Rather than studying transgenderism scientifically, psychopathology assumes there is something wrong with being transgedered. How does this shape the way transgendered people are misconstrued?

Citation: Wyndzen, M. H. (2004). The banality of insensitivity: portrayals of transgenderism in psychopathology. All mixed up: A transgendered psychology professor's perspective on life, the psychology of gender, & "gender identity disorder". Available: http://www.GenderPsychology.org/psychology/mental_illness_model.html

The Banality of Insensitivity:
Portrayals of Transgenderism in Psychopathology

It might seem absurd to you to think of the mental health community as a major source of the insensitive portrayals of transgenderism. Afterall, by their choice of career, they seek to help. It puzzles me. When I usually think of insensitivity, I think of: bullies in school stealing lunch money, whispered gossip on the hallways, exclusion from groups, and so forth. Shockingly, the insensitivity expressed in psychopathology towards transgenderism is actually quite similar. It comes in the form of stereotypes, as the imposition of value judgements, as the assumption that transgenderism is a problem, and in a 'paternal' way of assuming they 'know what's best' for us. In short, it's a insensitivity so pervasive in psycho-pathology that it starts to appear like a normal, natural thing to do. In what follows I hope I can highlight this insensitivity and, having done so, help all of us become more sensitive in the future.

Stereotyping: "You throw like a girl."

I am a graduate student of Developmental Psychology and occasionally our university hires another faculty member. Several years ago, our child-clinical area searched for a new professor. Since both child-clinical and developmental psychology study children, I volunteered to meet with a candidate with other graduate students for lunch. At lunch he was perfectly nice, we talked about topics like our research and this or that. His research was about childhood aggression. Just after lunch he gave a job-talk (40 minute lecture on his research). I escorted him to the room and brought him water while he was setting up. He continued to strike me as a very pleasant person.

Soon the room was filled with faculty and graduate students; it was so crowded that I sat on the floor. Then everything changed. He began his talk by discussing "effeminate boys" and the "problems they have." He never actually told us what those "problems" are. It was left as simply obvious. Why did he have to use the term "effeminate" rather than "feminine?" The word "feminine" at least acknowledges the affirming aspects of femininity, like sensitivity to others. I was completely caught by surprise. I didn't know he had studied transgenderism and, though I often read value-judgement laden things about us in journals, I had never actually seen somebody, in person, say such hurtful things. How could he think that? I saw a few professors who knew about my transsexuality glance at me. What were my professors thinking? What were my friends thinking?

Fortunately he switched to discussing his current research of childhood aggression I was able to endure sitting their silently. Afterward I rushed back to my lab. I had to find out, "what are the 'problems' of effeminate boys??" After looking up his research I found out: sub-optimal ball throwing and running. In particular, when compared to control groups of typically-gendered boys and girls, he found that male-bodied children with Gender Identity Disorder (GID) are more similar to the girl group than to the boy group. Rather than using this fancy scientific-language, he could say the same thing to his participants with the following words:

"You throw like a girl!"

"You run like a girl!"

What could be worse??? Clearly a major intervention and extensive therapy was necessary to make sure these children didn't grow up without resolving this horrific problem!! Underneath this absurdity lies a genuine issue. Why did this professor only look for 'bad' stereotypes of girls in 'effeminate' boys? Why didn't he also study 'good' stereotypes to find out if, for example, his participants were also especially sensitive the feelings of others?

Later that week a professor on the job-search committee spoke to me about the talk. She assured me that all of the Social Psychology faculty were disturbed by his gender stereotyping and, though he still had some support among the clinical faculty, he certainly would not get the job.

Imposing Value Judgements: "Something is Wrong with You."

The prospective child-clinical faculty member I just discussed did his research on GID decades ago. Could the same issues be true in psychopathology today? One thing I have noticed is that researchers of GID today are, on the whole, much more careful about appearing to defend gender stereotypes. Still, psycho-pathology continues to label gender identity issues as a "disorder." Using value-laden labels like this is antithetical to science. But even if it's not science, clinicians are certainly justified in seeking to help others overcome their problems. Clinicians often figure out how to do this by using the same methods as scientists. They even may publish science in some of the same journals. But does thinking about atypical gender identities as a problem to solve bias the way they conduct science? Does it bias the way they interpret data?

