In America, Pain is Up For Grabs

“Up for grabs.” I hate that phrase. Its variant, “Grab and go!” is not any better. The invitation to grab things is, I think, meant to connote ease of access. Possibly it also intends to obfuscate the fact that, unless it is a prize that is “up for grabs,” usually in return for the commodification of your attention, you will also have to pay for the thing you grab. To me, grabbing connotes snatching rapacity. But America is nothing if not rapacious. Of our time, our money. And our pain, if it can be used to grab our attention.


Recently Congress held hearings on the two Boeing 737 Max crashes that killed 346 people. 346 people. That objective number is horrifying. 346. As part of their hearings, they asked Paul Njoroge to testify. He lost his wife, his mother in law, and his 3 children in the Ethiopian airlines crash. Knowing that horrifies me. The fact of that loss is really all I need to know. I’m not sure why Congress needs to hear from him instead of about him in order to investigate Boeing, but I have noticed that it seems to be the American way to want to embody a thing in one person’s experience of it, as if one person’s experience was evidence of something large and important. If one person says it happened to them, and especially if they felt bad, then their bad feeling makes the bad thing worth responding to. Or more real. Or something. For example: There is an opioid crisis, and the news will cover it by honing in on the life of one person. If we can see how she lost custody of her child, how she suffers for her addiction, then we have the evidence we need that (a) addiction is bad; (b) people are suffering; (c) something should be done. But this culture needs to focalize through individual pain to believe. Or maybe individual pain sells ads.


Not only did Mr. Njoroge travel to Washington from Toronto to talk about his lost family, KQED played parts of his testimony on the radio. So I could hear the ages of his very young children and also hear him talk about how he imagines their last minutes, how he knows his wife and mother in law knew they were going to die and he hopes they could comfort the children. How he misses them every day.


Why do we need to hear this private pain? Does the broadcasting of it alleviate it? Justify it? Why does this culture need to spread the horror around, as far as it will go? I can’t shake the feeling the impulse is not humane, is not borne of a desire to help this man feel less alone – anyway how can I presume to know what he is going through? Why do I need the details of his private suffering to know that he is going through it? – but instead is a kind of insatiable voyeuristic frisson, driven by the knowledge that horror puts ears and eyes to public media.


And still, when there is yet another shooting, as in Gilroy this week, I am reminded of how it works, again. We are told it happened, and where, and how many died and were injured, if that number is available.  And then we are taken to a reporter who has rushed to the scene of the crime to find someone who was there, who was close enough to the horror to have lost something, but not close enough to have lost their life, because the dead can’t speak. If they could, I’m fairly sure they’d regularly be on the news, but only if they died in some horrifying way.


Ursula le Guin writes that pain is not interesting. It should not be celebrated as more valuable than joy. Other people’s pain is not interesting. It is horrifying. It should not have a display value. Why does this culture not know that?



Cis people need to internalize trans pain

It’s no secret that being trans is hard. It’s hard because of the outside forces that make it difficult-to-impossible to do basic everyday things that people who are not trans get to take for granted. Like go to the bathroom, or be addressed appropriately, or be able to trust that your doctor will probably not ask irrelevant and invasive questions when you have the flu. This is transphobia, a belief system which seeks to punish trans people for existing, which believes that their humanity is compromised by their gender, because humanity should rightly exist in two, specific, mutually dependent, static categories. (It never has and it never will). Transphobia denies people families, jobs, homes, education, access, basic safety and so on: injustice at every turn, as the transgender discrimination survey puts it.


But there’s another force that transgender people have to contend with. Trans as a gender modality should not be intrinsically painful, and if it is, it is not only because of blatant discrimination. Cisgender normativity is different to transphobia, the same way heteronormativity is different to homophobia, and similar to the way white privilege is difference to outright racism. The -phobias and -isms express a hatred of the other, an intolerance for difference, an investment in the relations of power that keep those in power at the center. The -normativities are not outright assertions of dislike or destruction. Instead, they simply assume that the other does not exist in the everyday operations of the world. If you want space, as an other to the center, you have to actively claim it, in the face of normativity. This functions to keep others in their place as outsiders. It reminds them they are not “normal.” It denies them access to the same fundamental human rights, on a cultural and spiritual level, as (pick your combination) white, cis, moneyed, hetero, and sometimes also men are automatically granted. It can be exhausting at best and, over time, extremely corrosive at worst, to have to continually assert your existence to people who just don’t consider you there at all.


