Consumer Relations
©2011 by Dallas Denny
Source: Dallas Denny. (2001). Consumer relations: WPATH’s evolving relations with those it serves. Chrysalis Quarterly, 3(1).
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Breaking Down the Doors of the Academy
I should point out that this history of WPATH is colored by my personal experience and history. Others may have different perspectives.
Consumer Relations
WPATH’s Evolving Relationship with Those It Serves
The World Professional Association for Transgender Health is the professional organization for researchers and care providers in the field of transsexualism and transgenderism. Before 2005 it was known as the Harry Benjamin International Gender Dysphoria Association.
As an organization, WPATH has moved from its formation in 1979 as an organization based on medical model of transsexualism—nd one which excluded transsexual and transgendered people from membership—to an organization that has embraced a transgender wellness model with full equity for transsexual and transgendered people as members and leaders. [1] The 1990s and first decade of this century saw an explosion in membership as this new sensibility took root.
The transition wasn’t without pain.
A Brief History
HBIGDA was created by attendees of the early international symposia on gender identity. The first three conferences were funded by FTM transsexual Reed Erickson through his Erickson Educational Foundation, but it was clear the money wouldn’t continue indefinitely. When word of the closure of the Erickson Foundation arrived in 1977 at the 5th International Symposium on Gender Dsyphoria in Norfolk, Virginia, attendees were motivated to form a professional association. [2]
By the late 1970s that organization was up and running. It got its name from pioneering endocrinologist Harry Benjamin [3] and the then-accepted clinical name for transsexualism. It was called The Harry Benjamin International Gender Dysphoria Association. The first president was psychologist Paul Walker [4], who also chaired the committee which drafted a set of guidelines called the Standards of Care for the Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons. [5]
The Standards of Care, first published in 1979, required a letter from a therapist before administration of hormones and two letters for surgery. The applicant for surgery was required to live as a member of the target gender for at least one year before surgery letters could be written.
The SOC were revised in 1980, 1981, 1990, 1998, 2001, and, most recently, 2011. Along the way they have grown from both sides of a single sheet of paper to 120 pages.
The First Move Toward Inclusion
My younger readers—and maybe even some of my older ones—may not realize that before the early 1990s transsexuals and openly transgendered professionals were locked out of the medical and psychological literature. Their written contributions were limited to their work within the forming transgender community and to the public at large by their autobiographies. There were dozens and even hundreds of these—but there were no names of transsexuals or out transgendered people as authors on textbooks, book chapters, or journal articles. We were actively excluded. [6] Nor did transsexuals attend professional conferences, except as subjects. Only in the 1990s were transsexual and transgendered scholars able to actively contribute to their own literature (Denny, 1995). [7] [8]
This exclusion was an invevitable result of the then-prevalent medical model, which objectified and demeaned transsexuals. Under the medical model it was simply impossible for transsexuals to be anything other than subjects or specimens.
In the 1980s HBIGDA and its members were fully invested in the medical model of transsexualism. This is hardly surprising, as alternative models had yet to be developed. Transsexuals themselves subscribed to the model. It’s important to understand that neither transsexuals or HBIGDA members can be retroactively faulted for their investment in this model. It was the only model available, and it did serve to open doors for hormonal and surgical sex reassignment for transsexuals—even if at the same time it made it impossible to think of transsexuals like other people. Consequently, HBIGDA’s initial membership included no transsexual or transgendered members. They were simply not allowed. This continued into the 1990s—but in its early days the organization did have a consumer advocate—Jude Patton. [9]
Jude was sponsored by SRS surgeon Donald Laub of the Stanford Gender Program, who bravely broke precedent.
In The Riddle of Gender, Deborah Rudacille writes:
Patton says that the votes were not against him personally—as “nobody really knew me”—but against the idea of having a consumer voice on the board at all. “I remember that someone stood up and said, ‘I will not serve on any committee that has a consumer on it,’” he recalls.
