On Chelsea Manning and Gender Identity (Part III)

(Follow-up to Part II)

“We sentence people to incarceration. We do not sentence them to untreated medical conditions. We don’t sentence them to untreated gender dysphoria just as we don’t sentence them to untreated kidney failure, untreated infections, or anything else of the sort. When the government takes on inmates and incarcerates them, it becomes responsible for their medical care. And this condition from a medical and scientific perspective is no different from any other medical condition that requires treatment. And increasingly from a legal perspective as well. Civilian courts have found in almost all cases that prisons are required to provide hormone therapy and increasingly surgery as well. Not to do so is considered cruel and unusual punishment under the Eighth Amendment.”
— Lauren McNamara, an activist and friend of, and former defense witness for, Chelsea Manning, explaining why hormone therapy is a medical necessity for trans people and why Chelsea ought to be treated in prison

The third perspective to which I alluded on Saturday (quite honestly, this was a busy week for me, so there’s why it took me so long to update) is the one McNamara speaks of in the above quote. Having fact-checked her on this, I found in an extensive  source referenced in Part II ample evidence to suggest not only that gender dysphoria is responsible for considerable struggles in the lives of many individuals, but also that the most effective treatment is transitioning. While the extent to which any given trans person would be best off transitioning varies, common elements of this process include hormone replacement therapy, SRS, and — most critically — integration into the authentic gender identity in a way that maximizes comfort with the self. As far as none of this causes unethical harm to the transitioning person or to others, the need for acceptance of trans people and demolishing of the myths surrounding transgender issues is undeniable.

Where, then, does this leave Private Manning? Currently, the prison in which Manning resides offers no more than psychiatric assistance for gender dysphoria as part of inmate health care. This may sound reasonable enough on paper, but the problems are twofold. First, as noted in the aforementioned source, the sort of therapy that is standard practice for military inmates is not nearly as effective as the remedies prescribed almost unanimously by psychological journals (e.g. the AJP). The former methods, which tend to focus more on eliminating the desire for elements not conforming to the norms of the birth sex (analogous to ineffective “pray away the gay” tactics), are as relatively inefficient as if we treated PTSD with Freudian psychoanalysis.

Second, these facts lead inevitably to the conclusion McNamara reaches: that the government has no more right to deny trans people any necessary treatment than it does to preclude mental health care for sufferers of depression. For many, as is medically demonstrated, dysphoria manifests as a form of depression and should be treated as such in urgency.

Why, many ask, should the people’s tax dollars go toward funding this treatment for a person at least a fair deal of the country considers a traitor? For the same reason taxes go toward any other sort of prisoner medical care: inmates are not legally allowed to pursue their own private health care, thus, as the system currently runs, they can only rely on the government’s provisions of such services. The alternative is to add unnecessary physical and mental suffering to the sentence, which is indeed “cruel and unusual punishment under the Eighth Amendment.” Those who take issue with this policy are doing just that; it has nothing to do with the rights of trans inmates specifically.

To close this post, consider this graphic:


In far too many — not all, but enough for us to care — cases, a lack of acceptance of trans people wreaks damage on multiple levels. Families are broken, jobs are lost or precluded to begin with, discrimination is imposed at every turn, physical and sexual abuse is endured, and lives come to tragic ends. This is a real problem, and it is not inevitable. The vast majority of that which plagues the trans community begins in the attitudes, speech, and actions of you and me. For those who are denied respect solely on the basis of their gender identities, in honor of Suicide Awareness Week, we ought to do better. Manning was once one of the youth described above, and her case brings light to the need for a paradigm shift in our overwhelmingly cissexist society.


On Chelsea Manning and Gender Identity (Part II)

(Follow-up to Part I)

Considering the number of openly transgender citizens in the U.S. alone, it’s clear that gender dysphoria is not some extremely rare and bizarre fluke of psychopathology. Nor, based on their overwhelmingly regret-less testimony (see page 21 of APA Task Force Report on Treatment of Gender Identity Disorder), is this entirely or even mostly a passing phase of childhood identity fluidity. There is a genuine psychological sense in which a person’s mind can conflict with not just his or her sex, but with the mold into which family, peers, and strangers attempt to force him or her.

None of this is to say gender dysphoria is a mental illness in the stigmatized sense of the term — while no one with mental illness deserves dehumanization or disrespect, we have no reasons to believe transgender people are in any way more prone to hostile behavior in the way someone suffering from, for example, borderline personality disorder may be. In other words, “transgender” does not equal “Buffalo Bill.” This is why I prefer to use the term “gender dysphoria” over the connotative “gender identity disorder,” the latter’s persistence in the medical community notwithstanding.

With these easily agreed-upon premises in mind, what conclusions can we draw? I can identify at least three seemingly exclusive perspectives, which may not be beyond harmony.