But more than this, one of the effects of the deep, deep roots of cisnormativity, which assumes a binary gender structure as the underpinning of what it means to be human, is that most of us internalize this assumption. It’s usually impossible not to. I’ve written at length about how and why binary gender has until recently informed Western culture’s ways of structuring the subject, of shaping how we each can come into knowledge of ourselves as individuals. S.J. Langer has written about some of the consequences for trans people when, from the very beginning of the building of their senses of selves, their caregivers misrecognize who they are, often even before they themselves can know. This is because of the assumption that they must, by definition, be cis. This assumed starting point for all humanity is one incarnation of cisnormativity.


The result can be a deeply embodied sense of wrongness, of being out of place, which exists in the pre-verbal part of the brain as an awful source of profound dysphoria you might not ever be able to name. Sometimes you may not have an idea of what is wrong because you do not have the concepts available to you, because your family and your school and your community are operating on the assumption that binary gender is all there is. Struggling your way to being able to conceive of yourself under these circumstances can be an extremely costly psychological battle. Not everyone survives it, not everyone emerges without deep wounds, and it is one way being trans is made to be so much more difficult.


As neuroscientifically-endorsed attachment theory, like the work of Alan Schore or Dan Siegel has shown, we are all reliant on the experience of being correctly mirrored. This is a necessary part of an infant’s development of a sense of self: it’s only by seeing ourselves in another that we know we are coherent selves, as our brains are forming in early childhood. It’s how we learn to self-regulate, to feel empathy. It’s what makes us human, what enters us into community with others and with ourselves. So when someone is putting together a sense of self in a world that assumes cisnormativity, not only do they eventually have to assert their existence to their family, their society, their culture, they also first often have to struggle through an internal landscape which is cluttered with obstacles.


Sometimes realizing you are trans means gradually bringing into consciousness a feeling of wrongness you have lived with your whole life, and then starting to try and make sense of it. This means groping for understanding through a level of white noise that is inside you because of the assumptions of the world outside you. As a person assigned female at birth in a family, community, and society which had specific meanings for me that did not fit me at all, I feel a cognate sense of relation. But at least I had some things I could take for granted as I struggled with this: I may have been a failed girl, but I was not a failed human. The terms I was searching for were foreign to me at the time, but they were not unimaginable to those around me.


We cis people have an important responsibility to take here. If we stop assuming our privilege, we also engage deeply with altering the binary structure of gender our culture takes for granted. We can make a real difference to some of the pain transgender people have to feel because of the system that informs and endorses us. I often write and talk about how this work benefits all of us, how binary gender limits everyone, how we are not doing trans and non-binary people any favors when we stop being transphobic or cisnormative: we are doing ourselves good. But the point I want to make today is a little different. It’s this: it’s already too hard to be a gender independent person, an outlier, an outlaw, creative or queer or trans with gender. It’s made harder by a world that, in addition to often hating trans people for the difference and/ or challenge they represent to what we take for granted, also behaves at a base level as though they were conceptually impossible. This is not only damaging on the external level, microaggressions and all. It can also be devastating to someone trying to figure out who they are, to come to terms with what’s inside them, when the terms they have been given actively get in their way. Cisgender privilege hurts on many levels. It can sometimes be deadly, if it makes it so difficult for a human who is not cis to be able to access who it is they are, that they cannot survive that process.


Our work is to internalize that trans and non-binary personality formations and expressions are as real and as human as the ones we have been used to taking for granted until now. We do this in part by understanding the damage we do when we continue to embody our gender privilege. This damage is not only enabling the perpetuation of transphobia in the outside world. It’s also making it harder for some people to be trans in the innermost, most private places where we each find and know ourselves. When we stop assuming that cis experience is and should be the norm, we will stop fussing about pronouns and bathrooms. But we will also make room in our culture for everyone, and make it easier for everyone, and on a very real level, make it safer to be trans.