Laub cast the deciding vote in favor of Patton’s membership, however, and Patton was elected. Patton served on the HBIGDA board from 1979 to 1981, and found the experience somewhat overwhelming. “I was very intimated,” he says. “I was still a grad student, and these people were big names in the field.” Still, he says, “they were polite and they listened to me.” But after his two-year term expired, the board did not appoint another consumer advocate until 1997, when Patton was once again asked to serve, together with Sheila Kirk, M.D., a MTF surgeon.
pp. 176-177
I Join HBIGDA
I’m not sure who the first openly HBIGDA member were, or when they joined. In December 1989 I began repeatedly writing Executive Director Judy van Maasdam, asking for an application. I didn’t hear from her. When I finally telephoned her to ask her to send me membership materials she was abusive on the phone, taking me to task for something I had written in Chrysalis Quarterly and refusing to send me a form. I kept on writing and calling, but no form appeared.
The Offending Material
This issue’s stupid quote:
To change a person’s God-given anatomic sex is a repugnant concept.
Donald R. Laub, M.D., and Norman Fisk, M.D. 1974. A rehabilitation program for gender dysphoria syndrome by surgical sex change. Plastic and Reconstructive Surgery, 53, p. 388.
This issue’s smartass quote:
Transsexuals… are distinguishable from females at large by their lack of special attraction to the helpless newborn and their imagery in coital fantasies. It is possible, though, that transsexuals will change their conception of the female stereotype to include these features after reading this article, since they are often influenced by reading about their condition.
John Money, Ph.D., & Clay Primrose. 1968. Sexual dimorphism and dissociation in the psychology of male transsexuals. The Journal of Nervous and Mental Disease, 147, p. 472.
—From Chrysalis Quarterly 1(1)
I included the quotes in the magazine because they were the perfect example of outrageous snipes at transpeople rendered acceptable by the medical model—even from those, like Money and Laub, who championed us. When I told Ms. van Maasdam on the telephone, “Judy, Donald Laub and Money are just men. They aren’t gods,” she assured me they indeed were gods.
Finally, I wrote a letter to Dr. Leah Schaefer, HBIGDA’s new President. I listed my credentials and experience and included the dates of my dozen or so written and telephone requests for membership materials. I once again asked for a membership form.
Dr. Schaefer promptly sent me a form, which I filled out and returned. I was accepted as a member of HBIGDA and van Maasdam was suddenly no longer Director.
HBIGDA 1993, NYC
I attended my first HBIGDA meeting in 1993, in New York City. The old guard was much in evidence. So, too, were a score or more of transpeople, who sat quietly in the audience, mostly trying to pass.
The 1993 sessions were all plenaries—everyone was in one room. All presenters were officially cisgendered. The first paper I saw was given by Dr. Robert Dickey of the Clarke Institute of Psychiatry [10]. Upon reaching the podium, he initiated an absolutely amazing display of masculine throat-clearing, shoulder rolling, and tie-straightening. After some thirty seconds of this gorilla-like behavior I was pretty sure he was one of the girls.
I tell this story because it’s indicative of the repressive tone of the 1993 conference, and because Dickey, who was famous among transsexuals at the Clarke for his abusive and demeaning treatment of them, shouldn’t minding taking a little of what he dished out for so many years.
Robert Dickey's Verbal Abuse of Two Transsexual Women
These stories originally appeared in Chrysalis Quarterly #3 in 1991 as part of my article “The Politics of Diagnosis and a Diagnosis of Politics.” In order to get hormones and surgery, both women were repeatedly required to travel two thousand miles from their home in Alberta to the Clarke Institute of Psychiatry in Toronto. They told me the name their abuser.
The text is as the original. To be circumspect, I disguised the clinic and the clinician.
Anna
Anna, who is from Alberta, made several trips to a gender clinic in a large Canadian city in the late 1980s and early 1990s. Anna spoke to CQ in Brussels, Belgium, where she had just had sex reassignment surgery.
My first trip to the clinic was in September, 1989. I saw a psychometrist who was in charge of the program. He gave me two tests. Then I saw a psychiatrist. I had an interview with another psychiatrist, but he canceled. The next interview was with a man who was not very nice to me. We argued the whole time. He told me my hands and feet were too big, that I was too tall, that I would never pass, that everything was wrong with me. He was very hateful.
CQ: Didn’t you have a name that worked in both genders?
L: Yes. My first name was Lonnie—I had started to spell it Loni—and my second named worked, too. But the clinic told me I had to change it.
