In Search of the “True” Transsexual (1996)
©1996, 2013 by Dallas Denny
Source: Denny, Dallas. (1996). In search of the “true” transsexual. Chrysalis: The Journal of Transgressive Gender Identities, 2(3), pp. 39-44.
Q: What’s the difference between a terrorist and a transsexual?
A: You can always negotiate with a terrorist.
— Transgender Community Joke
In Search of the “True” Transsexual
By Dallas Denny
Preface
I grew up knowing I was different from all the other little boys. My parents bought me trucks and sports stuff but I desperately wanted to play with dolls. I loved dressing up in my mother’s wigs and hats. My family thought I’d grow out of it. When I was five, I really hated being a boy. I was mad that I couldn’t wear dresses or play with dolls.
When people would come over, I’d want to brush their hair. By age seven, I’d stay home when my family went out and raid my mom’s closet. I’d cry myself to sleep, praying that I’d wake up a girl. It was awful.
The above is a composite taken from the tabloid Weekly World News, which frequently features sex -change stories. It certainly bears little resemblance to my story, or the stories of many other transsexuals. I have no recollection of wanting to be a girl before about age eleven or twelve. I didn’t particularly want to be a girl, or think I was one, when I was a small child. I didn’t play with dolls, but rather liked my guns and trucks. I didn’t look naturally like a girl; I had to work at it. I never attempted suicide, or even seriously considered it. I didn’t particularly hate my genitals, although I found them inappropriate. I was attracted to women, and rarely to males. All in all, I have little in common with the transsexuals in the articles from which I constructed the composite. And yet I am years post-transition and post-surgery, passable, with no regrets, and one of the individuals on which the above composite was based has stated that she made a terrible mistake.
What is a “true” transsexual? Does anyone really know? Is there some sort of specialness about “real” transsexuals which differentiates them from others who merely change their sex? Was transsexualism discovered, or invented? Is it a condition of ancient origin, or as Sandy Stone (1991) has implied, an identity, a script which can be learned, studied, and conformed to? (Ed.)
Although transsexualism and crossdressing have been widely viewed as mental disorders in contemporary Western society, transgendered (i.e., transgressively gendered, what we might today call transsexual or crossdressing) people in any number of cultures other than our own have filled established social roles in which they were viewed sometimes with scorn, sometimes with awe and respect, and sometimes with a mixture of emotions— but not as mentally ill or perverted. Evidence of this can be found in sources as scattered as a seventeenth -century sketch by Theodor de Vrie (reproduced in Williams, 1986), which shows transgendered Tinemuca Indians serving as stretcher bearers; a historical study by Roscoe (1994), in which he shows that emasculated gallae served as priestesses of the goddess Magna Mater throughout the Middle East and Eastern Europe; a Paleolithic cave drawing of a transgendered shaman (Dragoin, 1995); and cross-cultural (Nanda, 1989, 1994) and historical (Roscoe, 1990; Williams, 1986) studies.
In Western societies, transgendered persons have not fared well since their socially accepted roles were repressed by early Christians and others (Bullough & Bullough, 1993; Roscoe, 1994). For two thousand years, crossdressing has frequently resulted in prosecution, persecution, and even execution (Bullough & Bullough, 1993). With a few notable public exceptions such as the Chevalier d’Eon (Kates, 1995), those with transgender natures either lived quietly and probably unhappily in the gender and clothing of original assignment or as “passing men and women” (Dekker & van de Pol, 1989). Only in the past several decades have transgendered persons felt free to crossdress or crosslive openly, but even in the 1990s it can be dangerous and even fatal to do so (cf Minkowitz, 1994; Bowles, 1996).
In the nineteenth century, transgendered persons began to come under the scrutiny of Western science; they and homosexuals were initially characterized as “sexual inverts” (Uhlrichs, 1994). As Richard Ekins points out (1993), transgendered persons were not adequately differentiated from homosexuals until early in this century (Hirschfeld, 1910), and it was not until 1953, when details of Christine Jorgensen’s case were published in The Journal of the American Medical Association, that transsexualism was defined as a clinically diagnosable “syndrome” (Hamburger, Stump, & Dahl-Iversen, 1953).
