Revised Standards of Care: Perpetuating Pathology?

by Nancy Nangeroni February 2, 1998
I just returned from my first visit to the Harry Benjamin International Gender Dysphoria Association's web site showing the 8th revision of the proposed Standards Of Care. Frankly, I'm stunned.

I'm stunned to recognize (awakening from a pleasant dream, I suppose) that the title of this organization -- the "Gender Dysphoria Association" -- reinforces a view of gender-transgressive behavior that worships the "norm" and pathologizes difference. This organization's name presumes that there is some gender norm to which we've all agreed, and which us crazy gender dysphorics just can't seem to accept. OK, call me a gender dysphoric if you must, but it's not MY gender I don't like, it's society's idea of what my gender ought to be that bugs me. And this "Gender Dysphoria Association," by it's name, presumes that to stray from this norm is unhealthy, indicative of illness of some sort.

Baloney. The fact that gender norms are neither negotiated, nor agreed upon, but enforced to the great detriment of "transgender" individuals, continues to escape too many of our helping medical and psychological professionals. Personally, I hope to forever avoid treatment by any expert in "Gender Dysphoria." Anyone who thinks that way is sure to hurt me, sooner or later. The idea that there is a gender "normality" is itself unhealthy, not just to those of us who dare to challenge it, but also to the many who live out their lives forever boxed in by its limitations.

Looking into the proposed standard itself, one finds it replete with references to gender identity disorder (GID), using it in describing everything from transvestism to transsexualism to a girl child's refusal to wear a dress. With the current movement towards eliminating GID as a mental health diagnostic category, it is both surprising and disheartening to find that this, the flagship medical and mental health standards provider for the transgender community, remains solidly rooted in the backwards thinking that made my life, and those of many of my closest friends, miserable to the point of self-destruction.

I would like to suggest at this time that the problem we are seeing played out upon the lives of the transgender community is not one of gender dysphoria, but rather one of transgender dysphoria. For some reason, as yet unexplored by our leading mental and medical health experts, many members of our society experience a profound discomfort when confronted with a gender display which differs from their expectations. [Back in the sixties, this was called "uptight," but that terminology was eventually abandoned as too trendy and vague. We still await a succinct descriptor for the distress felt by those who, due to some element of their makeup, cannot abide by gender displays which fall outside of a narrow comfort range.]

To the members of the committee tasked with revising the Standards of Care, I have a brief message: lay off the pathology bit, please. Your need to pathologize me is no more healthy than my need to wear a dress. And my need to wear a dress is a lot more healthy than repression, denial, electroshock, drug, and behavior modification "therapies," which you probably don't support, but all of which your language encourages.

To transgender activists, I have a suggestion: if you want to eliminate GID, maybe a good place to start would be with the Harry Benjamin Association. They still seem to think that choice of clothing is a health, rather than political, issue. While we can't expect our health care providers to be terribly astute politically, we can and should expect them to have at least a passing acquaintance with the relationship between politics, power, and health care. It used to be commonplace for politically embarrassing or troublesome people to be labeled "insane" and incarcerated. Today, we reserve that treatment for children. And we have become much more sophisticated and subtle in our use of mental and medical care to regulate the behavior of our population. Please, stop acting as the tools of that regulation.

It's time that our health care providers acknowledged their role as enforcers of a normality that is dictated by those in power, whether the power is that of an doctor, employer, or parent. It's time for health care to be driven by the client, not by the care giver. Just as a salesperson does not decide what we buy, so too should a health care giver not decide what treatment is appropriate. That decision must rest in the individual recipient. The standards of care, while well intended and helpful, nonetheless serve -- as written -- to perpetuate the kind of disastrous thinking that used to advise transsexuals to abandon all personal support structures, falsify their past, and live a life of hiding.

The transgender movement is doing it's best to relocate this culture's gender pathology from us poor scapegoats in the transgender community, to the larger society. The problem is not of difference, but narrowness. The cure is not medical, but political.

The feminist movement challenged the gender restrictions imposed upon women. For the rest of us forgotten by feminism, it's our turn now.