CQ: Wasn’t it just a suggestion? (In the chapter on real-life test in Blanchard and Steiner’s 1990 text, Clinical Management of Gender Identity Disorders in Children and Adults, reviewed in this issue, Leonard Clemmensen writes that the Clarke Institute of Psychiatry “encourages” transsexual people to replace unisex names with more clearly sex-typed names. Was this what Anna’s clinic was doing— “encouraging”?—Ed.)
L: No, they told me I had to change it or forget about the program.
They told me to choose a surgeon, and they would write a letter for me. But I already had a letter from my doctor. The clinic didn’t help at all.
Britt
Britt, a registered nurse, had SRS on the same day as Anna. She had an experience with the same clinic.
My psychiatrist made me go through a bunch of those weird tests in his office in Edmonton. He put electrodes on my dick and showed me pictures of little naked boys being whipped, different sorts of fellatio, just to see if I passed the pervert test. He did the basic psychological profile. He suggested that I go to a certain gender clinic.
We contacted the clinic, and they sent me a big questionnaire. They wanted a profile about when I first started crossdressing, what my sexual preferences were—more pervert stuff.
About six months later, they set me up to go to the clinic, which was half a continent away. I asked if I couldn’t be examined in Edmonton, since it would be expensive to travel so far. They said no, that I had to come.
I was working as an aircraft maintenance technician. I really liked it. My psychiatrist told me that I had to quit. I think he did so on advice from the gender clinic. He said it wasn’t a very feminine thing to do. I said, “I’m not into flower arranging or basket weaving!” He made me quit, and I entered a continuing education program.
My first trip to the gender clinic was in the summer of ’86. I remember two doctors in particular, a woman and a man. They were very obstructionistic. “You’ll never be happy. You’ll always be lonely. If you have a male partner, he’ll be of below average intelligence, a homosexual, or a criminal.”
“How can you be sure of that?”
We just know it.”
I went to the gender clinic again after I started my nursing program. I saw the male doctor I had spoken to before.
“Why do you want to be a male?”
“What?”
“Are you going from F to M?”
No. I’m going from M to F.”
“Oh. So you’re a hooker. And you’re on drugs.”
“No.”
“You’re lying.”
“No I’m not. I’m enrolled full-time in a nursing program.”
“Bullshit. I don’t believe you.”
He wanted to see the documentation about the nursing program.
“We don’t think you’re ready.” (This, after two years of cross-living.) “We want you to finish the nursing program.”
“I’m not sure I want to finish. I don’t like it.”
He told me if I didn’t finish nursing to forget it. (No doubt this man would say he “encouraged” Britt to stay in nursing—Ed.)
The third time to the clinic was in May, 1990.
The same doctor again. “You look very nice. You’re small. That’s good. What are you doing?”
“I finished my nursing program. I’m now an registered nurse.”
“I don’t believe you.”
Well, this time I had brought documentation.
“Oh, excellent. You’re one of us.”
“One of us?”
“You’re in the business. You’re looking good, doing well. We had a conference about you, and we’ve decided to recommend you for surgery. We think you’ll do well, but you’re going to be a lesbian.”
“I don’t think so.”
“Oh, yes, we know that for a fact. If you liked women before, you’ll be a lezzie. How do you feel about that?”
Despite his insistence that I would turn out to be a lesbian, I didn’t. My work now is exciting, but you know—I really liked working as an aircraft technician.
Richard Green’s Presidency (1997-1999)
Change began in earnest in 1997, when psychiatrist Richard Green became HBIGDA’s 9th president.
Dr. Green had graciously contributed a chapter for my 1998 edited text Current Concepts in Transgender Identity. He wrote, in 1996 or early 1997:
Startling as it is for me to think it, I wrote the conclusion to Transsexualism and Sex Reassignment about 25 years ago. It’s been a long time since I re-read it. As I handwrite my reflections (I still do not type or word process), I am struck at the outset that the biggest change with this new text may be that it is edited by a transsexual.” (p. 419).
“It’s time,” he told Jude Patton (Rudacille, 2005, p 177). In 1997 Patton became a board member for real, serving until 2001. Dr. Sheila Kirk was also on the board from 1997-2001. [11] Patton and transsexual physician Anne Lawrence were appointed as members of the committee that prepared the 2001 revision of the Standards of Care. So was Aaron Devor, years before his coming out.