The shit that Castor Semenya has to put up with

Almost exactly a year ago, I wrote about the discrimination faced by the South African runner, Castor Semenya. This past week, the Court of Arbitration in Sport upheld a ruling by the IAAF that she may not run in women’s competitions unless she takes medication to lower her testosterone levels to some imagined “norm” for female people. The IAAF helpfully added that she is welcome to run in men’s events if she doesn’t want to take this medication.

 In my last blog I referenced the work that in some cases was, oh, you know, 20 years old, that proves why the rigid binary demarcation of hormones along gendered lines is scientifically inaccurate, and that the investment in correct hormone levels across some binary norm is an invested political fiction. And if you want a latest summary, there is Gina Rippon’s excellent new book, The Gendered Brain, which takes a comprehensive look at the self-fulfilling prophecies of much of the science of gender difference, including hormones.

 There has been, and continues to be, lots of pushback against this ruling, with many people making the point that the best athletes tend to have a biological advantage, and that Michael Phelps also has an natal condition which gives him an advantage over his competitors – but he is considered admirable, not freakish. Here is Trevor Noah on the topic. And make no mistake, Semenya is being disciplined for not being female enough – or for being “as good as a man.” She is being punished for exceeding some artificial notion of what a woman is, because she is winning.   

Here is a really good recent article outlining the flaws in the IAAF judgment, including calling out the transphobic undertones of this ruling and detailing the bad science behind its assumptions. It also points out that the speed advantage Semenya’s naturally high testosterone levels afford her is really not that big, and is utterly unquantifiable. The article, in The Conversation, sums up all the reasons why the ruling is confused, unethical, unreasonable, discriminatory, incoherent, based on false science and reductive thinking, and unjust.

There is one thing none of the protests I have read so far mentions. In addition to the racism, the implicit transphobia, and the gender policing, it seems to me that one of the reasons this is happening to Castor Semenya is because she does not look, at least to Western eyes, “properly” feminine: she is butch. And she is married to a woman. She both “looks” and “behaves” “like a man,” that old chestnut about same-sex-loving women. So I think there is a point to be made about homophobia, too, in this toxic mix. Racism + Gender Policing + Misogyny + Homophobia = The Shit That Castor Semenya Has To Put Up With.

Sis’Castor, you are too good for them.






When is the past past? When the present is understood through its terms

As a therapist, I am profoundly aware of the complexities of coming to terms with history while seeking change in the present. My work has shown me that we can’t “get over” something painful that has happened. We have to come to terms with it, understand that, as long as it remains unacknowledged, it will continue to impact us. Often my work with clients is to accompany them as they learn to tolerate the pain of what happened then, think through with them how that pain has shaped what has felt possible until now, and strategize with them specific ways of learning to be different in each moment that presents itself as available for that process. But coming to terms with the past is easier said than done. If our present is shaped by the events of our history, then whose terms are we agreeing to when we seek to understand what future to imagine into being?

This week, I drove to San Francisco to meet with the smart and articulate diversity facilitator and experienced school teacher and administrator, Lori Cohen. Fortuitously, on the way I listened to an airing of Forum on KQED with Michael Krasny about the Victor Arnautoff mural at George Washington High School in the city. The SF Unified School Board is considering a recommendation to remove or destroy the mural. It depicts slaves, and Native Americans subject to colonial violence.

Arnautoff was a Russian muralist who lived in San Francisco for about thirty years, from the 1930s to the early 1960s. He was a follower of Diego Riviera. The 1936 mural, “Life of Washington,” which is painted on the wall at the high school named after the slave-owning first president, was intended to be a critique, not only of Washington, but of white America’s self-narrative, according to Will Maynez, steward of the Diego Riviera Mural Project, who spoke on Forum for keeping the mural. You can read more about the whole debate in the San Francisco Chronicle. The article covers many of the points made in the KQED program: that students of color are oppressed and shamed by these stereotypical representations in their school; that “whitewashing” history is not the solution and that censorship is never the answer to these kinds of painful discussions. The comments from readers on the Chronicle site are pretty representative of the NPR debate details, too.

