Transgender & Science


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  • Transgender & Science

    1. 1. Transgender & Science The effects of GID on Transgender: An analysis of Judith Butler’s “Undiagnosing Gender”
    2. 2. Judith Butler <ul><li>Who she is: </li></ul><ul><ul><li>PhD in Philosophy </li></ul></ul><ul><ul><li>Highly respected poststructuralist philosopher, theorist and scholar </li></ul></ul><ul><ul><li>Many areas of interest, including Queer Theory, Western Feminist Theory and Ethics </li></ul></ul><ul><ul><li>Has received countless honors and awards </li></ul></ul><ul><ul><li>Credited as an expert in her fields of interest </li></ul></ul><ul><ul><li>Currently Maxine Elliot Professor in the Rhetoric and Comparative Literature Departments at the University of California, Berkeley </li></ul></ul>
    3. 3. Overview of Undiagnosing Gender <ul><li>The essay Undiagnosing Gender appeared in a compilation of Butler’s work titled Undoing Gender, which examined the regulation of gender and sexuality by psychology, aesthetics and society, and the impact it has on transgender individuals </li></ul><ul><li>Undiagnosing Gender looks at the opposing views regarding the psychiatric and medical diagnosis of Gender Identity Disorder (GID), and how it pathologizes transsexuality </li></ul>
    4. 4. Definition of Transgender <ul><li>Transgender is a broad term that refers to individuals who do not conform to the conventional male and female gender roles and do not associate with their biologically “assigned” sex </li></ul><ul><li>It is estimated that 1 in 30,000 people in the US is transgender </li></ul>
    5. 5. MTF <ul><li>MTF (Male to Female) refers to individuals that are born male but identify as female </li></ul><ul><li>Photography by Charlie White </li></ul>
    6. 6. FTM <ul><li>FMT (Female to Male) refers to individuals that are born female but identify as male </li></ul><ul><li>Thomas Beatie </li></ul>
    7. 7. Definition of Gender Dysphoria <ul><li>Literally means a deep unhappiness with regard to gender </li></ul><ul><li>Emerges as dissatisfaction and discomfort with the biological sex an individual is born with </li></ul><ul><li>Experience conflict between the gender identity they experience and the gender associated with their body </li></ul>
    8. 8. DSM-IV-TR Definition: Gender Identity Disorder (GID) <ul><li>GID is the formal diagnosis </li></ul><ul><li>used in psychology and medicine </li></ul><ul><li>for individuals who suffer from </li></ul><ul><li> gender dysphoria </li></ul>
    9. 9. DSM <ul><li>The Diagnostic and Statistical Manual of Mental </li></ul><ul><li>Disorders </li></ul><ul><li>Published by the American Psychiatric </li></ul><ul><li>Association </li></ul><ul><li>First published in 1952 </li></ul><ul><li>4 Revisions published since: </li></ul><ul><ul><li>DSM-I (1952) </li></ul></ul><ul><ul><li>DSM-II (1968) </li></ul></ul><ul><ul><li>DSM-III-R (1980) </li></ul></ul><ul><ul><li>DSM-IV (1994) </li></ul></ul><ul><ul><li>DSM-IV-TR (2000) Current Version </li></ul></ul>
    10. 10. DSM-IV Definition: Gender Identity Disorder (GID) <ul><li>The term GID was created when transexualism was added to DSM-III in 1980 </li></ul><ul><li>In each proceeding editions of DSM, the definitions related to transexualism and GID have been changed, illustrating the uncertainty that surrounds the diagnosis </li></ul><ul><ul><ul><li>E.g. In the most recent edition DSM-IV-TR (2000) transexualism has been replaced by the term “ Gender Identity Disorder in Adolescents and Adults,” while GID now falls into its own subcategory of Sexual Disorders </li></ul></ul></ul><ul><li>The diagnosis is now divided into 3 sub-categories: “ Gender Identity Disorder in Children ,” &quot; Gender Identity Disorder in Adolescents or Adults ,” and &quot; Gender Identity Disorder Not Otherwise Specified ” </li></ul>
    11. 11. DSM-IV: GID Diagnosis <ul><li>The four components that must be identified for an individual to be diagnosed with GID are: </li></ul><ul><li>a strong and persistent cross gender identification </li></ul><ul><li>feels a persistent discomfort with his or her sex </li></ul><ul><li>this discomfort is not due to being intersex or hermaphroditic </li></ul><ul><li>the discomfort causes significant distress or impairment in their life </li></ul>
    12. 12. Key Issue with DSM-IV’s Diagnosis <ul><li>Certain characteristics that DSM-IV associate with identifying GID are disconnected from both the diagnosis and psychiatry </li></ul><ul><ul><li>E.g. DSM-IV claims that you can identify a girl experiencing cross-gender identification if she “prefers boys clothes, short hair, has mainly boy friends, expresses the desire to be a boy, and they are often misidentified by strangers as boys .” The initial behaviors and characteristics mentioned relate to cross-gender id. However a strangers perception of a child has no relevancy to this context, and in no way confirms cross-gender id. </li></ul></ul>
