Autumn, 1998, Vol. 5, No. 1

Transcending the Gender Paradigm

Arryn Hawthorne-Jader: 2nd Year Clinical

Introduction

The expectations of gender and gender expression, tied with the homophobia in our society create an environment in which the transgendered individual faces both external and internalized oppression. The metaphor of gender and the language we use is not conducive to inclusiveness and, therefore, places people who transcend gender lines on the fringes of our society, making them socially vulnerable. Gender is not the binomial variable that it seems to be. With deeper exploration of what gender means, we learn that it is more complicated than "it's a boy" or "it's a girl." Transgender people live on the continuum of gender expression and biologically assigned sex; they live in the gray areas that are more difficult to label. Thus, transgender challenges one of the strongest paradigms by which we live, that of what is male and what is female. Moreover, gender and sexuality are different concepts, and one does not necessarily affect the other.

Due to the special issues presented when working with transgender individuals, many challenges arise; the most challenging aspect may very well be countertransference. Empathy, key to the therapeutic process, is impossible without exploration of our own responses. Just as with any other client, we have the responsibility to explore our prejudices, fears, and ignorance. In order to create a fuller understanding of the unique issues transgender individuals face, and their implications for the social worker profession, the article will discuss the following: gender as a dichotomous metaphor, the oppression of those who do not fit into the dichotomy, and the challenges and alternative approaches in the mental health system.

The Metaphor of Gender

Lakoff and Johnson (1980) propose, "Metaphors... are conceptual in nature. They are among our principal vehicles for understanding. They play a central role in the construction of social and political reality" (p. 159). In this way, gender is a metaphor. We use the terms male or female to categorize individual people into dichotomous categories. Each term is a simplification of multiple meanings based on experience, cultural stereotypes and expectations, and assumptions. In other words, defining people as either male or female aids in our understanding of the world; categorization gives us some order in which to create understanding. As examples of concepts that are "more sharply delineated than others," male and female constructs are clearly examples of dichotomous thinking (Lakoff & Johnson, 1980, p. 57; Berlin 1990).

Gender delineation is based on stereotypic behaviors and psychological associations, as evidenced by, for example, the designation of certain jobs and activities as masculine and others as feminine. There is some validity to these distinctions, but because there are people who do not fit solidly into either category, our understanding of what it means to be male or female is challenged and the delineation between the concepts of male and female becomes dull. It is in this place where transgender becomes reality.

Riki Anne Wilchins, author of Read my Lips: Sexual Subversion and the End of Gender, relates that, as the title implies, gender is not merely either male or female. Delving into the language chosen for and by transpeople, and referring to the current efforts of GenderPAC1 to increase usage of gender-inclusive language, Wilchins (1997) concludes that At some point such efforts simply extend the linguistic fiction that real identities (however inclusive) actually exist prior to the political systems that create and require them. This is a seduction of language, constantly urging you to name the constituency you represent rather than the oppressions you contest (p. 17).

Evidently, we see that gender is not as simple as it may initially seem. The language of gender is more than words: it has the power to create systems of oppression.

What is transgender?

In the preface to Transgender Warriors: Making History from Joan of Arc to Dennis Rodman, Leslie Feinberg (1997) says, "Transgender people traverse, bridge, or blur the boundary of the gender expression they were assigned at birth" (p. X). Transgendered individuals are people who in some way do not fit into our narrow ideas of what is female and what is male. This said, any of us could be perceived to be transgender and, therefore, suffer oppression and discrimination. Much like when a hate crime is committed, the perpetrators do not always know whether the victim is gay, straight, male, female, or trans. Wilchins (1997) suggests, "the regime of gender is an intentional, systematic oppression" (p. 25).

Oppression

By definition, labels are limiting. Gender labels are no exception. This section will address different levels of oppression experienced by people who identify as transgender, or are perceived as such. The levels include systemic, public attitude, the mental health system, and the internalization of oppression and its effects on transpeople.

Systemic

The predominant xenophobic attitude of American culture creates a systemic oppression of transgendered individuals. In regard to transgender, systemic oppression can be defined as cultural assumptions about gender and how people should express it. Our limited thinking about gender manifests itself in many ways. The doctor announces "it's a boy" or "it's a girl" and with this seemingly simple statement, the doctor's power as a medical practitioner infiltrates the lives of the child and his or her parents. The gender identity announced, based solely on external genitalia, is impressed upon the family. Since our culture holds strong beliefs about what is appropriate for each gender, the child who is born female- regardless of her interests and abilities- is generally expected to wear dresses, play with dolls, like boys, and aspire to having a family and (if she's really ambitious) a career.

