In this section I explain each of the four discourses: the medical discourse, the trans narrative, queer theory, and trans politics, that the young people used to construct their identities. As I will discuss in later sections the young people used several elements of different discourses. Here I will talk about each discourse, as it is understood in the community that generally uses it. All of the discourses are still evolving. The young people often made use of an older, perhaps even an outdated, version of a discourse that was more established in the wider community than the current one. So I will also talk about relevant earlier versions or elements of each discourse.
In the medical discourse section I will discuss the older diagnoses of transsexualism and gender identity disorder as well as the criteria for diagnosis of gender dysphoria in DSM 5, the latest version. In the transsexual narrative section I will look at the typical form of the narrative established in the 1960s and 1970s, but I will also talk about how there is now more acceptance of deviation from this form. The queer theory section will look at theoretical ideas from the 1990s rather than more recent queer theory. Finally, trans politics is not a coherent politics. It has developed from lesbian and gay identity politics of the 1980s and 1990s, but also from 1990s queer activism. I will outline these in my final section. The medical discourse I have outlined the medical understanding of trans in my introductory chapter. The significant documents used by medical professionals in Europe and North America are the DSM (The Diagnostic and Statistical Manual of Mental Disorders) published by the American Psychiatric Association, and the ICD (The International Statistical Classification of Diseases and Related Health Problems published by the World Health Organisation (WHO). WPATH (The World Professional Association for Transgender Health, formerly the Harry Benjamin International Gender Dysphoria Association) is a long established organisation particularly known for their ‘standards of care’ publications. These publications are used by health professionals alongside DSM criteria as guidance in diagnosis and treatment. Trans people seeking medical interventions also use them to guide their expectations of their treatment. The 5th edition of the DSM was published in May 2013, after my data collection. The DSM, ICD 10, NHS, and Department of Health criteria for diagnosis and treatment of ‘gender dysphoria’ are very similar (Coleman et al., 2012; Department of Health, 2009; World Health Organisation, 2013).
The current medical understanding of gender dysphoria is ‘a clinically significant distress or impairment in functioning associated with gender incongruence’. The description ‘gender incongruence’ is used in the DSM 5 to avoid pathologising gender non-conformity or cross-gender interests. The intention is that gender incongruence should not be seen as problematic in
itself, so it is necessary for a diagnosis that there is significant distress or impairment in functioning. The main areas of gender incongruence are described as: a strong desire to be or insistence that one is the other gender; presenting or desire to present as the ‘other’ gender especially in choice of clothes; dislike of one’s sexual characteristics or desire for the sexual characteristics of the other sex; cross-sexed interests or belief that one feels or thinks like the ‘other’ sex. To be diagnosed with gender dysphoria, as well as experiencing significant distress or impairment, people must meet a certain number of the criteria for gender incongruence, and finally the gender incongruence must be longstanding. Suggested treatment of gender dysphoria may or may not include medical interventions intended to align the body with an individual’s identity such as hormones or surgery. (American Psychiatric Association, 2011). The older diagnoses of gender identity disorder and transsexualism in the DSM 4 differed from diagnosis of gender dysphoria in the DSM 5 in two ways that are significant here. The DSM 4 required a rejection of one’s primary or secondary sexual characteristics. The DSM 5 allows instead ‘a strong desire for the primary and/or secondary sex characteristics that match one’s experienced gender’. This allows a trans person to feel very differently about the body they were born with. They may accept or even enjoy the body they were born with, while still strongly desiring a different body. The DSM 5 criteria also include the possibility of desiring to be an ‘alternative’ gender instead of the ‘other’ binary gender (American Psychiatric Association, 2011). This means there is a medical recognition of the possibility of non-binary genders, and some medical legitimation of individuals who identify outside of the gender binary.