HBIGDA 1997,Vancouver
My second HBIGDA conference was Vancouver in 1997, and it was in every possible way different from 1993. Transsexual and transgendered people were everywhere—on the board, on the committees, in the audience, and giving presentations and even keynotes. Change was in the air and on the program. Walter Williams and Aaron Devor blew it all apart at the opening plenary.
Here’s what I wrote about the opening session:
Dr. Marilyn Wilchesky of the gender program in Ottawa led with a paper about transsexualism (the same old stuff—separation and invidiuation, weak fathers, narcissistic mothers). Dr. Wilchesky was followed by Dr. Holly Devor, who set the tone for the conference by presenting a multi-factorial model of female-to-male gender variance and pointing out that gender variability is not prima facie evidence for psychopathology, but can be a healthy adjustment to restrictive gender roles. Dr. Devor brought many attendees to their feet when she called for HBIGDA to acknowledge and serve the many kinds of gender-variant people rather than dividing the world into transsexuals and nontranssexuals (Denny, 1997).
The session was a game-changer. Williams talked about transgender and two-spirit roles in North American First People cultures. Both he and Devor were coloring broadly outside the familiar medical model, exposing many HBIGDA members for the first time to alternate models of gender identity and expression. I watched the resulting buzz as many members starting thinking outside the binary for the first time, realizing that transgender expression can take many forms.
After this plenary, the talk was all about continuity and variability; the transgender revolution had finally come home to roost at HBIGDA. There were a few dour faces, which was only to be expected: HBIGDA’s world had just turned upside down. One member suggested that if there is nothing wrong with transsexuals, the organization simply disband (Denny, 1997).
I had the opportunity to address the entire assemblage at the Saturday plenary:
I noted that the change of viewpoint means that the organization is needed more than ever before; if it concerns itself with the use of medical technology to transform human bodies rather than the perhaps artificial notion of transsexualism, it will reach people, like heterosexual crossdressers, some of whom do the same things to their bodies as transsexuals, but have heretofor escaped the safety web cast by HBIGDA because they are not “transsexual” (Denny, 1997).
On Saturday afternoon Dr. Stephen Levine presented his committee’s work on a revision of the Standards of Care to the assembled members. The proposed Standards discarded numbered Standards and Principles in favor of a descriptive prose style. I liked that. Unfortunately, the committee also added additional restrictions for hormonal therapy, calling for a period of either psychotherapy or real-life experience before initiation of hormonal therapy in addition to the 90-day evaluation period that had been in effect since 1979. When that restriction appeared in Version 5 of the Standards, I resigned from HBIGDA in protest.
The 1998 Standards Committee had one transsexual member: Maxine Petersen, of what was then the Clarke Institute of Psychiatry in Toronto. After Vancouver, Jamison Green, Anne Lawrence, and I were appointed as advisers to the committee. This came about, no doubt, because of audience input at Dr. Levine’s session. When questions were asked about parity for female-to-male transsexuals in the standards, an obviously frustrated Levine told one of the questioners—Jamison Green—he was in charge of making that happen.
A Change in Terminology
At the Vancouver symposium Jamison Green and I, in co-presenting a paper, criticized certain descriptive terms used by professionals to refer to transsexuals—for instance, male transsexual to refer to transsexual women and female transsexual to refer to transsexual men. After our presentation Dr. Ira B. Pauly, a respected psychiatrist who was a contributor to both Green and Money’s 1969 Transsexualism and Sex Reassignment and my 1998 Current Concepts in Transgender Identity asked us, “What do you want us to call you?”
We told him we weren’t prepared to unilaterally answer that and promised to consult the community. And we did.
Two years later, at the 1999 HBIGDA symposium in Galveston, Jamison presented the results of a survey he and I did with Dr. Jason Cromwell, in which 134 transsexual and transgendered people indicated which descriptive terms they liked and which they didn’t.
Jamison told me our paper was well-received; after the session, he said, some presenters actually changed their slides, penciling in terms we suggested to replace terms our respondents had found offensive. Thanks to HBIGDA members, the usage our respondents found offensive is functionally extinct today.
