GID In Relation to Handicap and Disability (1993)

 

By Dallas Denny

 For Dr. Roger Weed

CPS 842

Georgia State University

14 December, 1993

 

In December, 1952, Americans became aware for the first time of an astonishing new possibility. Newspapers revealed that a young woman called Christine Jorgensen had once been a man named George (New York Daily News, 1952). A team of physicians in Denmark, led by Dr. Christian Hamburger, had given Jorgensen hormonal and surgical treatments to change his genitalia and secondary sex characteristics to approximate as closely as possible those of a female (Bullough & Bullough, 1993; Hamburger, et al., 1953a, 1953b).

Jorgensen suffered from a condition clinically called gender identity disorder (G.I.D.)– an unhappiness in her assigned gender. Her desire to change her social role and body to that of the other sex has come to be known as transsexualism– but the term, although extant since at least 1949, did not come into popular usage until 1966, with the publication of Dr. Harry Benjamin’s The Transsexual Phenomenon.

Transsexualism is a longstanding dissatisfaction with the gender role assigned at birth and the desire to live in the role ordinarily associated with the other gender (DSM III-R). Since Jorgensen’s time, an increasing number of American men and women with transsexualism have sought hormonal and surgical sex reassignment, and sex reassignment has come to be considered the treatment of choice for men and women who persistently request it (Lundstrom, Pauly, & Walinder, 1984).

Transsexual persons have habilitative and rehabilitative needs which extend well beyond the medical center. Fifty years after the Jorgensen headlines, discrimination is rampant, and many transsexual persons have trouble finding and keeping employment, housing, and social services (Sorenson, 1981a, 1981b). In childhood, they are often teased by their peers because of appearance or behavior which deviates from the norm (Green, 1974). As adolescents and adults trying to come to terms with their desire to live in the other gender, they are often alienated from their families, churches, schools, and other traditional sources of support. Helping professionals like school counselors, psychologists, ministers, and family physicians are usually at a loss when asked for assistance, and surprisingly often, can be actively hostile (cf McHugh, 1992; Michaud & Bold, 1979). Even those who have been living productively for years or decades in the new gender are not exempt from public exposure and discrimination. For example, Carolyn Cossey, a successful British model and actress, was brutally “outed” by the British Tabloid News of the World in the mid-1980s, with subsequent loss of income (Cossey, 1992). More recently, a woman who was running for public office in Colorado, went public after learning that her opponents planned to reveal that she had had transsexual surgery some twenty years previously (Sinclair, 1993a).

 

Civil Status

The legal rights of persons with G.I.D. can vary from country to country, and even from state to state. Post-operative transsexual persons can legally marry in most of the states, for instance (provided they reveal their status to their partner before marriage), but they may not marry in Great Britain (Elizabeth, 1990) or Texas (Frye & Meiselman, 2001). Both Mark Rees, a man who was once a woman, and the above-mentioned Carolyn Cossey, in efforts to obtain the right to marry, have taken their cases, without success, to the European Commission on Human Rights and the European Court of Human Rights (Cossey, 1992; Rees, 1985). Cossey has subsequently moved to the United States, and Rees has become involved in Press for Change, a Political Action Group which lobbies for the rights of transsexual persons in England.

Some states will allow post-operative transsexual persons to establish a legal identity in the new gender, facilitating this by a new birth certificate. Other states will amend the birth certificate, but Alabama, Florida, Idaho, Ohio, and Tennessee will neither issue a new certificate nor amend the old one. In fact, Ohio and Tennessee have passed legislation which expressly forbid the change of the birth certificate in the case of transsexualism. This can make it difficult for the individual to obtain legal documents in the new identity. Name change is possible in all fifty states, and can be accomplished either by simply taking the new name or by court action; nonetheless, some judges have refused to grant name changes to transsexual persons on the grounds they objected to the individual’s sex reassignment. Such attitudes are not common to judges; Green, et al. (1969), found a large percentage of the physicians they surveyed were opposed to sex reassignment, even when a psychiatrist indicated an individual would very likely kill himself without such treatment. Attitudes of helping professionals have changed somewhat for the better since Green et al.’s survey, (cf Franzini & Casinelli, 1986), but much misunderstanding and prejudice remains.