The ‘wrong body’ construction is also a medical discourse. Benjamin, Money, and Stoller were all significant in establishing that gender identity was independent of biological sex, and that gender identity could not be changed (Benjamin et al., 1966; R. Green & Money, 1969; Money & Ehrhardt, 1972; Stoller, 1968). This established that the medical treatment of transsexualism and gender identity disorder should be physical rather than psychiatric, achieving harmony between sex and gender by altering the body (Ekins & King,
1996). This explanation is still used in the current WPATH Standards of Care document:
While many transsexual, transgender, and gender-nonconforming individuals find comfort with their gender identity, role, and expression without surgery, for many others surgery is essential and medically necessary to alleviate their gender dysphoria (Hage & Karim, 2000). For the latter group, relief from gender dysphoria cannot be achieved without modification of their primary and/or secondary sex characteristics to establish greater congruence with their gender identity. (Coleman et al., 2012)
The medical discourse includes several elements that were important to the young people in my research. The constructions of trans in the older versions of the DSM are those generally in circulation outside of specialist medical institutions. These constructions are that: trans people are likely to feel negatively about the body they were born with; and trans people should identify across the gender binary from male to female or female to male. The ‘wrong body’ construction is very important for two reasons. It constructs the body as problematic; it also constructs gender identity as separate from the body and therefore located in the brain.
The transsexual narrative
We are all familiar with the ‘transsexual narrative’ as presented in television documentaries and newspaper and magazine stories. This narrative has a typical form. The person has felt ‘different’ since early childhood. If they were assigned female at birth they were tomboys and dressed as boys; if they were assigned male at birth they had an interest in crossdressing. The person did not feel comfortable in their assigned gender role, or pursuing expected interests. They often felt unhappy or distressed (Whittle, 2006). They often repressed or denied their cross-gender desires. If they presented in their preferred gender they felt comfortable with themselves. After social and medical transition to the opposite gender they became happier and able to lead a ‘normal’ life. These narratives represent many trans people’s feelings and experiences as seen in biographical and autobiographical writing (R. Connell, 2010; J. Green, 2004; Self & Gamble, 2000).
Some aspects of the trans narrative consistently fit many people’s description and recollection of their experiences. In Hines’ research ‘all but one of the people interviewed spoke of transgendered feelings during childhood or puberty’ (2007, p. 50). Many people have discussed the problems of retrospective research, but recollections of childhood are important to an individual in understanding and explaining their identity (Gagne et al., 1997). Mason-Schrock (1996) describes the narrative processes of moving to identify as transsexual in a support group for transsexuals and transvestites. The individuals in Mason-Schrock’s study spent a considerable amount of time sharing personal experiences. Newer group members listened to others’ accounts of how they came to understand themselves as transsexual. Through this new members came to understand the significance of childhood cross- gendered experiences. Importantly they also learnt that childhood experiences of being normatively gendered could in fact be understood as denial of their transsexuality. Mason-Schrock understood that established members modelled the narrative processes needed to understand oneself as transsexual, and guided new members to develop their narratives. Narratives that fitted the transsexual model would be encouraged and supported; anecdotes that didn’t fit would be ignored. Through this process new members established a narrative that explained and supported their transition to the ‘other’ gender. I discuss the use of silence in 4D in relation to the shared repertoire and reifications in chapter 9.
Identifying with the transsexual narrative is important for legitimation in some trans groups (Hines, 2010). Trans groups are designed to be places that people who identify as trans, or are questioning their gender identity can get social support or advice. To function as places of social support people often need to have at least some common experiences. If new people have very different experiences from established members there is likely to be a sense on both parts of being in the wrong place. If new people have similar experiences they will be accepted in the group. However people do not attend trans groups without some prior experiences of gender incongruence or non-conformity. In the process of coming to identify as transgendered, and describing their
childhood experiences of feeling different they will generally have found similarities in the narratives of others. Some trans or gender questioning people will not identify with the medical model of gender dysphoria, but it is important to recognise that ‘What trans people are trying to do is find a way of presenting their gender identity in such a way that the rest of the world will understand who they are.’ (Whittle, 2000, p. 3). Common narratives are shared with other trans people, but also have a typical form. Consequently they are recognised widely by non-trans people and are extremely important for people in feeling their identity is understood by others.
The medical discourse and the trans narrative are in some ways co-constructed, and so are closely linked. This has been recognised by both trans people and medical professionals, and is in some ways problematic (Hines, 2007, p. 62). The medical criteria for gender dysphoria are developed through meeting with people seeking treatment, as well as through forums such as the panels developing the new DSM and ICD guidelines, which invite contributions. People seeking ‘gender confirmation’ are seeking medical support to enable their gender identity to be better understood by others. Understanding and acceptance by a medical professional may be extremely important to an individual in their journey to understand themselves or be better understood by others, another route to the individual development of a trans narrative. However it is also well documented that many people choose to tell the story that will give them access to the support they seek (Cromwell, 1999; Hausman, 1995) which may then confirm or solidify particular trans narratives within the medical profession. Neither the trans narrative, nor the medical discourse is static, and both continue to evolve in relation to each other.