The first follows naturally from certain modern feminist thought, which we may call postgenderism. This philosophy asks why, if most gender roles are evidently arbitrary or culturally propagated, those who find their self-concept in conflict with the expectations of society should acquiesce to this system by switching one sexist classification for another. Suppose a person is born with male anatomy and assigned male designation by others, but this person finds through growing up that male gender roles and the male body image are exceptionally uncomfortable. Would not this person find it more satisfying to integrity, and to the value of demolishing gender inequality as is the feminist ideal, to challenge the very idea that an individual’s personality and actions should be pigeonholed — even as the more desirable gender classification?

This thought experiment does raise some fair points. The solution of gender transitioning is not a perfect one, as it tends to invoke stereotypes that constitute the lesser of two evils for trans men and women. If the hypothetical trans woman above were to prefer not to adopt some of the superficial expectations of Western women, such as hair length or “feminine” grooming, she would face about as much scorn from sexists as she would for embracing other feminine elements as a “man.” With the range on a spectrum of supposed masculinity and femininity extending so vastly even for cisgender (“cis” for short) men and women, the function of gender identity itself (beyond the practicality of distinguishing the sexes) may seem depleted.

While the postgenderist view certainly merits respect for its sensitivity to the problems faced by those who cannot entirely fit any unreasonable ideal of masculinity or femininity, it does not present a strong enough argument that this entails we should abandon gender altogether. The ideas of masculinity and femininity are not at fault here; the irrational standard up to which only a minority of men and women can live is the cancer. Not everyone needs to value gender identity for those who do value it to use it to their advantage, without forcing sexist assumptions on others.

If nothing else, postgenderists and trans people can reconcile by realizing that their disagreement is largely a fight over words. Postgenderists would be perfectly okay with a person assigned the male sex at birth choosing to express herself in ways we currently see as feminine, since this would be an expression of liberty against the arbitrations of the gendered society. Likewise, most trans people would have no issues identifying as they do in a postgender world, having only used gender identity as a social utility because of the connotations carried by terms like “man,” “woman,” “he,” “she,” and so on. This is why the use of their desired names and pronouns is respectful to trans men and women — in a world that, regardless of whether this is a good thing, cares about gender distinctions beyond pragmatic boundaries, calling a trans man “she” conveys to him a dismissal of who he is, even if your intentions are innocent.

The second perspective maintains that there is indeed meaning to distinctions of gender, to a point that it simply is not possible for those born anatomically one sex to integrate into the opposite gender. Many people may hold this view for religious reasons, as is apparently the case with the Catholic Church, which does not officially recognize gender identities different from those assigned to its members from birth. From what admittedly little I know of the Church’s position, this may either be an essential consequence of the biblical narrative of the God-given and enshrined spirits of masculinity and femininity — as seen in the proverbial Adam and Eve of Genesis — or a declaration contingent upon known psychological evidence, just as the Church sometimes condones military means of a country’s self-defense despite a general principle of pacifism. If it is the former, the conflict may well be non-negotiable, especially when the acceptance of a transgender Catholic’s marriage is at stake.

The other possibility is both more hopeful and more rationally defensible. At the very least, the Church — which in this context I am using as a model for any view skeptical, but not necessarily rejecting, of the vision of trans acceptance so far outlined — has no more reason than anyone else to deny gender nonconformists the freedom to go against gender roles that are empirically superstitious. None of us has the prerogative to say that wearing a dress is “wrong” just because someone was born with a Y chromosome, nor that people without such a chromosome cannot do tool-based home improvement. What is really in question when religious values come into play is the virtue of undergoing physical transitioning, which some may view as playing God with the natural order.

Viewing this as a spiritual matter, some may contend that procedures such as sex reassignment surgery (SRS) violate a categorical ethic that supersedes any utilitarian considerations, just as Jains see the killing of insects in the typically casual manner as unacceptable independent of whether these organisms are conscious of their suffering. This is at least understandable as far as it goes, but does SRS (which not all trans people undergo) in fact go against a rule intrinsic to the ethics of Christ? Matthew 19:12 casts doubt on this notion, but then we could debate scripture interpretation for centuries. More compelling is the following line of reasoning: if the Church’s values truly centered on respecting that which God has created, this would have to include respect for individuals’ well-being, basic happiness, and ability to live their best lives. “The Sabbath was made for man,” after all.

The inevitable question, of what exactly constitutes the best way to grant these needs to those who suffer from gender dysphoria, brings me in Part III to the third aforementioned perspective, and how this relates to the Manning case. I apologize for the long-windedness of this series, but there is a lot of ground to cover for a topic so crucial to the acceptance and fulfillment of many people. I expected to connect this subject to Suicide Awareness Week, which ends today, so don’t bother correcting me on that note if I bring up the matter next post.