The publication of Benjamin’s book The Transsexual Phenomenon in 1966 legitimized the mid-twentieth century category and identity of transsexualism, in which individuals with a presumed mental disorder called (at least initially) transsexualism use or wish to use medical technologies in order to change their bodies to resemble those of the other sex. [1] Within this framework, sex reassignment came to be seen not as an option that a reasonable individual might choose in order to have a body and gender role more to his or her liking, but rather as a medical treatment, a way to give relief to the suffering of the individual by altering the body because he or she had a mental condition which could not be “cured” by psychotherapy or other traditional means. Even those who dissented did not argue that transsexuals did not have a mental disorder. Their disagreement was in regard to the use of medical technology to modify the body. They contended that the proper way to treat a mental illness was by altering the mind, and not the body; they considered sex reassignment “collusion with delusion” or “collaboration with psychosis,” and argued against it (cf Ostow, 1953; Socarides, 1976; and Wiedeman, 1953).
Considering that the initial center of academic interest in the United States was Johns Hopkins Hospital, where John Money had been working with intersexed persons since the 1950’s (Money, 1991), it is not surprising that the treatment system which arose to meet the needs of transsexual persons and the concomitant terminology which arose to describe them followed this medical model. Under the medical model, transsexual people became not merely presumably competent individuals who sought medical intervention to change aspects of their bodies and social roles which displeased them, but, because of the clinical and general societal zeitgeists of the time, patients with a mental disorder; it was incumbent upon medical and psychological caregivers to determine who would and would not benefit from sex reassignment, in which the individual’s body, behavior, and social role were modified as much as was feasible to mimic that of the other sex.
In Transsexualism and Sex Reassignment (1969), Richard Green and John Money of Johns Hopkins presented a variety of clinical perspectives on the phenomenon of sex reassignment. A number of viewpoints were represented in their book, but later clinicians and researchers narrowed rather than expanded Green & Money’s focus, with the result that the literature came to consist almost solely of papers based on the medical model; other viewpoints rarely if ever made it into print.
During the 1960’s and 1970’s, the process of sex reassignment was viewed as fraught with peril, and was considered best done in a highly restrictive setting under the guidance of an interdisciplinary team which made treatment decisions in the supposed best interest of the patient (Lothstein, 1979a). In actuality, these teams usually actively dissuaded individuals— and especially those who did not fit the characteristics of transsexual people as depicted in the emerging literature— from pursuing sex reassignment; only those most persistent and who most closely fit the clinics’ models of what a transsexual was were offered sex reassignment (Denny, 1992). To this day, many gender clinics continue to place needless and often sexist (Bolin, 1984) requirements on their patients. In a survey of gender programs, Petersen & Dickey (1995) found that some clinics still withhold hormonal and surgical procedures for such things as the “wrong” (i.e. post-transition gay or lesbian) sexual orientation; for inability or unwillingness to pass as a nontranssexual member of the nonnatal sex; and for refusal to adopt a stereotypical cross-gender role and mode of dress (i.e., those who fail the “Barbie” and “Ken” tests). Not uncommonly, all treatment is withheld if the individual does not desire (or profess to desire) surgical sex reassignment (SRS) (cf Dickey, 1990)— this despite the commonly acknowledged fact that most transsexual people who transition (i.e., permanently cross gender roles) never, for one reason or another, have surgery.
In 1979, the Harry Benjamin International Gender Dysphoria Association (HBIGDA) put into place minimal Standards of Care for hormonal and surgical sex reassignment (Walker, et al.,1984). Standardization of treatment was in fact badly needed, but the Standards of Care placed mental health professionals in the unenviable position of having the ultimate say-so about whether the applicant for sex reassignment procedures actually obtained them. A number of writers (Bolin, 1988; Denny, 1992; Kessler & McKenna, 1978; Stone, 1991) have commented on the unfortunate effect this “gatekeeping” function has had on the therapeutic relationship. The power dynamics inherent when one party (the transsexual) is dependent upon “permission” from another (the therapist) for a highly desired commodity (medical treatment) is hardly conducive to honest communication. The therapist may use this access as a tool for motivating the transsexual client to deal with other issues or to entice the client into continuing with therapy. The client, on the other hand, will say or do whatever he or she thinks will maximize the chance of obtaining permission for hormonal therapy and surgery.