A New Journal
A part of the change at HBIGDA was a new focus on nontranssexual transgendered people. Previously, the organization’s attention had been exclusively on transsexualism. Now HBIGDA recognized the community’s diversity and began to take steps to address it.
One of those steps was the creation of a professional journal. Drs. Eli Coleman and Walter Bockting were primarily responsible for the title—The International Journal of Transgenderism. They had been using the term transgender for years at their Program for Human Sexuality at the University of Minnesota. PHS had taken an early lead in presenting its clients with a variety of lifestyle and identity options at a time when other centers were fast-tracking selected transsexuals for surgery and rejecting everyone else.
Launched in 1997, IJT provided HBIGDA with a much-needed peer-reviewed scholarly journal. The journal was initially edited by Drs. Friedemann Pfafflin, Eli Coleman, Walter Bockting, Richard Ekins, and Dave King; today Bockting is the editor.
IJT provided an alternative to the already extant Archives of Sexual Behavior. Archives was founded in 1971 by Dr. Richard Green, who was editor until his resignation in 2001. Archives is a peer-reviewed general sexuality journal, now edited by Dr. Kenneth Zucker, who is considered a reactionary by some because he continues to do reparative therapy with gender-variant children. IJT provided an alternative to Archives, which was firmly ground in the medical model and devoted only a fraction of its content to transsexualism. IJT is today, in my opinion, the definitive journal for scientific papers about gender identity and expression.
HBIGDA to WPATH
HBIGDA’s new name. World Professional Association for Transgender Health, adopted in 2006, reflected the focus and interest of the organization. Gone was the term gender dysphoria, replaced by transgender and health.
The name change wasn’t without controversy. Former HBIGDA president Richard Green, a psychiatrist with new credentials in jurisprudence, threatened to sue the organization for not following voting procedures. [12] I’m not sure of Dr. Green’s reasons, but I suspect they had to do with the removal of Harry Benjamin from the organization’s name. It was indeed unfortunate Dr. Benjamin’s name was removed, but I think leaving it in would have resulted in an awkward and less effectual name. The new name symbolizes HBIGDA’s reincarnation as an organization devoted to the health and well-being of all gender-variant people.
WPATH Atlanta, 2011
WPATH’s symposium in Atlanta in September 2011 revealed an organzation in its maturity. I don’t know the number of attendees, but I’m guess there were more than 500. The programming was exciting and there were lots of fresh faces in the membership and presenting papers.
The WPATH meeting was held concurrently with the Southern Comfort conference and the annual meeting of the Gay and Lesbian Association. It was easy to travel from one hotel to another, and many attendees registered for two or all three conventions.
At a town hall meeting at Southern Comfort held Thursday, 22 September, outgoing President Walter Bockting, incoming President Lin Fraser, and incoming President-Elect Jamison Green previewed a new revision of the Standards of Care, which were released as on Sunday.
The new standards—version 7—are a dramatic and wonderful departure from versions 1-6. They reduce gatekeeping, focusing instead upon informed consent and wellness. They’re not yet perfect, but according to Drs. Bockting, Fraser, and Green, revisions will be forthcoming at a much faster rate.
Inclusion
The most dramatic change at WPATH has been the ascendancy of transsexual and other transgendered people in the organization and especially on the board of directors. Marsha Botzer and Jamison Green are currently serving on the board, and Jamison is President-Elect. He will be WPATH’s second transsexual president; Stephen Whittle served from 2007-2009.
You know, I think it’s time I rejoined!
