The construction of Gender Dysphoria at 'Classifying Sex: Debating DSM-5'

On the American Psychiatric Association’s (APA) website the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is promoted as the “most comprehensive, current, and critical resource for clinical practice available to today's mental health clinicians and researchers of all orientations” (American Psychiatric Association, 2012a). The manual is ‘comprehensive,’ indeed; it has grown in size since its first edition to over 900 pages in its current DSM 5 incarnation. We could argue as Farley, the former president of the American Psychological Association, does that the DSM authors are contributing to an increase in “the relentless production of disorders and pathologizing of normal extremes” (Gornall, 2013: no page no.) and the facilitating of mental illnesses. In response to the publication of the DSM-5, a two-day conference at the University of Cambridge took place: Classifying Sex: Debating DSM-5, at which discussants debated the potential impact of the manual’s criteria for pathological, paraphilic and by default ‘normal’ sexualities, gender identities, and psychiatric practice. The delegates considered amongst many other topics the role of power and evidence, at least that is how I understood many of the contributions to the debate. The panel that I was invited to contribute to featured Kenneth Zucker (Chair of the Sexual and Gender Identity Disorders workgroup of DSM-5) to whom I was to critically respond. In this reflective commentary I would like to focus on power and evidence because Zucker has previously described the DSM’s international influence as spreading from clinical care, clinical training to clinical research (Zucker, 2010b). Moreover, in Zucker’s conference talk: The Science and Politics of DSM-5 (Zucker, 2013) it invoked these conceptual frameworks. Zucker’s intriguing first presentation slide read: “Power is the ultimate aphrodisiac (Henry Kissinger 1973).” This was followed by a slide illustrating the sum of publications Zucker and the other Chairs of the DSM-5 working groups had published accompanied by Zucker’s remarks that these publications were part of the reason why they were selected by the APA’s Board of Trustees (BOT) and as Chairs of their respective work groups. This generated in me a sense that power and evidence to support these tangled, conflicting positions of power were being played out in a number of domains, profiting from many tactical partnerships (Foucault, 1998 [1984]): the BOT, the contributors to the working groups, the academe and in some cases the (parents of) patients themselves through data from the clinics

Bound to the dual-sex/gender system: (trans) gendering and body modification as narcissistic self regard

This chapter looks at the way that transsexuals neotiate their body projects, by balancing their ego ideals, bodily intactness and social roles. I draw on a reconstituted notion of (positive) narcissism to eplain the various modalities of transsexual body modification

Erotic images: towards new conceptualizations of trans sexualities

The sexualisation of transgender is a thorny issue due to the negative undertones within sexological texts. After many years of being on the one hand, silenced about sexuality or on the other hyper-sexualized, for fear of being pigeon-holed as unworthy recipients of medical interventions by the medical teams providing healthcare, transsexual and transgender people have started to explore and produce their “sexual bodies” and represent them in novel ways through prose, poetry and pornographic film. The move to demonstrate a wider ‘spectra of desire’ (Stryker, 2006) and experiences of trans sexuality was announced to be politically important as a way of shifting stereotypical associations surrounding trans, gender and sexuality generally. Trans pornography and erotica are two sites that offer many semi-aurobiographical accounts of trans sexualities that often speak back to hetero and homo normative perspectives that are usually underpinned with medicalized narratives. I argue that in the words of Kate Bornstein (1994: 163), over a decade ago, that these cultural productions offer “irreverence for the established order” and incorporate the “often dizzying use of paradox.” Using textual data, I will illustrate that gender transitions (sporadic, permanent or undecided) are not solely about gender, as a core characteristic, and suggest that sexuality is part of trans subjectivity too. I will draw on the work of Bataille and Deleuze and Guattari to illustrate that trans sexualities should perhaps be theorized through trans bodily aesthetic affects that simultaneously engenders ‘becoming identities’ in the erotica. This conceptualization helps us move to more helpful descriptive analyses than identitarian (hetero/homo/bi) and sexological conceptualizations can offer us; and understand helps us understand trans sexualities as endless and rhizomatic

Researching trans sexualities

This workshop explores the ways different disciplines (sexology, psychosexology, transgender studies and feminism) have researched trans sexualities. Ethical considerations will be viewed from the position of the trans person, rather that the researcher. The workshop will also introduce some contemporary trans sexualities research, that explores sexuality beyond the identity positions of lesbian, gay and bisexual to open up 'a wider spectra of desire.