Queer theory
Queer theory offers valuable insights into the ways in which some transgender cultures radically challenge normative taxonomies of gender and sexuality, and it provides a radical vision of deconstructed genders and sexualities. (Hines, 2007, p. 27)
Queer theory arose in the late 1980s and early 1990s in part as a development but also a critique of 1970s and 1980s identity politics (Jagose, 1996). Queer
theory seeks to disrupt ideas of natural, particularly binary and dichotomous identities, by showing that all identities are socially produced (Anzaldúa, 1987; Butler, 1990/1999; Sedgwick, 1990). Butler challenged the understanding of gender as constructed on a natural sexed body, proposing that gender and sex were both discursively produced and naturalised through a process of performativity. This means neither sex nor gender is a natural category instead both require constant reiteration to appear natural. This means that both sex and gender are unstable and are open to resignification.
That gender reality is created through sustained social performances means that the very notions of an essential sex and a true or abiding masculinity or femininity are also constituted as part of the strategy that conceals gender’s performative character and the performative possibilities for proliferating gender configurations outside the restricting frames of masculinist domination and compulsory heterosexuality.
Genders can be neither true nor false, neither real nor apparent, neither original nor derived. (Butler, 1990/1999, p. 193)
Butler and other queer theorists have been very influential in some LGBT and queer communities. Queer theoretical ideas have been reinterpreted and have become established alternative discourses of sex and gender, and sexuality. A very small minority of the members of 4D engaged with queer theory directly. Most, however, engaged with discourses developed from queer theoretical ideas. The quote from Butler above encapsulates many of the important ideas that have become queer discourses of sex and gender. ‘Performative possibilities for proliferating gender configurations’ becomes the possibility of generating a multiplicity of new identities. ‘Genders can be neither true nor false’ means that a person’s preferred identity is as authentic as a their sex assigned at birth; this identity can also be outside the gender binary. In 4D, these discourses permitted the young people to say how they identified with the expectation that their gender identification was accepted as authentic, even if this identity seemed to contradict their gender presentation or performance.
Trans politics
The idea of trans politics has been around since the early 1990s (Bornstein, 1995; Stone, 1991; Stryker, 1998). Roen (2002) described trans politics as having two strands: liberal and transgressive. Like LGB politics, trans politics still falls into two broad categories. As well as the conflicts between the two areas of trans politics there are conflicts with trans, queer, and LGB politics, which I will not explore here (Namaste, 2000; Stryker, 2004). Liberal transgender politics is concerned with gaining rights and acceptance for transgendered people. Transgressive trans politics seeks to challenge and disrupt gender norms. The liberal discourse demands that trans people should have the same rights as everyone else because they are like everyone else. The liberal discourse therefore constructs trans people to look and behave in normatively gendered ways. The Gender Recognition Act (2005) and the Equality Act (2010) have given trans people significant rights, making it safer for people to disclose their trans status. This has changed the liberal political discourse enabling the possibility of being open about one’s trans status, although individuals often prefer to be normatively gendered. Gender transgression requires visible transgressions of gender norms beyond being ‘out’ as trans or genderqueer. This discourse constructs trans people to look and behave in ways that are contrary to normative gender expectations. These different expectations about behaviour and appearance can make the two strands of politics seem to be opposed to each other, and to create two types of trans individuals. Hines (2010, p. 609) warns that the ‘duality of ‘transgressive’ and ‘normative’ prevents us from seeing that ‘queers’ of all genders and sexualities can be decidedly ‘normal’, and that what (or who) appears to be ‘normative’ may actually be pretty queer’. In any case, LGBT and queer communities overlap, with individuals moving between and living in multiple communities; individuals are likely to be more or less visible or transgressive in different circumstances. As Roen (2002, p. 521) says ‘crossing openly may be necessary and useful in some circumstances (whether or not for reasons of political activism), while passing may be essential in some circumstances.’