Transsexual Psychotherapy and Cissexual Attitudes toward Gender Variance: A Review of Whipping Girl, by Julia Serano

The following is my term paper for my Intro to Psych class, of which I spoke in my previous post. If you have any interest in this subject, please buy this book, because it is absolutely spectacular.

After the 19^th century established that people with psychological differences could actually be treated as pathology and not simply excluded to asylums, the 20^th century and the birth of post-modernism witnessed a massive movement toward questioning the assumptions about what psychological differences could even be considered pathology. Now, moving into the 21^st century, there have been huge popular movements in response to much 20^th century psychology, where average people are affected by psychological diagnoses to the extent that they are being moved into action and contributing their own voices to conversations previously maintained in the realm of scientific scrutiny. In transsexual woman and practicing biologist Julia Serano's Whipping Girl, she brilliantly unravels the many layers of cissexual privilege and assumption that surround and have surrounded transgender psychology, pointing out the many discrepancies between public, scientific, and clinical perceptions of and interaction with trans spectrum and cissexual people. Although, as a minority, trans* people already face a lot of misunderstanding and discrimination from society, the multitude of faults in clinical approaches toward them, both in the past and continuing today, are frankly embarrassing. In understanding trans* perspectives toward their own experiences and self-knowledge, valuing their input above our assumptions, we, as the cissexual community, come one step closer to humanizing this extremely valuable and victimized demographic in our society.

Serano begins by laying out some fundamental definitions surrounding the topic – distinctions between sex and gender (where sex includes everything physical, not solely chromosomal or genital sex), distinctions between transsexual and other transgender identities, and the definition of transsexuality (explaining that transsexual status doesn't exclude non- or pre-op individuals, but that it simply means living as a member of the other sex). In the second chapter, she explains the media's bias in attention toward transgender women versus transgender men, treating them with an overwhelmingly greater sense of fear and hostility. Whereas transgender men are largely excluded, society's approach to the feminine as both inferior and repulsive in “men” (whereas masculinity is more acceptable in women) results in characterizations of transgender women as either “deceptive” - dangerous, disgusting, horrifying - or “pathetic” - harmless, gross, pitiable, strange. Her third chapter focusses on public sensationalization of transsexual transition, with an unbelievable focus on “before” and “after” pictures, objectified and fetishized presentations in porn, and TV shows akin to those on extreme makeover that present trans gender experience as shocking or strange. A fascinating and frank discussion of the differences between male and female hormones and their effects on stereotypical gendered experience follows in Chapter Four, describing the extent to which emotions, senses, sex drive and experience, and cognition are affected by her and other trans women's switches to estrogen. While the interpretations and expressions of emotions were generally more overt and easier to express, the emotions themselves were, for the most part, the same; senses were enhanced; cognition did not change; and sexual experience was intensified for her despite the decrease in drive. It became clear in this chapter that the cissexual community had much to learn from the trans* community about our own stereotypes and gender blame games, and that our exclusion of trans* people from conversation is harmful and remarkably counterproductive.

In her next chapter on Gender Entitlement, Serano addresses the blind spots in cissexual curiosity about transsexual experience, where many ask many questions without ever being open to whatever answers they receive. She also pulls apart the difference between gender identity (which is socially-shaped) and subconscious sex (which is the internal perception of concordance or discordance between mental and physical sex) as well as the various effects that gender dissonance and anxiety have on trans* individuals. Chapter Six was a fascinating deconstruction of both radical and conservative perceptions of the gender binary, and here she explains why we perceive a binary – male and female – as correspondent to various patterns of attraction, performance, mannerism, dress, speech, etc. if they aren't necessarily linked. Shifting from either model of gender criticism, she advocates for an all-inclusive gender activism where, regardless of gender/sex identity, each may identify as they are and be celebrated as such. She links societal resistance to this mode of thought to oppositional sexism, which is – in contrast to traditional sexism (which also plays a part), or the notion that masculinity is superior to femininity – the notion that there are two mutually exclusive sexes that correspond to two mutually exclusive genders that cannot ever mix. Building on these ideas in Chapter 7, she offers a largely scathing and embarrassing criticism of 20^th-century psychological responses to transgendered individuals. Though I will spend much of the next piece of my paper on this chapter, I will say here that her main point was that oppositional sexism lead to an objectifying, cis-centric psychiatric treatment of trans* people that often reflected psychiatrists' own cissexual biases and projections. Treatment and understanding was extremely narrow and weighed down by hundreds of checkpoints that only contributed to incredible distress on the part of the transsexual, and it becomes increasingly clear as the chapter progresses that the system was not set up as psychotherapy ever aims to be, with the focus on forcing the individual to be acceptable in the eyes of society instead of helping them to alleviate their symptoms of gender/sex dissonance.