[1] The medical model assumes that transsexualism is a form of mental illness. Since it cannot be cured, the best medical science has to offer is palliative care—sex reassignment— which serves to allieviate the suffering of those with the illness. For further discussion, see Cole et al., 2000. [2] Without the work of sociologist Aaron Devor, Erickson’s contributions would most likely have been lost to history. My paragraph on Erickson is based on Devor’s web page at http://web.uvic.ca/~erick123/. [3] Benjamin was a German immigrant to the United Stateswho worked extensively with transsexuals from the 1950s on. His 1966 The Transsexual Phenomenon described the syndrome of transsexualism and argued for sex reassignment in selective cases. See the Chrysalis Quarterly Glossary on this website for Harry Benjamin’s bio. [4] See the Chrysalis Quarterly Glossary for Paul Walker’s bio. [5] For a brief discussion of the Standards of Care and access to their texts, see the Chrysalis Quarterly Glossary. [6] Anthropologist Anne Bolin once showed me a paper rejected by a professional journal. One of the reviewers had scrawled on the cover page, “Obviously a transsexual.” This meant, of course, that since Dr. Bolin was presumably transsexual she couldn’t possibly have anything relevant to say about transsexualism. Although Anne plays with her gender presentation as a female bodybuilder, she is not to the best of my knowledge transsexual. [7] Virginia Prince was a notable exception. In the 1950s and 1960s she alone and with Peter Bentley published articles in journals like Sexology, The Journal of Sex Research, The American Journal of Psychotherapy, and Journal of Abnormal Psychiatry. In 1973 she gave a paper at the Second International Symposium on Gender Dysphoria Syndrome inPalo Alto, CA. [8] See the accompanying article on transsexual and transgendered scholars and artists. [9] For a biography of Jude Patton, See the Chrysalis Quarterly Glossary. [10] The Clarke Institute of Psychiatry is now called The Centre for Addiction and Mental Health. Canadian transsexuals referred to it, with some justification, as “The Jurassic Clarke.” References Benjamin, Harry. (1966). The transsexual phenomenon: A scientific report on transsexualism and sex conversion in the human male and female.New York: Julian Press. Cole, S.S., Denny, D., Eyler, A.E., & Samons, S. (2000). Diversity in gender identity: Issues of transgender. In L. Szuchman & F. Muscarella (Eds.), The psychological science of sexuality, pp. 149-195. New York: John Wiley & Sons, Inc. Cromwell, J., Green, J., & Denny, D. (2001). The language of gender variance. Paper presented at the XXIV Harry Benjamin International Symposium on Gender Gender Dysphoria, Galveston, TX, 31 October – 3 November, 2001. Denny, D. (1992). The politics of diagnosis and a diagnosis of politics: The university-affiliated gender clinics, and how they failed to meet the needs of transsexual people. Chrysalis Quarterly, 1(3), 9-20. Reprinted in Transgender Tapestry, Summer, 2002, 1(98), 17-27. Denny, D. (1995, Spring). Writing ourselves. TransSisters: The Journal of Transsexual Feminism, 38-39. Dallas D. (1997, October). XV HBIGDA conference highlights. AEGIS News, (1)12, pp. 1-2. Denny, D. (Ed.). (1998). Preface. Current concepts in transgender identity, xv. New York: Garland Publishers. Devor, H. (1997). A social context for gender dysphoria. Paper presented at the XV Harry Benjamin International Gender Dysphoria Association Symposium: The State of Our Art and the State of Our Science, Vancouver, British Columbia, Canada, 10-13 September, 1997. Green, R., & Money, J. (Eds.). (1969). Transsexualism and sex reassignment. Baltimore: The Johns Hopkins University Press. Green, R. (1998). Conclusion to Transsexualism and sex reassignment: Reflections at 25 years. In D. Denny (Ed.), Current concepts in transgender identity, pp. 419-423. New York: Garland Publishing. Laub, D.R., & Fisk, N. 1974. A rehabilitation program for gender dysphoria syndrome by surgical sex change. Plastic and Reconstructive Surgery, 53, p. 388. Money, J., & Primrose, C. 1968. Sexual dimorphism and dissociation in the psychology of male transsexuals. The Journal of Nervous and Mental Disease, 147, p. 472. Prince, C.V. (1957). Homosexuality, transvestism and transsexualism: Reflections on their etiology and differentiation. American Journal of Psychotherapy, 11, 80-85. (This is so far as I’ve been able to tell Prince’s first article in the professional literature. But note the initial C. I suspect C. stands for Charles, her pseudonymous male name.) Rudacille, D. (2005). The riddle of gender: Science, activism, and transgender rights. Pantheon. Williams, W. (1997). Two-spirit gender variant roles in Native American, Polynesian, and Southeast Asian cultures. Paper presented at the XV Harry Benjamin International Gender Dysphoria Association Symposium: The State of Our Art and the State of Our Science, Vancouver, British Columbia, Canada, 10-13 September, 1997.
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