In my earlier examination of the literature (Denny, 1994), I was struck by the fact that it reflected a curious tunnel-blindness. Despite the fact that as early as 1978, studies by sociologists and anthropologists clearly indicated problems with the medical model (Kessler & McKenna, 1978), the model itself has never been never seriously questioned by clinicians. Nor have clinicians, before this decade at least, seemed to really listen to the things transsexual people have been telling them about their lives— their sexuality, their developmental histories, their views of masculinity and femininity (see Devor,1994, for some interesting data on transgender sexuality which arose from a sociological study). No one seriously questioned a literature which depicted transsexual people in various unflattering ways which were in actuality reflections of the power struggle which centered around access to medical technology: as untrustworthy and manipulative (Stone, 1977), as inventing their early histories (Knorr, Wolf, & Meyer, 1968), as having highly stereotyped notions of masculinity and femininity (Althof & Keller, 1980; Kando, 1973), as having various characterological and personality disorders (Levine & Lothstein, 1981; Lothstein, 1983), and even as having a propensity for violence (Lothstein, 1979b) and murder (Milliken, 1982). Baker (1969) characterized much of what was said in the literature about transsexual people as “psychiatric name-calling.” I myself have noted that the literature is “full of countertransference, which surfaces as namecalling, inaccuracy, misperceptions, opinion posing as fact, humor at the expense of transsexual people, and perhaps even some lies” (Denny, 1993).
Not surprisingly, it was not until someone not directly involved in the patient/caregiver cycle took a careful look at transsexualism that this clinical microcosm was put into perspective. Anne Bolin, a cultural anthropologist, building upon the theories and observations of Kessler & McKenna (1978), studied a group of transsexual women outside the clinical setting. Her doctoral thesis, which was published in 1988 with the title In Search of Eve: Transexual Rites of Passage, was a participant- observation study of a small group of transsexual women in a city in the Midwest.
Bolin found that many of the clinical truisms did not apply to her subjects. They did not, for instance, have highly stereotyped and exaggerated feminine appearance, as had been widely reported (cf Althof & Keller, 1980; Kando, 1973). Instead, Bolin found a diversity of personal styles and sexual orientations which paralleled those of a group of nontranssexual women.
But Bolin’s most important contribution was her analysis of the client-caregiver interaction. She confirmed the findings of Kessler & McKenna (1978) that the cultural assumptions of caregivers affected the way they viewed and reacted toward their transsexual clients. Bolin charged that:
… inherent in the Standards of Care and in the policy relations of caretaker to client is an inequity in power relations such that the recommendation for surgery is completely dependent on the caretaker’s evaluation. This results in a situation in which the psychological evaluation may be, and often is, wielded like a club over the head of the transsexual who so desperately wants the surgery. Such power dynamics often breed hostility on the part of transsexual clients. (p. 51).
The imbalance of power germane to transsexual-caretaker interaction along with transsexual resentment of psychiatric classification as a mental illness has culminated in transsexual hostility and distrust towards caretakers, particularly psychiatrists. Such feelings unfortunately override, and in some ways offset the great concern and advocacy efforts of many psychiatrists and psychologists. (p. 55).
Bolin’s work has had little direct impact on the clinical literature, which continues to rely heavily upon a pathology model. However, by placing the clinical literature in context, she has had an immense impact by pointing out that there are alternative ways to view it. Consequently, to many clinicians, researchers, and transsexual people themselves, much of the clinical literature of the sixties, seventies, and eighties is colored by unfair and untrue assumptions about the nature of transsexual people; by power dynamics in the treatment settings which generated the literature; and by selection criteria which washed out all subjects except the ones who filled the expectations of the authors (Denny, 1992).
Science lurches drunkenly onwards, often stumbling, sometimes heading in the wrong direction, but always moving forward. The literature of transsexualism and crossdressing has slowly begun to reflect changing ideas about the nature of transgendered persons. The ideas of social constructionists, who believe transsexualism is an invention rather than a discovery (see Birrell & Cole, 1990; Ekins & King, 1995; Hubbard, in press); the criticisms of Janice Raymond (1979, 1994); and most importantly, the emerging voices of transsexual and transgendered scholars (see Boswell, Cromwell, Denny, and J. Green, in press) have resulted in a new zeitgeist, a paradigm shift, if you will, much as happened with homosexuality (Bayer, 1987). As gay men and lesbians have assumed prestigious roles in politics, business, and science with no objective evidence of dysfunction, it has become impossible to portray them as pathetic and mentally ill. Those, like Charles Socarides, who continue to maintain against all reason that homosexuals are seriously disturbed, begin to look seriously disturbed themselves (Socarides, 1996). Similarly, it is becoming increasingly difficult to discount or pathologize transsexuals as they— I should say we— begin the same slow climb to social equality.
