zucker "Gender Identity Service“ Center for Addiction and Mental Health Toronto Lynn Conway Professor of Electrical Engineering and Computer Science, Emerita University of Michigan, Ann Arbor, Michigan Member, National Academy of Engineering versus http://www.hrc.org/blog/entry/camh-suspends-conversion-therapy-services
  64. 64. Medical Malpractice Against Intersex People  “The basic problems faced by the intersexed are socio-cultural in nature and not medical and are a result of the dogmatic fundamentalism inherent in the current binary construct of sex and gender”  “Some intersexed individuals are subjected to genital mutilation in childhood as a result of this totalitarian, sexist oppression”  “Informed consent?”  “First, do no harm?” Curtis Hinkle Founder: Organization Intersex International
  65. 65. Intersex Activists Confront the AAP  “…early surgical intervention leads to more than ‘just’ physical scars and sexual dysfunction”  Lack of education and counseling for intersexuals, their families, and the community at large “does not lead to a blissful, healthy, well-adjusted ignorance. Rather, it too often leads to a life-threatening shroud of silence, secrecy, and self-hatred.”  The AAP ignored the letter’s request that representatives meet with the activists, instead releasing a press statement summarizing their John Money–inspired medical policy for intersex treatment Max Beck and “Hermaphrodites With Attitude” Boston, 1996
  66. 66. Genital “Normalization” Surgery - Dismal Outcomes Researchers never asked: What if we did nothing?
  67. 67. Standards of Pediatric “Care”Diamond, M. Sex, gender, and identity over the years: a changing perspective Child And Adolescent Psychiatric Clinics Of North America 13:591-607 (2004).
  68. 68. Intersex Erasure  New pathologizing terminology (DSD) – AAP ignored the wish of intersex activists to be designated as “intersex” – In 2006 instead devised “Disorders of Sexual Development”  Intimidation of patients to accept one-size-fits-all treatments – Testosterone treatment for XXY patients to make them into “Adams”―even for those who don’t feel male or who like their bodies the way they are – These treatments often change the patients’ bodies in ways they abhor  Prenatal “intervention” – Selective abortion – Hormone treatment of fetus (dexamethasone to prevent virilization in CAH)  “Gender Dysphoria in DSD” – DSM-5 includes a new form of craziness – For intersex people who are unhappy with the gender assigned to them at birth!
  69. 69. Intersex in Every Cell  Four “transcriptional sexes” in PBMC* – XX/no T (female) – XY/T (male) – XX/T (intersex) – XY/no T (intersex)  157 genes of PBMC expressed differently in males vs. females – Sex chromosome programming of 11 genes – Androgen-dependent programming of 146 genes (not affected by circulating hormones)  Intersex people have ‘intersex physiology’ in every cell of their bodies and thus have their own health issues *PBMC = peripheral blood mononuclear cells Holterhus P-M, Bebermeier J-H, Werner R, Demeter J, Richter-Unruh A, Cario G, Appari M, Siebert R, Riepe F, Brooks JD, Hiort O. Disorders of sex development expose transcriptional autonomy of genetic sex and androgen-programmed hormonal sex in human blood leukocytes BMC GENOMICS 10:292 (2009)
  70. 70. The Right to Your Own Body!  On Human Rights Day 2013, Hida Viloria explained to the United Nations that it’s very easy to discriminate against intersex people because they are closeted. “That’s why even though intersex is 1.7% of the population, as common as having red hair, you don’t all know that you know an intersex person. And the stigma against us is so great that right now―everyday, today, in New York, in San Francisco, in the most liberal western cities in the world―we are being cut up. Our bodies are being decimated to remove our traits, and the discrimination is that great that it’s considered better to do this to a baby than to let them have an intersex body.” https://www.unfe.org/en/actions/human-rights-day-round-up  In January 2014, The United Nations condemned medically unnecessary normalizing procedures, such as irreversible genital surgeries, saying evidence has shown the procedures may be physically and psychologically harmful, and infants and young individuals cannot consent to them Hida Viloria President American Chapter International Intersex Organization
  71. 71. Historic Lawsuit Against the State of South Carolina Pam and Mark Crawford, adoptive parents, and intersex child M.C. His adoptive mother said, “By performing this needless surgery, the state and the doctors told M.C. that he was not acceptable or loveable the way he was born. They disfigured him because they could not accept him for who he was —not because he needed any surgery.”
  72. 72. Reform LGBTI Medical Care!  Scientific message that “core sexuality is innate” needs to reach everyone  LGBTI people are natural variations - different, but not disordered!  Health and happiness of LGBTI patients must be medical goal  Healthcare providers must be educated and given sensitivity training about LGBTI people  Ethical guidelines for medical treatment of LGBTI people must be established
  73. 73. Medical policy should be based on scientific evidence and ethical principles - NOT religious myth!

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