While I appreciate the critique the mural offers, and agree with the one side that it’s an opportunity for high school students to learn facts about the past not provided by traditional textbooks or by white America’s idea of itself, I found myself convinced by the argument made by Paloma Flores, the program coordinator of the Indian Education Program at San Francisco Unified School District Office of Access & Equity. She kept saying, “Representation matters,” and insisting that in the absence of the curriculum changing to accurately reflect minority histories and cultures, and in the ongoing marginalizing experiences of black and Native American students, this mural was hurtful. The reduction of black and Native people to abject stereotypes reinforces these stereotypes and reinforces a racial hierarchy that students find uncomfortable to navigate, given that the hierarchy still exists. Where, she asked, is the integration of the heroic, valuable, positive content of the histories and cultures of people of color into mainstream structures, including schools? Until that happens, she said, the mural belongs in an art museum and not in the kind of public space that is supposed to facilitate the growth of all young people.

 Her point was not responded to directly in the program, but it was endorsed by the two mothers of students of color who called in to reiterate that their children already had to manage reductive and stereotyped representations of who they are in this culture, and that having this repeated throughout the school day was not helpful, to say the least. Maynez’s main response was the slippery slope to censorship argument, and the idea that democracy is best served when all the information is available to everyone, so we can all make informed decisions. Who, he asked, should be tasked with deciding what you see otherwise?

 This is a fascinating, infuriating debate. It helped me enormously that Lori got it immediately, and was able to articulate why one-sided versions of black and Native American experiences are not helpful for students in their places of learning, even as it remains important to insist on the truth of America’s brutal history (which brutality is embedded in all the current structures – this really was the point that was not properly engaged with, but that’s not surprising.) What it left me with was a renewed sadness, if that is the right word, about the in-fighting amongst progressives. The most striking thing about the Arnautoff mural controversy is that the two sides want the same thing: to honor the experiences of those who have been oppressed in the building of America, and who continue to suffer in the face of its self-fashioning.

 It’s telling to me that the discussion points of and comments to the NPR segment rehearsed the points made in and in response to the Chronicle’s article. Many of the points are valid. But until we can take seriously the ongoing effects of the history depicted in the mural, and prioritize the experiences of those who suffer them over any sense of the importance of dominant cultural artifacts, we will be stuck infighting while the real enemy continues to play the structure to his, and his cronies’, increasing advantage.




This week I saw the movie, Captain Marvel. I’m so grateful that middle class white women are finally being given the credit we deserve for all the years we worked our asses off trying to save the world. Yes, I am being a little sarcastic. I also think with real affection and respect about all the middle class white women I’ve met in my twenty years working in non-profits and in mental health who are genuinely committed to the work they do and the populations they serve. And there is a very real politics that comes with being this kind of woman doing this kind of work. I think it has changed somewhat in the last two decades, since I first started being one of these white women. But in my day, at least in South Africa, non-profits were dominated in leadership positions by well-intentioned white women, whose organizations tended to serve people who were not middle class white women. Good intentions are not enough to manage the complexities of this situation.


It is not only a problem of white liberals speaking for society’s others. It also calls into focus a fundamental and really quite shitty aspect of being a white woman: as a woman, you bear part of the brunt of thousands of years of Western cultural chauvinism, and the patriarchal oppression that enabled it. As a middle class white woman, not only do you have class privilege and white privilege, which means you get to take for granted a whole series of benefits and entitlements, but you also carry the burden of all the things that were done by Empire in your name. By this I mean to acknowledge the ways in which various kinds of violence against men of color have been perpetuated in the name of “protecting” white women. I also mean to acknowledge the ways in which women of color have been made to bear the abjected aspects of female sexuality on our behalf. We white women have benefitted from these exercises of power, and been made subject by them. Aspects of this dilemma are invoked for me precisely by the figure of the hard-working middle class white woman, saving the universe, either by working for little pay in socially under-valued jobs where she nevertheless holds specific kinds of economic and institutional power, or by this movie, the story of how Carol Danvers discovers her grit and comes into her power. In the discussion that follows, I’ll be representing from memory the things characters say, so please note that the content represented as speech is not actual verbatim quotes.