In dealing with my own transsexualism, and in working with hundreds of other transsexual people, it has become clear to me that transsexualism, as conceptualized by Benjamin (1966), is an invented way of looking at a much larger transgender phenomenon, and that the process of sex reassignment, as outlined in Green & Money’s 1969 Transsexualism and Sex Reassignment, is but one way of dealing with that phenomenon. Transsexualism has a set of convenient diagnostic characteristics and its treatment (sex reassignment) gives only two choices: remaining in the sex of original assignment or doing everything possible to “change one’s sex.” There is no middle ground.
The Medical Model
Clinicians from Benjamin onward have noticed that transsexual people are a diverse lot and have looked for ways to distinguish between types. Most commonly, they have differentiated between primary and secondary transsexualism. The fictitious transsexual at the start of this article would meet the criteria for what has been called in the clinical literature primary transsexualism (Person & Ovesey, 1979a). Secondary transsexuals were considered to be those who gradually develop a transsexual identity in adulthood, after a period of fetishistic crossdressing” (Person & Ovesey, 1979b). Primary transsexuals were attracted to males as sexual partners; secondary transsexuals had a heterosexual history and had often been married and had children. Clinical wisdom held that primary transsexuals were more “naturally feminine” than secondary transsexuals, and made better candidates for sex reassignment (Stoller, 1975). Consequently, those who presented with histories suggestive of primary transsexualism were more likely to be accepted by gender programs than others, as they were considered to be more likely to have successful postsurgical adjustment.
Although men and women had been slipping “across the sex border” (Turtle, 1963) since time immemorial, transsexualism as we know it began only in the 1950’s, after the news of Christine Jorgensen’s sex reassignment rocked the world. Suddenly, people realized, it was possible to “change sex.” Large numbers of men and women began to approach medical professionals, requesting medical treatment to do just that. Before, most had known only that something was going on within themselves, but they had no name for their problem; now, there was a new script to follow, and many auditioned for the part.
The publication, in 1966, of Harry Benjamin’s The Transsexual Phenomenon formally codified the “syndrome” and its method of treatment:
There is hardly a person so constantly unhappy (before sex change) as the transsexual. Only for short periods of his (or her) life, such as those rare moments of hope when a conversion operation seems attainable or when, successfully assuming the identity of a woman in name, dress and social acceptance, is he able to forget his misery (Benjamin, 1966, p. 66).
Benjamin saw relief for this unhappiness in medical intervention:
Now, it is possible for this desperate human being to be helped. Through surgery and hormonal techniques, transsexuals can be transformed into normally functioning members of the opposite sex. Dr. Harry Benjamin, long-recognized as an expert on sexology and a leader in transsexual treatment, tells you how it can be done (Benjamin, 1966, endplate).
But sex reassignment, as it came to be called, was only for those patients who had been appropriately evaluated, who were mentally stable, and who could pass in the new gender— and, most importantly, for those who were terribly unhappy (pp. 136-137). After surgery, the presumption was one “was” a woman or man, and life would be fabulously improved:
I have found happiness that I never dreamed possible. I adore being a girl and I would go thru 10 operations, if I had to, to be what I am now. A girl’s life is so wonderful. The whole world looks so beautifully different (“H,” in Benjamin, 1966, p. 85).
For transsexual people, this process had come to represent the only possible way of achieving happiness. One had but one real choice: to make an 180° change from man to woman, or from woman to man. If one did, if one was “really” transsexual, then everything was fine forever after, as one had “become” a woman or a man. Otherwise, the script called for a miserable life in the original gender, and possibly suicide. And the more the process was popularized, the more transsexuals there were to read for a part in the play.