 

U.S. Military

The U.S. military, which until after World War II periodically held large drag shows in which servicemen were sometimes required to crossdress, will not allow transsexual persons to serve as enlisted persons or as officers. The mere revelation of transsexual feelings in a person who does not plan to pursue sex reassignment or simply being observed crossdressed off duty (even in an individual without gender dysphoria) can result in dishonorable discharge. The situation is similar to that with gay men and lesbians in that while there is an official policy of zero tolerance [1], superiors often look the other way until the matter becomes public. Recently, for example, Kaycee Donovan was discharged from the Air National Guard after reporting in a woman’s uniform after having sex reassignment surgery (Sinclair, 1993b). Her superiors reportedly knew of her sex reassignment but didn’t take action until she showed up in her new identity. Similarly, Joanna Clark resigned after a distinguished seventeen-year career in the Navy and Naval Reserve as a man, and several years later joined the Air Force Reserve as a woman. She was discharged after twenty-two months of exemplary service, when her transsexual status became known, She sued for the right to serve (Clark v. United States, 1980). Her case was settled before going to court, but similar suits by other transsexual persons have been unsuccessful (cf Leyland v. Orr, et al., 1987).

Even being in a relationship with a transsexual person can end a military career. Marie Von Hoffburg, a genetic female, was dishonorably discharged for being married to a female-to-male transsexual person (Von Hoffburg, v. Alexander, cited in Elizabeth, 1990).

 

Employment in the Civil Sector

Title VII of The Civil Rights Act of 1964, amended by the Equal Opportunity Act of 1972 (42 U.S.C. s. 2000 et. seq., (Supp. III, 1973), prohibits employment discrimination based on race, color, religion, sex, or national origin (Elizabeth, 1990). A variety of courts have ruled that Title VII does not apply to transsexual persons; that is, it protects women, and it protects men, but it does not protect transsexuals. The most notable case was that of Karen Ulane, a pilot for United Airlines, who was fired after having sex reassignment surgery (Cotton, 1986). The U.S. District Court ordered her reinstated with back pay, but the decision was overturned by the Seventh Circuit Court, and the U.S. Supreme court denied certiori (i.e., refused to hear the case).

If transsexual persons have been denied protection under Title VII, they are specifically excluded from protection under the Americans with Disabilities Act of 1990. An amendment sponsored by Senator Armstrong of Colorado denies protection to transsexual persons, lumping them with transvestites, homosexuals, and pedophiles (Health Law Committee, 1992).

 

Transsexualism as Handicap and Disability

Is transsexualism a handicap? If having a handicap means that one of more of one’s life activities are substantially limited, then certainly transsexualism, which can result in estrangement from family, divorce, court-enforced separation from minor children, loss of employment, public humiliation, and general rejection by society, can be a handicap. And yet some transsexual persons report little or no limitation of their life’s activities, or even increased functionality after sex reassignment; this has also been noted in the literature (Fisk, 1978). Some successful transsexual persons manage by hiding their transsexualism, both on the front end, by constructing an appearance that does not differ appreciably from the norm of their original gender, and after sex reassignment, when they blend successfully into society. But others are “out” about their transsexualism, and report few problems; Caroline Cossey, is successful, for instance, even though her transsexuals status is widely known (Cossey, 1992). Success under these conditions is no doubt due to the increasing familiarity of the American public with transsexualism and may be a reflection of an increasing willingness of Americans to tolerate diversity. Reactions vary widely (and largely unpredictably), but in some cases, transsexual persons who are open with their condition do not have their life activities substantially limited, and so are not handicapped. Others have their life activities limited by external forces such as neighbors who harass them and community leaders who are openly hostile to them. Yet others are limited by internal factors secondary to their transsexualism, such as anxiety, guilt, or justifiable fear of social sanction. Those whose life activites are limited by their transsexualism can be said to be handicapped.