The film seeks to address sexism: early in the movie, Captain Marvel is told her weakness is that she is “too emotional”; her final repartee to this criticism is, as she kicks smarmy Yon-Roggs’s ass, “I don’t have to prove anything to you.” It is kinda cool and satisfying. It’s clear that this, Marvel’s first superhero movie to feature exclusively female heroes, is taking the glass ceiling seriously.  


But here’s the thing: Carol’s best friend is a black woman, Maria Rambeau, who has a black daughter, Monica. Who says to her mom, when Carol asks Maria to blast into space with her to fight evil aliens and Maria tells her she can’t because she has a child to care for, “Mom, what kind of example are you setting for me?”


Interestingly, Monica Rambeau is the name of one of the many alternative comic book Captain Marvels, this one from the early 1980s. So the film is indicating that Maria’s child grows up to be like her Aunty Carol. There is a shot in the film, towards the end, when Carol takes off to go into space and help the refugee Skrull families find a new home (see? Middle class white women work so hard to make the universe a better place!), that presages this. Monica and Carol say a touching goodbye, and then Monica stands outside the front steps of her house looking up into the sky after Carol, a beautiful smile on her beautiful face, as Carol zooms into the stratosphere.


On the one hand, I love the sisterhood being represented here. On the other hand, it makes me cringe. There is too much unacknowledged whiteness at work here. Black people are once again cast as the supports to white people. Black women are once again the facilitators. And Carol is the inspiration for Monica, in what runs the risk of being an uncomfortable recasting of the White Man’s Burden. This is all especially noticeable in a film that is so conscious about its gender politics.


Perhaps most egregious, there’s a very real history of mainstream feminism not acknowledging the difference that race makes to a woman’s experience in the world. Monica’s message to her apparently single mother, to leave her child and go to work, to not set the “bad” example of being a woman who stays at home, sums it up. The desire to leave the home to work in the world was historically a middle class white woman’s desire, and a white woman’s privilege. For centuries, the right to stay at home with one’s children was denied many black women.


I’m not saying Maria can’t be her own person, and Monica can’t be a child of the class for whom going out to work is desirable as a gender norm. But taken all together, the movie seems to me to whitewash a much more complex relationship between women, and one that deserves to be treated more carefully. Or it runs the risk of reinscribing the mistake made by well-intentioned middle class white women. Again.  

Gender Violence at the IAAF

In 2009, when she was 18, South African athlete Caster Semenya won the Women’s Athletic World 800m championships. Because of her superior abilities combined with her gender presentation, Semenya went on to endure very public speculation about her sex, and “gender tests” administered by the International Association of Athletics Federation (IAAF). In South Africa, her femaleness was loudly asserted by politicians as part of a nationalist response to the racism at play, and also as an explicit rejection of the proper Africanness of gender non-conformity and, implicitly, homosexuality (while I don’t know how Semenya identifies - there are a number of African options available to her, in addition to the Western rainbow alphabet - she married her long-time girlfriend, Violet Raseboya, in 2015). As scholar Mark Epprecht wrote,

“South African politicians and media… embraced Semenya as part of the South African family, but only to the extent that her femaleness and femininity were publicly confirmed. They vigorously denounced as racist those who questioned her credentials as a woman, as if gender ambiguity was an affront to the very idea of blackness and hence, an insult to all Africans” (Sexuality and Social Justice in Africa. London and New York: Zed, 2013. p.4).

This is a relevant, if tangential, point to make, because the gender bullying I want to write about today is not the province only of the racist West. While the power dynamics and the historical details may be very different, a patriarchal version of modern African identity continues to refuse to accept the gender and sexual variations that are, and always have been, as much a part of African cultures as heteronormativity. It’s also, as I’ve written about elsewhere, a tragedy: it’s the product of colonial Christianity, which imposed Victorian values on the African cultures it denigrated and sought to eliminate.

It’s important to me to say this, although it’s not the focus of today’s post. In addition, I don't want to be arguing for the quality of Semenya's femaleness, or constructing a rejection of gender non-conformity. Semenya is both non-normatively female in her gender presentation and possibly in her biology, and a woman. It's not an either/or.  