Very seldom did the transsexuals we interviewed refer to themselves as “transsexual” … in other words, although they may at one time have been seen as one gender and were not seen as the other, they were never outside one of the two gender categories… they are not changing gender, only correcting a mistake … (Kessler & McKenna, 1978, pp. 121-122).
This is the medical model of transsexualism, as formalized by Benjamin. One has a birth defect and grows up feeling trapped in the wrong body. The recognition that one is “really” a girl or “really” a boy comes at a very early age. Childhood is unhappy, adolescence is miserable, and adulthood is a travesty. Eventually, there comes a time when the individual must either transition or die. He or she then seeks help from the medical profession, which recognizes his or her misery and grants relief in the form of hormonal therapy and eventual sex reassignment surgery. The results are marvelously successful, unless the individual is not “really” a transsexual, in which case a horrible mistake has been made, For this reason, it is important to rigorously screen candidates for sex reassignment to wash out those who are not really transsexual.
Transsexuals quickly learned to give histories which maximized their chance of acceptance (Bolin, 1988; Denny, 1992; Kessler & McKenna, 1978; Stone, 1991):
It took a surprisingly long time—several years—for the researchers to realize that the reason the candidates’ behavioral profiles matched Benjamin’s so well was the candidates, too, had read Benjamin’s book, which was passed from hand to hand within the transsexual community, and they were only too happy to provide the behavior that led to acceptance for surgery (Stone, 1991, p. 281).
Thus, every transsexual was a primary or “true” transsexual. This created an undefined category of wannabees, who were presumably “not-true” transsexuals, unable to benefit from the dramatic life change made possible by the surgery. A number of professional papers were written to help clinicians to screen out these “unsuitable” patients (cf Abel, 1979).
Occasionally a transsexual said something that suggested that he/she was not concerned with displaying some aspect of the natural attitude toward gender. We then found ourselves questioning the “reality” of that person’s gender. In other words, we found ourselves wondering whether that person was “really” a transsexual, and “really” a member of of the gender to which he/she claimed to belong. (Kessler & McKenna, 1978, p. 124).
The construction of transsexualism enabled some transsexual people to obtain medical treatment, but at a terrible price to their peers; for every applicant accepted for sex reassignment, many more were rejected, turned away from their only source of help with instructions to live their life in the original gender. And the ones who were most often accepted were those most willing to falsify their histories to conform to the script provided by Harry Benjamin and his disciples. Those who said they “wanted to be a woman” or “wanted to be a man” were suspect; those who said they were women, or were men, were acceptable. The thinking was that the former did not have gender identities which were sufficiently feminine; in actuality, it had much more to do with following the medical model script. Those who were passable because of fortuitous biology, who were skilled with makeup application and hair, who happened to have sparse beard growth, who acted in a highly camp manner, who were attracted exclusively to the same biological sex, who were unable or unwilling to function in the assigned gender role, were much more likely to receive treatment than those who did not look like women or men to the clinicians. Those who were accepted tended to play out, in dress and demeanor, the stereotyped roles of men and women. Internal feelings took a back seat to skill with makeup and other artifice.
It is this “Biff and Buffy” or, as Wendy Parker puts it, “Rambo/Bimbo” dichotomy to which feminists like Mary Daly (1966) and Janice Raymond (1979, 1994) objected. They noted, and rightly, that the medical model of transsexualism perpetuated the binary gender norms they were working so hard to destroy.
The truth is, there are many ways of being transsexual. Transsexualism is not about adherence to stereotyped notions of masculinity of femininity, or sexual orientation. It is not about passing, and it is not about being dysfunctional, whether that dysfunction manifests as suicidal thoughts, hatred of one’s genitalia, or withdrawal from life in general. It is not about going into the woodwork after transition. And it is not about actually finding the wherewithal to go through with sex reassignment. It is, quite simply, about steadfastly desiring (or identifying with, if you will) the social role and physical characteristics of the “other” sex, whatever one’s characteristics or history, and regardless of whether one’s physical characteristics and social obligations make transition a reasonable life choice.