    13. 13. Key Issue with DSM-IV’s Diagnosis <ul><li>While the intention of GID is to establish the criteria by which a transgender individual can be identified, through articulating the specifics of the diagnosis itself, the diagnosis creates another rigid version of gender norms </li></ul>
    14. 14. Key Issue with DSM-IV’s Diagnosis <ul><li>The way they conceptualize the relationship between GID and homosexuality </li></ul><ul><ul><li>Follows the gender inversion model </li></ul></ul><ul><ul><li>Understands homosexuality as inverted heterosexuality, but maintains sexuality as heterosexuality: boy traits will lead to a desire for women, and girl traits to a desire for men </li></ul></ul><ul><ul><li>Disregard for “queer crossings” that exist among the GLBTQI </li></ul></ul><ul><ul><li>Claims that gender identity is a predictor of sexual orientation </li></ul></ul><ul><ul><li>Implies that homosexuality is the “damage” that follows a sex change </li></ul></ul>
    15. 15. <ul><ul><li>Not all transgender individuals are homosexual, in contrast their is diversity of sexuality among transgender individuals </li></ul></ul><ul><ul><li>In addition, although some individuals’ sexual preference changes after transitioning, others remain the same </li></ul></ul><ul><ul><li>The reality is that although sexuality and gender relate, transgender does not always equate to homosexuality and hence shouldn’t be reflected as so </li></ul></ul>Butler Illustrates These Conceptions Are
    16. 16. Debate Regarding GID <ul><li>The tension regarding GID exists between two groups divided by those who want to keep it , and those who want to eliminate it : </li></ul><ul><li> There is… </li></ul><ul><li> ✔  Group 1: “those seeking entitlement and financial assistance for costly procedures” </li></ul><ul><li>Versus… </li></ul><ul><li> ✗  Group 2: &quot;those who seek to ground the practice of transsexuality in autonomy ” </li></ul>
    17. 17. ✔ Keep It: Positive Effects of GID as a Diagnosis <ul><li>Diagnosing an individual with GID offers certification of a medically accepted condition </li></ul><ul><li>GID diagnosis provides access to a variety of medical and technological means for transitioning </li></ul><ul><li>Insurance companies are only willing to contribute to treatments provided they are “medically necessitated,” and therefore require a professional’s GID diagnosis </li></ul>
    18. 18. The Cost of Transitioning: Sex Change Surgery & Hormones <ul><li>Average Cost of a male to female sex change * over two years: </li></ul><ul><li>$17,000 (Cost of Surgery) </li></ul><ul><li>$1,000 (Therapy) </li></ul><ul><li>$1,500 (Hormone Treatment) </li></ul><ul><li>$500 (Doctor visits/tests) </li></ul><ul><li> Total: $20,000 </li></ul><ul><li>This high total cost clearly illustrates the importance of insurance coverage for certain procedures </li></ul><ul><li>* This estimate only includes the cost of the principle procedures for a sex change, additional procedures are listed on the following slide </li></ul>
    19. 19. Transitioning: “Medically Necessitated” Procedures <ul><li>Psychological counseling for the initial diagnosis, obtaining the letter required for surgery; additional psychological guidance and support during transition </li></ul><ul><li>Hormone Replacement Therapy (HRT) to adjust body to new gender </li></ul><ul><li>Reoccurring doctor visits to support and monitor HRT </li></ul><ul><li>Permanent facial hair removal for transsexual women. Usually laser treatments and/or electrolysis on the face, neck, and other areas of the body </li></ul><ul><li>Breast augmentation for trans women </li></ul><ul><li>For trans men, penile and testicular prostheses </li></ul><ul><li>Bilateral mastectomy and chest reconstruction for transsexual men </li></ul><ul><li>A hysterectomy may also be medically indicated for trans men </li></ul><ul><li>In many cases, genital reconstruction surgery is indicated for trans men and women </li></ul><ul><li>Skin flap hair removal </li></ul><ul><li>Certain facial reconstruction procedures as appropriate for the patient </li></ul>The World Professional Organization for Transgender Health states that the necessary procedures includes:
    20. 20. However… <ul><li>Butler also presents the strong counterargument as to why GID should be eliminated as a diagnosis, exploring the arguments of </li></ul><ul><li>&quot;those who seek to </li></ul><ul><li>ground the practice of </li></ul><ul><li>transsexuality in autonomy” </li></ul>✗