Because the content is fairly dense and the second half of the book is an application of the first half from the standpoint of activism (rather than psychology, which is mostly covered by the first 200 pages), my reflection will focus only on these first seven chapters that I just covered. I have tremendously enjoyed this book, and it has allowed me to come to a much fuller conscious understanding of my own attitude toward the trans* community. Although I went into this book far more educated than the average person about transsexuality, I found myself correcting a multitude of extremely basic misunderstandings I now cringe to think I may have had, many of which I had even learned from members of the trans* community, especially online – for example, that the word “transsexual” was misleading, antiquated, and unacceptable, since it made transgender people (which was the correct terminology) objects of sexual attention. Much of my personal reaction to the material entailed my ability to more fully understand transgendered friends of mine, and their positions on this spectrum (from more broadly transgender to more narrowly transsexual), which has been exceptionally helpful and appropriate, as two of them went on hormones and changed their names as I was preparing for this paper. But in addition to external awareness, the reading has also granted me a profoundly-deepened understanding of my own gender and some elements of dissonance I have experienced in the past and continue to experience as I mature.

Before I review some of the elements of Serano's message believe are most necessary for the cissexual community to hear from the trans* community, I would like to spend some time expanding upon and commenting on Chapter 7, which dealt deeply and very intensely with the scientific community's various approaches to transsexuality over the years. Even as someone that's usually only casually interested in psychology, I was embarrassed to read about the ignorance, blatant prejudice, and lack of professional respectability extended by many of these clinicians, therapists, and doctors. Although I may not be heading into a counseling direction, I do intend to become a doctor, and their behavior is occasionally despicable to me as an aspiring healthcare professional.

Serano uses history to frame much of her discussion in this chapter, beginning with Harry Benjamin, a 20^th-century endocrinologist that was the first doctor to begin prescribing transsexual hormones and, later, sexual reassignment surgery (or SRS) for the alleviation of gender dissonance. The HBIGDA (or Harry Benjamin International Gender Dysphoria Association) was named in his honor before its renaming as WPATH (World Professional Association for Transgender Health), and he is an inspiring, revolutionary historical figure to me, to say the least. From a strictly psychiatric point of view, the method of treatment he pioneered is clearly the most effective method. Just hearing Serano's fairly objective descriptions of the way individuals were said to have responded to the treatment makes it extremely clear to me (though I have never once doubted this in the two and a half years that I've been researching this topic) that transsexual transition is unquestionably the most medically and psychiatrically effective way to alleviate the symptoms presented. After all, what one can sometimes forget while discussing contentious, socially- and morally-involved topics like this is that the men treating, diagnosing, and testing transsexual people (predominantly women) in the 20^th century were scientists, doctors, and other healthcare professionals. They should never have been morally-invested, and should always have had the best interest of the patient in mind. But after Harry Benjamin had been at his work for several years, demonstrating that satisfactory results were being achieved, his practice gained the public eye and people became wary that there weren't ample restrictions on the number and nature of people that should transition, so they imposed an increasingly-stringent slew of completely unnecessary and harmful checkpoints in the process.

The requirements are astoundingly unrealistic and unfair. Transsexuals had to prove themselves by living as their identified gender for a year or even two before being allowed the medications and treatments that would allow them to be perceived by their societies as part of their sex, which would have been a great enough psychological stressor in and of itself that it would have discouraged anyone from trying. Furthermore, the individuals all had to be extremely gender-conforming, performing their gender in much more exaggerated ways than would ever be expected of cissexual individuals, especially in a clinical light. They were also to be heterosexual, even decades after non-heterosexuality was removed from the DSM. This shows absurd amounts of oppositional sexism, as if the trans people couldn't be trusted to decide for themselves whether they wanted to subject themselves to these kinds of extreme and (especially at that time) socially-difficult transitions and needed cissexuals to tell them whether they were really serious or not. I, as a cissexual individual, am offended by their short-sightedness and inability to see that their patients' distress were coming from the social stigmatization they suffered and not their gender-based confusion. It should have been clear to them that their symptoms showed almost no connection to their descriptions of sex or gender, but to their experiences of the oppression that they themselves were counter-productively engendering and perpetuating in the field of transsexual medical and psychotherapeutic treatment.