Facilitating LGBT Medical, Health and Social Care Content in Higher Education Teaching and Postgraduate General Practice Training

Student teaching has tended to position heterosexuality and gender normativity — people conforming to social standards of what is ‘appropriate’ feminine and masculine behaviour — as the primary context in which health and illness is viewed. Models of health care that promote these views of sexuality and gender identity over others can create an environment in which gender stereotypes and heteronormativity — the cultural bias in favour of opposite-sex over same-sex sexual relationships — result in lesbian, gay, bisexual and transgender (LGBT) people becoming ‘add ins’(Hicks & Watson, 2003), if and when they are considered. Even the term LGBT assumes that the Ts have co-extensive healthcare issues as with the Ls, Gs, and Bs, and can be taught together as an extension of the same theme. It is important to respond to the requirements of L, G, B, and T populations accessing health care with different models, not in the form of mainstream tolerance, but by changing institutions in lasting ways (Vaid, 1995). Obstacles to this include the lack of time and resources and the willingness and ability of faculty to teach LGBT-related curricular content. There is little medical education about LGBT issues in terms of health promotion, prevention, and care at a strategic or operational level. This is a neglected area of education that would cross several Royal College of General Practice’s and education providers’ curriculum statements in relation to diversity and human rights, where education is crucial to transforming health care for LGBT communities. However, education must not inadvertently pathologise LGBT communities by situating their associated health problems as purely LGBT health issues, whilst simultaneously showing that health inequities do affect LGBT communities in complex ways (Davy & Siriwardena, 2012). As such, this research explores barriers and facilitators of providing LGBT curricula for medical, health and social care students to help ‘mainstream’ LGBT individuals as health citizens

School cultures and Gender Diverse Children: Parents’ and guardians’ perspectives

Children’s transgender issues have emerged from the periphery of general consciousness to center stage within human rights discourses, and as a controversial medical topic. Moreover, gender diverse children, known sometimes as trans (gender), are increasingly visible within the school system in the UK. Most of the small amount of research on gender diverse children in schools has been conducted in the United States (US) in which they often concluded that social service professionals, teachers, and administrators of schools are often uncomfortable with them. Additionally, many school service providers fail to create a safe and respectful atmosphere for gender diverse youth. This study I am presenting here sets out to look at this topic from a different angle and to explore the educational environments that families are experiencing in the UK with their gender diverse children. The study was created to understand parents’ and guardians’ views on the schooling system and the challenges they face in relation to being parents and guardians of gender diverse children

Suppressive tropes: (mis)recognition of transsexuals’ agency

I examine the some of the implications of the usage of the trope of the ‘wrong body’. I want to suggest that this trope, utilised by both the transsexual and medical establishment, is rarely employed with indeterminacy in mind, that is, in an attempt to cause metaphoric blurring. The ‘wrong body’ trope is utilised to augment a sense of ideology. I argue that these tropings are often used in an effort to salvage a narrative of an original gendered self, which nature has somehow got wrong. I suggest that this usage is counter productive, in three types of narratives utilised by transsexuals, the medical narrative, the Cartesian narrative and the intersex narrative as it undermines their narrative logics. Moreover, the usage contests others in the community and beyond. Utilising life history interviews with twenty-three transpeople from the UK who identified as both male-to-female and female-to-male, I go on to argue that this trope suppresses agency insofar as it restrains transsexuals from disclosing aspects of their particular choices within their specific contexts and habitus. I propose that we must allow for a substantive model of transpeople’s agency, which is situational, and which can account for the diverse potentialities of transgender embodiment

Bodily aesthetic affects in trans erotica: towards a wider ‘spectra of desire’