    21. 21. ✗ Eliminate It: Negative Effects of GID as a Diagnosis <ul><li>It assumes that those who are diagnoses are affected by external and internal forces – including dysphoria and delusions – that they don’t understand </li></ul><ul><li>“ Disorder” implies sickness, mental illness, abnormality which can have particularly damaging affects on diagnosed youth </li></ul><ul><li>It implies the need for “correction, adaptation and normalization” of those who are diagnosed </li></ul><ul><li>Associated research suggest GID is the result of failure of family </li></ul><ul><li>It supports transphobic ideas </li></ul><ul><li>Shuns the acceptance and concept of transgender as it does not conform to society’s definition of male and female gender </li></ul><ul><li>Denies individuals their right to exercise autonomy </li></ul>
    22. 22. The Right to Exercise Autonomy <ul><li>The concept of autonomy related to one’s individual rights to freedom and liberty </li></ul><ul><li>In the US these imply certain legal protections and rights </li></ul><ul><ul><li>the “pursuit of liberty” is guaranteed in the US Constitution </li></ul></ul><ul><li>Every individual has the right to execute autonomy, and regarding gender and self-determination there should be no exception </li></ul>
    23. 23. However… <ul><li>Through dictating whether or not transitioning is deemed “medically necessitated” insurance companies demean individuals liberty and autonomy </li></ul>
    24. 24. Example <ul><ul><li>A butch lesbian who required a single mastectomy consulted her doctor about having both breasts removed to avoid the cancer’s reoccurrence. However, due to her appearance and sexuality her insurance company felt that the second mastectomy was an “elective” surgery and that paying for it would “set a precedent for covering elective transsexual surgery.” </li></ul></ul><ul><ul><li>Although she did not identify as transgender, the woman faced having to submit herself to psychological evaluation as being diagnosed with GID was the only way she would qualify for a double mastectomy covered by her insurance </li></ul></ul><ul><ul><ul><li>= Demeaning her autonomy and right to self-determination </li></ul></ul></ul>
    25. 25. Explored Alternatives <ul><li>Strengthen and redefine GID </li></ul><ul><ul><li>Could strengthen the diagnosis as a tool of self-expression and self-determination </li></ul></ul><ul><ul><li>Runs the risk of having unintended consequences e.g. those who are diagnosed may not be – or want to be – transgender </li></ul></ul><ul><li>Jacob Hale recommends GID should be separated from psychiatry and psychology and aligned with the relationship between medical professional and patient </li></ul><ul><ul><li>Psychological evaluation is not required for other reconstructive surgeries </li></ul></ul><ul><ul><li>Eliminating the requirement for a mental health evaluation would reinstate individuals’ rights of entitlement </li></ul></ul><ul><ul><li>As it is considered a mental health diagnosis there is a likelihood that medical professionals would still base decisions off the existing definitions </li></ul></ul><ul><ul><li>Removing it from psychology could discrediting or eliminate it altogether </li></ul></ul>
    26. 26. Conclusion: Final Interpretation of Undiagnosing Gender <ul><li>Butler clearly and successfully illustrates the value of both sides of the GID diagnosis debate: </li></ul><ul><li>On the other hand, transgender is not a disorder and the pathologizing affect that GID has only contradicts this fact. In addition there is the importance of self-determination, and the reality that gender identification should be chosen at will not dictated by society’s need for psychiatric and medical explanations like GID. </li></ul><ul><li>One the one hand, we should not underestimate the benefits that GID offers transgender individuals. Neither should we outlook the role that it plays in binding the norm that governs the way in which society perceives and accepts transgender. </li></ul>✔ ✗
    27. 27. Conclusion: Closing Thoughts <ul><li>The key point that Butler illustrates in the conclusion is that there is evidence the DSM and its definitions of GID and gender dysphoria: pathologizes transgender; empower insurance companies; influence societal perceptions; and restrict self-determination. However the reality is that until the empowered insurance companies adapt to offer fair and effective means for transgender individuals to access necessary procedures, GID will remain contrastingly vital and detrimental to the transgender community. </li></ul>
    28. 28. Works Cited <ul><li>Butler, Judith. &quot;Undiagnosing Gender.&quot; Undoing Gender . New York: Routledge, 2004. 75-101. Print. </li></ul><ul><li>The World Professional Association for Transgender Health . Web. 3 Apr. 2011. <>. </li></ul><ul><li>&quot;Transgender at Work.&quot; . Web. 04 Apr. 2011. <>. </li></ul>