In 2015, the IAAF tried to ban Semenya from participating in world athletics because of her higher-than-average testosterone levels. At that time, they failed to prove that having higher testosterone is enough of an advantage to warrant banning female athletes with this genetic variation. Yesterday, I heard that they have now produced new regulations, focused on the distances Semenya runs, which require that female athletes with high testosterone levels take medication to lower them, or be banned from competing with other women.

Let’s leave aside the flawed science behind this ridiculous decree. Let’s even, if you can stomach it, leave aside the persistent targeting of a black woman for being too good. Many others are writing about this outrage with skill and clarity. Let’s think, for a moment, about what is at play when a person assigned female at birth, with female anatomy and a female identity (three different, and independent, markers of femaleness), is targeted for discrimination, as not female enough, because of something her female body does. These are not the only claims to female identity, but since we are engaging in the realm of “science” and its underwriting of gender norms, let’s proceed with those terms for now.

While I can’t find any reports that are not produced out of the controversial way she has been treated across the past decade, as she continues to excel, Semenya might be intersex. This does not mean she is not female. It does require us to broaden our definitions, so that women who do not look like women are “supposed to”  are not bullied and shamed for the ways they express their femaleness. Who decides how much of which kind of hormone makes someone male or female? In fact, the discovery of testosterone and estrogen as binary sex hormones was not a purely biological event. It was, as Anne Fausto-Sterling described almost twenty years ago, and as Victoria Pitts-Taylor continues to demonstrate, also political. Gender definitions have always been political.

Semenya is a woman, and her body produces higher than average amounts of testosterone. This might be one of the things that makes her fast – some others being qualities of grit, self-discipline, commitment, physical intelligence, the ability to strategize under pressure, and so on. Using her testosterone levels to ban her from running against other women is like setting a height limit for basketball players; if someone is unusually tall, and therefore has an advantage in a sport where height is a benefit, surely they have an unfair advantage over the other players. Ban them. For that matter, why not test the testosterone levels of male runners, and force those with higher than average levels to reduce theirs, so as to be fair to the other athletes? The logic is patently absurd. But there is something about the targeting of Semenya’s gender as the problem – together with her blackness, since they can’t in truth be separated – which really needs to be called out, in the midst of all the other injustices at play in this situation.

Punishing Semenya for being both female and black and very fast, in terms that call into question her gender as something that requires policing, correcting, chemical castration, seems so obviously as assertion of power, a reactive attempt to keep black women, and from there, all women, in their places. It’s vile and cowardly and wrong. It also extends its policing into the lives of all transgender, non-binary, and gender non-conforming people, all those humans who do not or cannot conform to the rules that require women and men to exist in complementary and hierarchical relation. It’s an attempt to reduce and impoverish the definitions of what it means to be human. It has to stop.

There is a lot of pushback against this ruling, and I hope there continues to be. I hope it’s quickly overturned. I want to add to my voice, and help spread the word. Please pass this on.

Reality Check

Gender affirming mental health care has come a long way;  it's no longer the norm to  assume that transgender people are deviant at worst, deluded at best. Although it remains appropriately controversial that we even need a diagnosis to ensure access to care, the DSM V’s renaming of Gender Identity Disorder in 2013 was a step forward. Now Gender Dysphoria, the diagnosis at least recognizes that a gender independent person (the term is used by Jake Pyne) does not have an identity disorder, but experiences unbearable dissonance with the gender they were assigned at birth. A lot of potential for thinking more sensibly about what it means to be trans or non-binary is made possible by this conceptual shift.

But we still have an awfully long way to go. This is obvious if we look at the current noxious political climate and the backlashes against our gains it is enabling. It’s also obvious in the physical and emotional violence that continues to be perpetuated against trans communities, and by the targeted victimization of trans women of color especially. In fact, as I was getting ready to post this today, the Huffington Post published an article which details how hate crimes against LGBTQ people are the highest they have ever been, due to Trump’s election and the rhetoric he continues to use. Again, people of color bear the brunt, with over 70% of deaths last year suffered in those communities, according to the report.