Today, the requirements have certainly become less stringent than they were in the 20^th century, but there are still hordes of rules and regulations that are insultingly cissexist and disrespectful to transsexual people. Even though there is an incredibly diverse array of transgender experiences, there is a single diagnosis going into the DSM-5: Gender Dysphoria. Though I'm unsure of the ways this change from Gender Identity Disorder to Gender Dysphoria will change procedure, the current practice is for people to have to go to a psychotherapist and convince them over a period of several months (which can be very costly, especially for those without the means) that they really have wanted to transition for a significant enough amount of time that they really should be getting this treatment. Although it's good to have a checkup or two before receiving any medication that's going to alter your body, the focus, as Serano also points out, seems to be on determining whether or not the transsexual person really is qualified enough to fit into predetermined standards of acceptable gender, not to help the individual determine whether they are prepared to begin transitioning into their identified sex and to cope with the various changes they'll be experiencing, the ignorance of people around them, the family/church/employment challenges they will face, etc. Of all things psychotherapists might do in treating transgender people, subjecting them to a series of scrutinizing tests should be the last one, and in comparison to the slew of other things they should be focusing on if they really wanted to work to the best interest of their patients, the currently-accepted method of diagnosis and prescription is small-minded and unhelpful.

Furthermore, there's this strange and obvious oppositional divide in the clinical attitude toward cissexual people versus transgender people. As Harry Benjamin also found, there are varying degrees of gender and sex dissonance that require different degrees of transition. Contrary to many cissexuals' assumption, it is overwhelmingly easier for most people with a transgender dissonance that doesn't extend entirely to transsexuality to live in a more gender-ambiguous state that has allowed them the physical change they need to put physical and subconscious sexes in concordance with one another than to live on either side of the binary. Trans* people are put in a bind where they must either perform to exaggerated versions of the perceived “opposite” gender to convince the professionals they are forced to treat as authorities of some sort (which is unbelievably patronizing, especially when many of them clearly have less of an idea of what they're doing than the trans* people do) or remain without treatment. What would make an overwhelmingly greater amount of sense, and which Serano doesn't spend very much time discussing, is if a post-binary model could emerge that sought to treat all trans*-spectrum individuals based only on their descriptions and the changes they feel would be necessary for their bodies to and minds to come into accord. The professional's goal should be to help this individual, and if the best way to do that is by listening to their descriptions and prescribing them medications that will help them, it should be done without consulting the gods of Gender Binary. God did not place humanity in any binary regarding attraction, sex, or gender: there's an entire spectrum of intersexed individuals, there's an entire spectrum of sexual orientations, and there is a large spectrum of different sex/gender experiences, presentations, identities. To me, failing to recognize and respect that would be missing out on a particularly fascinating piece of creation on top of the blatant disregard for another human being's experience. But for the very institutions that presume to understand these people's psychology and desire to help them to turn on them in these ways is unjust and backwards to me.

For the cissexual community, professional and average Joe alike, to begin to extend their hand to the transgender community would mean two things: a decrease in the exclusion of our trans* siblings and an increase in our understanding of the way gender and sex and sexuality work within ourselves. It is heartbreaking to me that this minority group has been so oppressed by society for basically the entirety of history, because I have gained so much from learning from them – I have been able to come to understand myself outside of the oppositionally-sexist binary I have also been presented, and have been able to live more fully because of their example. Trans* people are so far from a threat to society that I find it emotionally difficult to believe that anyone thinks that way anymore.

With the advent of the Internet Age, beginning the process into the acceptance of transgendered individuals is so simple and easy. The internet is saturated with forums, videos, and articles on transgender identities, experiences, and expressions, and all it takes it curiosity and openness of mind to learn. What's more, in exploring this community, you learn about yourself – it's not just an externally-focused process. Every one of us experiences gender and sex in some way or another, and cissexual people approaching the system from the point of view of this group of people that have been marginalized for beginning to fully live the exceptional gender and sex identities they find themselves in can be an amazing opportunity for both trans* and cis people. My hope is that the rest of this century will continue to see a revolution in the breakdown of assumptions about gender and sexuality that we have begun to see in the LGB sexual revolution – perhaps it is time we included the T.