Certainly, many transsexual people do fit Benjamin’s model. But many others don’t, and they are no less transsexual than those who do. What they have in common is the fact that their bodies are not to their liking. Whether they choose to interpret their internal feelings as being due to a “birth defect” or as a “desire;” whether they decide to transition; and whether they choose to woodwork or to become political activists makes them no less transsexual. The differences are purely due to politics, and transsexualism, so far as internal feelings are concerned, is not about politics. Transsexualism is, in the last analysis, about identity.
Raymond (1979, 1994) and others have criticized transsexual people for perpetuating what she sees as an inherently evil bipolar man/woman male/female gender system, but her criticism would more appropriately have been directed at the treatment system which insisted that they move from a social role as a man to a narrowly defined role as a woman, rather than taking whatever steps they found necessary to feel comfortable in their own skins.
During the 1990’s, and even before, transgendered people have begun to claim this middle ground. Prince (1978) was the first to ask just why it is important for transgendered people to have or claim to want SRS in order to live productively in the desired gender role. Her 1978 talk, given at The Fourth International Conference on Gender Identity, went virtually unremarked. When Boswell (1991) raised the question again, Prince had been living successfully as a woman for more than 15 years, without surgery.
While many transgendered people identify as “men trapped in women’s” and “women trapped in men’s” bodies and seek sex reassignment, as classically defined, others claim an essential transgender nature, and seek a level of comfort and personal satisfaction which may or may not involve genital surgery or hormonal therapy, and in which they may or may not attempt to “pass” as members of the other sex. For the first time, postoperative transsexual men and women are not disappearing into the closet of assimilation, but being open about their transsexual status, and adopting appearances and identities which are far from the stereotypes the clinical literature has claimed they inevitably portray. It is time to re-examine the basic tenets of the medical model of transsexualism.
Should medical technologies continue to be available only to a narrowly defined class of persons called transsexuals, with mental health professionals having the responsibility and privilege of deciding who does and does not qualify to receive it? Should the technology continue to be available only in an all-or-none fashion, with the invariable goal being to produce picture-perfect males with neophalluses and females with neovaginas? Or should it be available, as are other body-sculpting medical technologies, in piecemeal fashion to those who can give informed consent? Must the inevitable result of masculinizing or feminizing surgical and hormonal procedures be to produce a member of the “other” sex with “appropriate” genitalia who will disappear into the greater society, or is it acceptable to produce persons who identify as neither or both sexes, or as a third or fourth sex, or who function in society as men with vaginas or women with penises? Is it necessary or desirable or accurate to continue to depict those who desire the application of such technologies, or who wish to change their social roles from male to female or vice-versa as dysfunctional, pathetic, and unfortunate?
Neither I nor anyone else has definitive answers to these questions, as data have not yet begun to accumulate. But my belief is the Benjamin model of transsexualism has had its day as the sole way to view persons with gender identity issues, and sex reassignment will in the future be but one of many options for them.
Respecting Choice
Feelings can run high (and often do) when identities are built on ideologies. Those for whom the medical model seems appropriate view themselves as women or men with an unfortunate birth defect; sex reassignment offers an opportunity to live a normal life. Those who have undergone a life full of self-doubt and persecution from others—a common lot for transsexual people—cannot be faulted for wanting to find happiness by disappearing into the larger society. Neither should those who acknowledge or are proud of their transsexual status be faulted, or those who desire sex reassignment but make the difficult choice not to seek it. No one has legitimate claim to being more authentic, more “real,” more appropriate, more transsexual, than anyone else. What separates the people who make these choices is the way they construct their transsexualism; the force that drives them to change their sex is the same.
It’s permissible and appropriate to undergo sex reassignment and put one’s past behind oneself. But it’s entirely as appropriate to be visible and out. Both are valid choices which can lead to productive lives. Neither choice is “better,” except as it affects the individual. Every individual has the right to make one of these choices, or the choice not to seek sex reassignment, or any of an increasing palette of choices which include nonoperative status, androgyny, or gender blending. Those who are undercover will inevitably become frustrated with those who are politically active, for fear that their own security may be compromised.
Those who are out will doubtless become frustrated with those who do not help them in their struggle for political change. Those who choose not to have surgery may be frustrated by those who do, and those who have surgery may not understand those who don’t. But we all can, and should, respect each other and the choices we make.
Note
[1] Today, transsexualism is lumped with similar “conditions” and classified in DSM-IV as “Gender Identity Disorder” (see Pauly, in press).
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