It can be easy, in the Bay Area especially, amongst our wonderful, gender affirming colleagues, to also forget the ways in which the members of the mental health establishment are still often reactive, ignorant, or unreconstructed. I recently came across an infuriating example of an article that takes the gains that have been so painstakingly made, and tries to recast them as the tainting of apparently objective scientific thought by a wrong-headed concern with human rights.

Last year, the Journal of Sex & Marital Therapy published an essay by Stephen B. Levine entitled, “Ethical Concerns About Emerging Treatment Paradigms for Gender Dysphoria.” Levine is a psychiatrist who has been involved in formulating rules for best practices and diagnosing gender-related issues. He’s well-known as an expert on human sexuality and gender. In this recent paper, Levine developed an argument he made in the same journal almost 10 years earlier (the citations are provided at the end of this post, for those who are interested). Both papers argue that there is a difference between a discourse of civil rights, designed to advance claims of personhood in a culture, and clinical pathology that needs to be named as such, and not subverted to a political cause. 

In the earlier paper, “Meanings and political implications of ‘psychopathology’ in a gender identity clinic: A report of 10 cases,” published in the Journal of Sex & Marital Therapy in 2008, Levine and his co-writer begin by asserting that an, “Emphasis on civil rights is not a substitute for the recognition and treatment of associated psychopathology” (2008, p. 40). They write about how patients “unknowingly disrespect the professional” when they “announce, ‘I am a transsexual,’ urgently want hormones, and impatiently threaten the doctor to go elsewhere” (Levine and Solomon, 2008, p. 51). They say that this political pressure is one reason professionals facilitate transitions instead of more properly treating the desire to transition as part of a profile of mental health co-morbidities.

Another reason is “the” transgender community’s (as though there were only one) rejection of psychiatry’s need to categorize. In a reductive representation of a complex debate, Levine and Solomon defend the necessity of the concept of a diagnostic category, and object to the “outrage” of advocates and community members about the necessity of a diagnosis for (what was then called) gender identity disorders: “Not only does this complicate productive dialogue between lay and professional audiences, it skews what is publicly said about these problems” (2008, p. 41). The very presence of transgender voices in a discussion about how they are understood by the profession is understood as confusing and problematic. If transgender people are allowed the right to articulate their own identities, this is wrong-headed political correctness at work. There are transgender rights, and then there is good clinical practice, and by definition, according to Levine and Solomon, they are opposed to each other.

Levine and Solomon’s “gender professional” is a bemused cisgender doctor, helplessly caught between the ethical desire to do no harm and the tantrums of confused, co-morbidly ill patients and the politicized imperatives of a crazy discourse of human rights. They appear not to consider the growing number of professionals who are also transgender or gender non-binary, and whose experiences are arguably the best place to begin looking for answers to the issues that bother Levine about gender affirmative care: that political imperatives skew clinical judgement in this arena. “When organizations mix audiences of the transgendered [sic] and professionals, professionals are not free to have an in-depth discussion of the issue. Social forces then conspire to create a gender identity problem that is not a pathology” (2008, p. 45), he and Solomon write. Implicit in this presentation of the problem is the belief that “professionals” should – indeed, to properly do their job need – to be left alone in peace to talk about the people they claim to listen deeply to. Explicit is the assertion that gender identities that are not cis are pathological.

And Levine’s thinking clearly hasn’t changed in the decade between this paper, and the one I read last year. Ten more years he has been working with transgender people vulnerable to his professional power. A decade of disrespecting the things they say about their own experiences:

"Gender incongruence or gender dysphoria could be viewed as something closer to mental illness than mental health. From a life course perspective, there is a vast array of cisgender adaptive possibilities that become increasingly apparent over time to males or females. Transgender narratives about their true identity are based on stereotypes. Equally important, if not more so, is that perceptions of the retreated-from gender are also based on stereotypes… To cis adults, these stereotypes are often offensively oversimplified notions that signify aberration if not mental illness" (2017, p. 7).