Most children with GID do not grow up to become transsexuals. One way to interpret childhood gender identity conflicts is as children trying on different possible roles. There is actually a vast literature on how we try on roles as adolescents. Since gender becomes established long before roles like occupations, it makes sense to that those who will explore their options for gender roles do so at a young age. But here is the puzzle. When children try on various gender roles, they have a pathology. When adolescents try on various occupational roles, they are viewed as particularly healthy. This tendency to try on roles is called an "identity moratorium" and it's an important stepping stone to "identity achievement." Those who don't try on roles, like children who follow a career path given them by their parents, are called "identity foreclosed." This is viewed as unhealthy and is associated with bad things like being rigid in their thoughts. Given the obvious parallels you might think someone has already studied if, for example, children with GID grow up into adults who are more flexible in their thinking about gender roles. But this study has not been done. To my knowledge, there are no published studies about the affirming aspects of being transgendered. Treating transsexuality and transgenderism as mental illnesses has given researchers a myopic view of the phenomena. They seem to see only the bad, but never the good.

I do not mean to suggest that all published empirical studies of transgenderism, by those who advocate psychopathological models, contain value-judgements. One study is particularly noteworthy, to me, as an excellent work of science. It contains remarkably little value-laden language, the authors take care to avoid over-interpreting data, and they thoroughly conducted the study (e.g., including relevant control groups). The primary author is Kenneth Zucker, who is a principle advocate for the psychopathological model of gender identity incongruence. They (Zucker et al, 1999: "Gender constancy judgments in children with gender identity disorder: Evidence for a developmental lag." Archives of Sexual Behavior, v.28(6), pp.475-502) found that children with GID lag behind typical children in going through Kohlberg's stages of gender understanding. These stages are milestones in children's growing tendency to essentialize gender (e.g., if you cut a girl's hair short & put her in pants, she is still a girl). While doing science, Zucker was able to avoid imposing his value-judgements.

About a year later, Ken Zucker published a chapter about GID in the "Handbook of Developmental Psychopathology" (Zucker, 2000: "Gender Identity Disorder" in Sameroff, A. J.. Lewis, M., et al, (Eds), 2nd ed., pp. 671-686). In it he refers to this study as revealing a possible cognitive deficit/deficiency in children with GID. Even though Ken Zucker could write a single article as a work of science, out of that context he returned to interpreting the results as something bad about these children. This is quite striking. Some branches of feminism oppose an essentialist model of gender. There is an on-going debate in Developmental Psychology about the value of constructivist versus essentialist models of gender (e.g. see Liben & Bigler, 2002: "The developmental course of gender differentiation: Conceptualizing, measuring, and evaluating constructs and pathways" in "Monographs-of-the-Society-for-Research-in-Child-Development" v.67(2)). Of course, it's completely okay for Ken Zucker to personally believe an essentialist understanding of gender. Debate is healthy. But it is disconcerting to see him describe those on the other side of the debate, those who have another model of gender, as having a cognitive deficit.

Name Calling: "You're 'really' a man."

Nobody is purely a scientist in everything they do. For example, even though I know some research about teaching, I teach primarily with intuition about how to best communicate with students. Psycho-pathologists with an interest in science seem, to me, to share a similar view. When they treat clients they primarily use their intuition even when they have knowledge about the research. There is nothing wrong about having non-scientific beliefs. I do. But what can be disconcerting is how sometimes the language of science, with it's implied objectivity, can be used to advance non-scientific beliefs. It is especially disconcerting to me, as a transsexual, when the belief that some male-to-female transsexuals are 'really' men is advocated as though objective science.

Anne Lawrence made widely-known to the transgendered community a scientific theory about us, Ray Blanchard's mis-directed sex-drive model of transsexuality. In particular, she focused on Blanchard's notion of "autogynephilia" because it was something that greatly helped her understand herself. "Autogynephilia" is a theoretical term describing how some MtF transsexuals can become enamored with sexual fantasies of themselves as women, and consequently seek to become women.

Lawrence titled her first essay on Blanchard's model, "Men Trapped in Men's Bodies." It's a clever pun on the old cliche definition of transsexuality. I imagine it's also a bit self-deprecating in that it kind of admits she's worried she's still a man if Blanchard's model is correct. Her humorous response is understandable. Often people turn their fears into humor; think of the classic sit-com MASH. No, no, no, not Klinger!!! Think of the main doctors who used humor as a way to cope with the situation they found themselves in. Anne Lawrence was severely, and I feel unfairly, criticized for sharing her beliefs. I would guess what her essay really dredged up for others was that many of us share this fear: maybe we are 'really' our biological sex? That is, I personally doubt it is so much her belief in Blanchard's model that upset people, but rather what upset transsexuals most was the implication that science could be saying we're really our biological sex. For this reason, even though I appreciate why Anne made the choices she did, I wish she had chosen different words.