Systemic oppression fuels vicious hate crimes and murders. Our society's public institutions, like the police, reinforce the oppression.

Marsha P. Johnson was one of NYC=s oldest and best-known drag, transgendered and African American activists. Her work covered 20 years, back to the days of the original Stonewall Rebellion. Three years ago, Marsha was seen being harassed and verbally assaulted by some teenage kids near the Christopher Street piers. Later that same night, she was found floating dead in the Hudson River, not far from that location. The police refused to investigate, stating there was not reason to suspect a bias crime, or even any crime at all [Italics added for emphasis] (Transsexual Menace Web Page, April 1998).

Marsha is only one of many beaten or murdered because she was gender-different2; violence is only one of many forms of power and oppression suffered by transpeople. Not only do gender-different people have to live with the discord of rectifying their identities, but also they must face the fear of violence.

Public Attitude

The understanding of gender as a dichotomous concept is evident in the general public. Television and entertainment examples are cited in this section as factors that also contribute to the pervasive oppression of transpeople. Television and entertainment promote our cultural views on transgender, and more often than not make transgender a source of "humor" in which a man dresses in drag or a woman dresses as a man. The thematic story-line in an April 1998 episode of Murphy Brown was about transgender people. The program began with the staff of the prime time news show discussing a recent "newsworthy" event: a senator was found in a compromising position on the steps of the Capitol Building with a "she that was really a he." The next "funny moment" on the show was when Lily Tomlin, one of the show's stars, dresses as a man and tricks the rest of the staff. Recall Flip Wilson's Geraldine, Dustin Hoffman's Tootsie, and a recent short-lived program on the Fox network about a man who loses his job as a sportscaster and decides to dress as a woman to get his job back.

Nightclubs, like the Baton in Chicago provide drag entertainment where the purpose and joke is to determine the gender of each of the performers. Granted, a number of these performers enjoy their work, and appreciate a place where they can be themselves. It is the response of the audience that indicates the public attitude.

The Mental Health System

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) also contributes to oppression of people who do not fit our narrow categories of gender expression. The manual designates transgender as a pathological illness, in need of cure, and, as Rosario (1996) points out, "the DSM-IV definition is exceptional in that it incorporates the demand for medico-surgical intervention as one of the diagnostic criteria" (p. 37). The DSM-IV is the criteria that insurers use to decide if they will pay for certain treatments, and it is the guiding force for many professionals in the field. Therefore, it has power over individuals for whom a diagnosis is decided with its criteria.

The trans community currently debates this topic. Most believe that the category should be abolished from DSM, but are conflicted because some of the treatments (e.g. hormone treatment and surgery) would not be available for those who not only want them, but also could benefit from them (Daphne Scholinsky, reading at Gerber/Hart Library).

Randi Ettner, Ph.D. (1997), a clinical and forensic psychologist who works exclusively with transgendered people, says that she considers Gender Dysphoria a medical condition, because it is treatable with hormones for some, counseling for others. Like homosexuality, which was removed from the DSM in the 1970's, gender identity is not something for which individuals can be cured. The interventions should have the goal of affecting the individual's coping skills and ability to accept himself or herself for the person he or she is. Although the causes of this condition are not known, Dr. Ettner postulates that Gender Identity is partially determined by environmental factors, and partially determined by biological factors.

Gender expression and sexuality are separate concepts, but DSM-IV requires a specifier that describes the sexual orientation of the client. The specifiers are: "sexually attracted to males," "sexually attracted to females," "sexually attracted to both," or "sexually attracted to neither." In the chapter on Sexual and Gender Identity Disorders, a false connection between sexuality and gender identity is made. In order to understand a client with severe gender dysphoria3, much of the early literature about transgender4 clung to what Rosario (1996) calls a "heterosexual transsexual paradigm" (p. 39). Naming the condition transsexual connotes that it is a sexual issue and not a gender expression issue. In the same chapter, Rosario (1996) quotes Dr. Charles Socarides5, a psychiatrist known for denouncing homophobia, who says,

Transsexualism is evident in the homosexual who, in attempting to resolve the emotional conflicts of his homosexuality, hits upon the idea of changing his sex through the mechanism of denial...and thus alleviates himself of guilt for his homosexual object choice (p. 39).

In particular, the medical literature tends to focus interventions solely on surgeries and hormone treatment. However, this same literature does not speak about individuals who do not want either.

When society as a whole tells transgender individuals that are not worthy, and systems are set up that reinforce this idea, transgender individuals begin to believe it. Internalized oppression inevitably turns to depression and self-hatred. Therefore, in addition to the reconciliation of identity, transgender persons battle depression inflicted upon them by an unaccepting public.