Where is the evidence that there is a generalizable pattern to “transgender narratives”? Where are the studies that show that “cis adults” (what, all of us?) are offended by said monolithic constructions? Stating something as though it were true does not make it true. Making claims in a scientific journal with no evidence is to pretend that assertions and assumptions should be underwritten by the profession just because someone who says he is a gender expert decides to make them. In fact, over the past ten years, actual research suggests the exact opposite: that if we believe the things gender independent people say, and we support them, they live happy and healthy lives (see, for just a few examples, De Vries 2014; Ehrensaft 2016; The Family Acceptance Project; Hembree 2013; Hidalgo 2013).

Levine’s evidence, if such it is, for the idea that the need to transition is pathological, lies in the list of difficulties someone is likely to face as a transgender person. He provides an appropriately scientific-looking table of “potential negative consequences” of transitioning (2017, p. 5). These include:

"Emotional distancing and isolation from family with eventual persona non grata status with married siblings with children; Exchange of friends for friends from the trans community; Greatly diminished pool of individuals who are willing to sustain an intimate physical and loving relationship with you; Become of sexual interest to a special group of men who are interested in your trans status; Eventually being neither male nor female… being in the category of trans rather than simply a man or a woman;… Higher death rates; The larger world will always regard you with suspicion."

The obvious rebuttal is that the cause of pathology here is transphobia. Levine knows this. “Stigma may not be the sole explanation for the repeated observations of adaptive disadvantages, adverse outcomes, and shortened life spans of trans individuals” (2017, p. 9), he writes. Maybe not. But insinuation is not scientific evidence; and the scientific evidence that does exist suggests that stigma (and prejudice, oppression, exclusion, and violence) is a significant part of the explanation of why many transgender individuals struggle with some mental health issues. In addition, many transgender people live loving, happy, and fulfilled lives. “Declaring trans identity as a healthy choice does not make it so” (2017, p. 9), Levine insists. But declaring it by definition an illness does not make it so either, and declaring it a choice is ignorant and disrespectful.

The number of people, including youth, identifying as transgender, non-binary, or other terms indicative of a gender expansive identity is on the rise. This is not because a discourse of human or civil rights has overtaken clinical common sense, as Levine suggests. It also does not correlate with an increase in mental illness in this population, as his argument would lead us to believe. Instead, some cultural space is finally being made for the truth of gender identity as fluid and not necessarily binary.

Transgender and non-binary children, youth, and adults who are unable conform to the binary gendered rules of Western society are not mentally ill. However, they are particularly vulnerable to punitive policing of their bodies, minds, and senses of self, especially now. Given these vulnerabilities, it is not surprising that the incidence of poor mental health outcomes is high within these groups. The antidote to this scale of mental, emotional, and socio-economic suffering is a gender affirmative understanding of the lives of transgender people – not irresponsible stigmatizing statements and counter-transferential acting out on the part of cisgender providers. And in this current political climate, such prejudice is complicit in the increase in violence being perpetrated against transgender people, as well as other folks who subvert heteronormative gender and its assumptions about sexuality by being LGB or Q.


Works Cited

De Vries, A. L. et. al. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics. 134(4):696-704

Ehrensaft, D. (2016). The gender creative child: Pathways for nurturing and supporting children who live outside gender boxes. New York: The Experiment. 

Family Acceptance Project.

Hembree, W.C. (2013). Management of juvenile gender dysphoria. Current Opinion in Endocrinology, Diabetes and Obesity 20(6): 559-64.

Hidalgo, M.A. et al. (2013). The Gender Affirmative Model: What We Know and What We Aim to Learn. Human Development. 56. 285-290.

Levine, S.B. (2017). Ethical concerns about emerging treatment paradigms for gender dysphoria, Journal of Sex & Marital Therapy, 0(0), 1-16. 

Levine, S.B. & Solomon A. (2008). Meanings and political implications of ‘psychopathology’ in a gender identity clinic: A report of 10 cases, Journal of Sex & Marital Therapy 35(1), 40-57.

Pyne, J. (2014). Gender independent kids: A paradigm shift in approaches to gender non-conforming children. Canadian Journal of Human Sexuality 23(1) pp. 1–8.