The sexualisation of trans people is a thorny issue due to the pathologizing undertones within sexological literature. After many years of being on the one hand, silenced about sexuality or on the other hyper-sexualized, for fear of being pigeon-holed as unworthy recipients of medical interventions by the medical teams providing healthcare, both transsexual and transgender people have started to explore and produce their “sexual bodies” and represent them in novel ways through prose, poetry and pornographic film. ’The political move to illustrate the wider ‘spectra of desire’ (Stryker, 2006) and experiences of trans-sexuality was announced to be politically important as a way of shifting stereotypical associations surrounding trans embodiment and sexuality generally. These projects of sexual representation rely on transforming spaces and discourses within cultural mediums in which transpeople explore their sexuality. Using trans erotica texts, I will illustrate that ‘transsexualism’ and ‘transgenderism’ are not solely about gender, as a core characteristic, and suggest that sexuality is part of trans subjectivity too. I will suggest further that new representations of trans-sexuality within the erotic representations pose challenges to the medical policy and practices surrounding trans medicalization and the sedated ideas surrounding transpeople as either non-sexual or hyper-sexual. This focus on erotica allows for new analyses and conceptualizations of trans-sexuality that incorporate bodily aesthetic affects of the transitioned and transitioning body. Simultaneously, understanding trans bodily aesthetic affects helps us move away from territorialized identitarian markers, such as gay, lesbian and bi and explore a wider spectra of trans desire

Transsexual recognition:embodiment bodily aesthetics and the medicolegal system

This thesis develops recent work on transsexual/gender embodiment that has emerged from the field of transgender studies. The empirical study has been influenced by poststructuralist theory and feminist phenomenology and focuses on the constructed personal meanings of embodiment and bodily aesthetics for transpeople. Furthermore the thesis explores how trans embodiment is constructed within the medicolegal system and transgender politics in the United Kingdom. This study reviews the medical and legal work on transsexuality, which forms the basis. of being recognised in law as either (trans) men or (trans) women and how medical theories and legal prescriptions have been adapted through time on the basis of trans bodily aesthetics. Transmen and transwomen's personal bodily aesthetics are discursively and materially constructed and recognised through body images of the "phenomenological, " "sexual" and "social body, " which all provide for understandings surrounding their gender identities. Moreover, the thesis investigates how embodiment and bodily aesthetics are framed in three Transgender Community Organisations (T-COs). The epistemological approach of phenomenology in this thesis allows for detailed descriptions surrounding the diverse bodily practices of the trans participants, and their experiences with the medicolegal system and T-COs. The study employed semi-structured interviews and photograph elicitation methods with fourteen transwomen, eight transmen and one person who had had male to female SRS but had decided to live as "bi-gendered. " The age range of the sample ranged from twenty two to sixty years old, who were at different stages of transition, and who all recognise themselves as being of a different gender to that which was given at birth. The thesis identifies diverse embodied practices by transpeople, which all help constitute a commitment to a specific gender identity. These findings challenge the traditional medical models, which constitutes the "true transsexual" as always requiring a normative bodily aesthetic. I consider the processes of attaining a masculine or feminine body and how different discourses of embodiment are 'utilised or challenged and how imaginatively anticipated bodies are actualised through technology. The thesis argues that transmen and transwomen differ in their engagement with technology and discourses of embodiment of the self, within transgender politics and within the medicolegal system. Furthermore, it suggests that bodily aesthetics are important aspects of lived experience in relation to transpeople's phenomenological, sexual and social selves

Transsexual body modifications as narcissistic self-regard, a UK context

The aim of my research is to investigate transsexual bodily aesthetics and the use that transsexuals make of body modification technologies in the construction of a gendered identity. This will be explored within the context of the UK’s Gender Recognition Act 2004 (GRA 2004), the Gender Recognition Panel (GRP), and the clinical setting. The focus will be on body parts that have specific relevance to transsexual experiences of gendered embodiment. Thus, focussing on other body parts in addition to genital surgery will enable us to understand in more depth the gendered ‘nature’ of body parts in relation to transsexual experiences. After all the genitals only represent about 1% of body mass (Valentine and Wilkins 1997). However, within the sexological literature, genital reconstructive surgery is implicitly and explicitly emphasised as the most important factor in the construction of a happy and satisfied transsexual identity. A consequence of this concentration is that the transsexual is constantly equated with genital surgery, which has implications for authenticity in the clinician’s office, transgender studies and transgender politics. I chose to focus on modifications of body parts and not solely on genitals because these other characteristics have been overlooked in much of the sexological and transgender literature. Furthermore, the UK’s Gender Recognition Act 2004 does not state that genital reconstructive surgery is a necessary body modification in order for the transsexual to apply for gender recognition