Our fears were reignited with the release of J. Michael Bailey's book. Throughout the portion of the book on MtF transsexuality is the implication, in supposed accordance with Blanchard's model, that MtF transsexuals are either 'really' gay men or 'really' straight cross-dressing men. He even uses Anne Lawrence's pun as a title for one of his chapters. Of course, it's completely J Michael Bailey's prerogative to personally believe we are really our biological sex. He would certainly not be the only person who believes so. What worries me is that he conveys with the title of his book that he is revealing the "science" of gender-bending. But the belief that we are 'really' our biological sex is not science, it's a personal philosophy. I hold another philosophical belief. To me, causality is not the defining attribute of category membership. In this particular application of my philosophy, this means the accuracy or inaccuracy of Blanchard's model does not say anything about if we are 'really' men or women. It's disappointing that those studying transsexuals do not take greater care to distinguish their own philosophical and personal beliefs from science.

Personal beliefs do not only influence scientific accounts intended for a general audience. I often read the psychological literature about transsexuals. It's actually sometimes hard for me to read it. We're referred to with gendered terms like "he" and "she" as though we are our biological sex. But all MtF transsexuals should be discussed as "transsexual women" and all FtM transsexuals should be discussed as "transsexual men." When making reference to out sexuality, it should be consistent with our gender identity. For example, a MtF transsexual who is attracted to men should be viewed as a straight transsexual women but instead she is often called a "homosexual transsexual." This may seem obvious, but rarely does the psychological literature treat us so kindly.

You might believe psychology just has some particular standard which bounds researchers to write this way? Perhaps there is a bias to favor biological categories (i.e, anatomical sex) instead of psychological categories (i.e., gender identity)? There is not. Actually, the standards really suggest we should be discussed as members of our target sex. There is a publication manual for the American Psychological Association (APA) that should be followed for all APA accredited journals. Among the many other standards is the need for appropriate use of language in referring to your study's participants. Your participants should never be dehumanized; the participant should be described as a person "participant" instead of a passive almost-rat-like "subject." Care should be taken to refer to people by language that is not offensive to those people. The APA manual gives examples of race and sexual orientation. Even though transsexuals are not explicitly mentioned, this applies to us as well.

Cynicism: "What are your 'real' motives?"

A widespread cynical belief among clinical psychologists who study "Gender Identity Disorder" and "Transvestic Fetishism" is that transgendered people are deceptive. This belief is especially popular among advocates of Blanchard's mis-directed sex-drive model of transsexuality. At researchers' least sophisticated moments, this cynicism has bordered on turning Blanchard's scientific theory into an unfalisifiable, unchallengable, unscientific dogma. When researchers' are most concerned about self-presentation, they give a particular slant to certain findings. To illustrate what a "self-presentation concern" is, consider when you go on a job-interview. You try to put your "best foot forward". That is a self-presentation concern because you are always thinking "in the back of your mind" about the impression you are giving others. Ray Blanchard, Leonard H. Clemmensen, & Betty W. Steiner (1985) "Social Desirability Response Set and Systematic Distortion in the Self-Report of Adult Male Gender Patients" suggests that the more concerned transsexuals are with self presentation, the more likely they are to present themselves like the stereotypical transsexual (e.g., being sexually pure with no fantasies, being like their target sex as children). These findings are used to suggest that transsexuals who deny matching Blanchard's model are lying. Is this a valid interpretation?

Let's imagine we found in a rich all-white community that those most concerned with self-presentation were least likely to acknowledge racial prejudice. Does this mean that rich white people are racists, regardless of what they say? Of course not. What our hypothetical findings suggest is that racist beliefs are something rich white people believe are embarrassing or taboo to discuss. That is, our findings tell us more about the culture rich white people live in than about rich white people themselves. Let's imagine we found that among researchers of GID, those most concerned with self-presentation are also those least likely to endorse gender-stereotypes. Does this mean that researchers of GID are sexist? Of course not. What our hypothetical findings suggest is that researchers of GID find it embarrassing or taboo to gender stereotype. That is, our findings tell us more about the culture GID researchers live in than about GID researchers themselves. What do Blanchard's findings tell us about transsexuals? Do they mean that transsexuals are kinky or act like their biological sex as kids, regardless of what they say? Of course not. What the findings suggest is that transsexuals find it embarrassing or taboo to discuss kinky sexual fantasies and they find it affirming to discuss their childhood cross-gender experiences. That is, the findings tell us more about the culture transsexuals live in than about transsexuals themselves. A similar cynical over-interpretation of data is drawn from the study by Ray Blanchard, I. G. Racansky, & Betty W. Steiner (1986) "Phallometric Detection of Fetishistic Arousal in Heterosexual Male Cross-Dressers"

Perhaps the most unhealthy conflict between transsexuals and researchers of atypical gender surrounds this tendency to accuse one another of having devious motives. Once we decide the other group has sinister intent, it is often incredibly easy to find "just so" stories that describe those we dislike unfavorably. J Michael Bailey's book, "The Man Who Would Be Queen: The Science of Gender Bending and Transsexualism." provides several examples of how easy it is to portray transsexuals and other transgendered persons this way.