Is transsexualism a disability? Certainly, it has been considered to be a mental disorder by the American Psychiatric Association since 1980, when it was included in the DSM III (coincidentally, at the same time as homosexuality was removed as a mental disorder). It is a condition with a specified course of medical treatment (hormonal therapy and genital surgery), and there is a professional organization which has published Standards of Care for this treatment, the Harry Benjamin International Gender Dysphoria Association, Inc. (Walker, et al., 1985). There is a voluminous scientific literature with hundreds of studies of etiology, prevalence, treatment methods, and outcome (Denny, in press). Hormonal and surgical treatments are no longer experimental, having been performed on tens of thousands of persons. And yet most insurance companies specifically exclude surgical treatment of transsexualism from coverage, and the Internal Revenue Service will not allow deductions for medical expenses related to transsexualism (Elizabeth, 1990).

Many transsexual persons report depression, poor emotional adjustment, poor employment history, difficulty in beginning and maintaining relationships, self-injurious behavior (including substance abuse) and other dysfunctionalities (Money & Walker, 1979). In fact, early workers considered such poor adjustment to be a sign of “true” transsexualism, and turned better-adjusted people away without treatment (cf Denny, 1992, 1993). Researchers and clinicians are beginning to realize many transsexual persons function at high levels, both interpersonally and vocationally, and, in fact, good adjustment is a positive factor in prediction of success in sex reassignment (Brown, 1990; Gilbert, 1992). There is a corresponding realization that those who exhibit poor adjustment before sex reassignment do not find a magic cure for everything that ails them. In fact, many transsexual persons who undergo sex reassignment may end up less functional than before because of peculiar appearance in the new gender role. It is not uncommon for a man, employed, married with children, and popular, to end up after sex reassignment, alone and unemployed, afraid to go out in public in the new gender role (Blanchard, 1985). Those who are not disabled by their transsexualism have better prognoses and are less in need of rehabilitative services.

In Western society, transsexualism is a condition which has come, since 1952, to be defined in terms of its medical treatment. And yet, before 1952, there were certainly transsexual persons, even though medical treatment was not available– in fact, it was not even sought, as there was no general realization that sex reassignment was possible. Bullough & Bullough (1993) and Green (1969) provide evidence throughout recorded history of men and women we would now call transsexual; even without benefit of medical treatment, these men and women lived in the gender role opposite that assigned at birth (see also Money, 1992).

Many other cultures have institutionalized social roles for transgendered persons. Ford & Beach (1951) found some form of institutionalized “homosexuality” in 49 of 76 (64%) of the cultures they surveyed. The most common form was the berdache tradition, in which a male “dresses like a woman, performs women’s tasks, and adopts some aspects of the feminine role in sexual behavior with male partners. Less frequently a woman dresses like a man and seeks to adopt the male sex role” (p. 130).

Despite increasing acceptance, transsexualism is a condition in which individuals who are physically and emotionally capable of working and who have been productive, useful employees often find themselves out of a job simply because of their public expression of their gender identity. Whether or not they are disabled, whether or not they are handicapped, society treats transsexual people as if they were, and then denies them the services ordinarily offered to handicapped and disabled individuals. They have the disadvantages of being stigmatized by a DSM diagnosis which labels them as mentally disordered, and yet they are exempt from protection under the Civil Rights Act of 1964 and the Americans With Disabilities Act of 1990.

This unusual status has occurred because transsexual people have had no advocates, and have been unable or unwilling to serve as self-advocates. However, this decade has seen the birth of the radical transsexual left, which picketed the American Psychiatric Association national convention in San Francisco in May, 1993; the emergence of “out” transsexual psychiatrists, psychologists, and attorneys who are transsexual; and the formation, in Great Britain, of the first Political Action Committee for transsexual persons. Increased political activity may result in political change, just as has begun to happen with gay men and lesbians. Until then, however, transsexual persons are officially disabled, but officially not handicapped.

 

Note

 

[1] “Enlistment of transsexuals would not be in the best interest of the individual or the military service. Transsexuals are not considered psychologically or sociologically suited for military service, and they require continuing sophisticated medical care because of the absence of organs and glands normally present in an individual at birth” (Letter from Department of the Army to Joanna M. Clark, dated 21 December, 1978). The official reason is because of “Major abnormalities and defects of the genitalia such as a change of sex, a history thereof, or complications (adhesions, disfiguring scars, etc.) residual to surgical correction of these conditions.” (Air Force AR 40-501,

Chapter 2, Section IX, paragraph 2-14s). Information from this note taken from Elizabeth (1990).

 

References

 

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