Clinically Appropriate Treatment of Transgender Clients

The appropriate way to treat a client perceived to be transgender is simply to ask his or her name and ask how he or she prefers to be addressed. Randi Ettner says that Gender Dysphoria or Gender Identity Conditions are self-diagnosed (PFLAG Regional Conference, April 1998). There is no diagnostic test to determine these conditions.

When a client presents in a way that leads us, as practitioners, to believe that gender identity is in question, we must ask ourselves for whom the identity is in question. Contrary to the pathologizing point of view set forth in the DSM, and supportive of the strengths model of psychotherapy, we focus on the strengths of the individual. The individual may or may not come to us with an interest in "working on" transgender identity.

When a client presents in a way that a practitioner perceives to be transgender, it is crucial to identify any countertransference. Some of the most common discomforts that people (including practitioners) have with transgender relate to our beliefs about the way things "are supposed to be." Thus, causing the traditional gender paradigm is threatened.

Miriam Oles, M.S.W. (1977) proposes that countertransference reactions to those transsexual individuals who want hormone treatment or surgery are derived from "unfamiliarity; ethical and moral objections; attitudes toward gender and gender appropriate behavior; and other conscious and unconscious emotional factors within each individual" (p. 73). She proposes that, "When the therapist or caseworker feels that he or she has a bias, for whatever reason, against sex change, or is persistently uncomfortable with transsexual clients, it may be best to refer the client elsewhere" (p. 73).

Understanding the Unique Issues

The purpose of this essay was to acquaint practitioners with the unique issues of the transgender population. However, I think it is important to consider that by singling out this population as a subject of study, we can very easily separate ourselves from the individuals who comprise it. It is my hope that practitioners will develop an interest in understanding the stories of transgendered individuals, explore their own fears and prejudices, and then empathize with their clients' experiences.

ENDNOTES

1 Founded in Cincinnati, OH, June 10, 1995, GenderPAC's purpose is to support national gender activism.

2 The terms gender-different and differently gendered are terms currently used by GenderPAC in their lobby efforts in Washington, D.C.

3"A persistent aversion toward some or all those physical characteristics or social roles that connote one's own biological sex" (American Psychiatric Association, p. 767).

4 At that time, like now, transsexual, rather than transgender, was the term in favor by the medical community.

5 Interesting to note as an aside: Dr. Socarides has a son who is one og the highest ranking gay officials in the U.S. His son, Richard, is President Clinton's liaison to the gay and lesbian community.

References

American Psychiatric Association (1995). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, D.C.: American Psychiatric Association.

Berlin, S. (1990). Dichotomous and complex thinking. Social Service Review, 64, 46-59.

Ettner, R. (1997). Confessions of a gender defender: A psychologist's reflections on life among the transgendered. Evanston: Evanston Publishers.

Feinberg, L. (1996). Transgender warriors: making history from Joan of Arc to Dennis Rodman. Boston: Beacon Press.

_____. (1993). Stone butch blues. Ithaca, NY: Firebrand Books.

Herman, J.L. (1997). Trauma and recovery. New York: Basic Books.

Lakoff, G. & Johnson, M. (1980). Metaphors we live by. Chicago: The University of Chicago Press.

Levince, C.O. (1978). Social work with transexuals, Social Casework 59(3), 167-74.

Oles, M.N. (1977). The Transsexual client: A discussion of transsexualism and issues in psychotherapy. American Journal of Orthopsychiatry, 47(1), 66-74.

Pratt, M.B. (1995). S/he. Ithaca, NY: Firebrand Books.

Rosario II, V.A. (1996). Trans (homo) sexuality? Double inversion, psychiatric confusion, and hetero-hegemony. In B. Beemyn & M. Eliason (Eds.), Queer studies: A gay, bisexual & transgender anthology. (pp. 35-51). New York: New York University Press.

Scholinsky, D. (1997). The last time I wore a dress. New York: Riverhead Books.

_____. (1998, May). The last time I wore a dress. Reading and book signing. Gerber/Hart Library and Archives, Chicago.

_____.(1998, April). Targets of Prejudice [Web Page]. Transsexual Menace. Available http://www.apocalypse.org/pub/tsmenace/souce/in_memoria.html.

Wicks, L.K. (1977). Transsexualism: a social work approach. Health and Social Work 2(1), 179-93

Wilchins, R.A. (1997). Read my lips: Sexual subversion and the end of gender. Ithaca, NY: Firebrand Books.

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