For a moment, let's flip around this idea and look for what might be equally sinister motives that transsexuals could ascribe to Bailey and colleagues. For example, let's take the endorsement of Blanchard's model in the DSM and HB-SOC. Why these endorsements despite the lack of scientific evidence for Blanchard's model? Here is one plausible "just so" story:

GID researchers, as old white men who gender stereotype others, are unable to tolerate transsexuals as having legitimate genders. They labeled transsexuals as having a pathology. That's why earlier versions of the DSM focused on how transsexuals suffer in the biological sex roles. But they came under criticism for imposing gender stereotypes on transsexuals. Others said, "Why do you have to say there is something wrong with a male-bodied child who throws like a girl?" GID researchers became concerned, "What if we lost control of transsexuals? They pay us so much money for the therapy we force them to accept if they want surgery. Controlling another's fate makes me feel powerful. Saying something is wrong with another makes me feel there is something right with me. ... Wait, I have a new idea! Really transsexuals are just people *obsessed* with being their target sex. See, those transsexuals are gender stereotyping, not us. In fact, that's there big problem! They had better keep seeing us for therapy if they want surgery. Whew, seeing that transsexuals have bad gender beliefs allays my fears that I might be bad. And better still, let's describe their obsession as sexual! Since people in a prudish society have a natural reluctance to talk about sexuality, we can easily get the scientific finding that higher self-presentation concerns mean the less someone admits to sexual things. So any transsexual who denies our claims is lying and any transsexual who agrees with us provides supporting evidence. We can't lose!" GID researchers looked for another 'spin' on transsexuality to help them feel better and preserve their control. Finding Blanchard's model most consistent with their new 'spin', they wholeheartedly adopt it.

Of course, I do not really believe the above "just so" story despite it's remarkable correspondance with many facts. It simply illustrates how easily I could put together facts to make a plausible cynical account. We need to be cautious about our cynicism and our imagination that we know the motives of those we disagree with. This is true for both the transgendered and the mental health communities. Whatever the extent GID researchers are justified in challenging the motives of transsexuals, is the extent to which transsexuals are justified in challenging the motives of GID researchers. Yet neither transsexuals nor GID researchers are nearly so sinister as they sometimes suggest is true of each other. I hope we can all stop impugning the motives of others, and instead focus on coming to understand one another.

Sensitivity or Science: Must We Choose?

Many people see sensitivity as important in and of itself. Many people also see developing a scientific understanding as important in and of itself. So far in this essay I have focused on how insensitive the science of Gender Identity Disorder has been. What can be said about the quality of science in light of this insensitivity? One possibility is that we have to choose between being scientific and being sensitive. This argument is often embedded in the words of scientists who like to promote themselves as "politically incorrect." For example, J. Michael Bailey "likes to call himself politically incorrect" according to the June 2003 issue of the Chronicle of Higher Education. In this interview, J Michael Bailey says, "I can't be a slave to sensitivity." If he is right I am faced with a huge dilemma. It's important to me to be both sensitive and a scientist. What if I can't do both? Fortunately for caring scientists, several preceding points suggest viewing sensitivity and science as mutually exclusive is wrong.

Sensitivity actually helps science. It is not a hindrance. When you are sensitive you observe more acutely. When you are sensitive you can put yourself in the place of your participants and see your study from their perspective. This can help you see other ways of interpreting your data. I find this also helps me understands the subtleties of my participants' behavior. Insensitivity actually can harm science. Consider the previous example of how some sexologists think of male-to-female transsexuals are really men. What influence might this insensitive assumption have on research? Many studies from many areas of psychology, like developmental and social psychology, show that context and labels of people can change evaluations or further categorizations. One example comes from the social psychology of prejudice. A participant in this study is told either a construction worker or housewife hit somebody. When asked to elaborate, the construction worker is characterized as having been more violent than the housewife (Kunda & Sherman-Williams, 1993; Krueger & Rothbart, 1988). Participants' stereotypes of men as more violent than women lead than to interpret the violent acts of men as more violent than the same acts by women.

Could the stereotype of men as more sexual than women bias science? Consider Ray Blanchard's claim that male "non-homosexual transsexuals" (meaning transsexual women not exclusively attracted to men) have an atypical sex drive. To find this out, a scientist would typically compare transsexual women to a control group of typically-gendered women. Blanchard did not have this control group. A peer-review didn't lead Blanchard to revise his methods. How could a study with such an obvious methodological flaw be published? Compare Blanchard's study to the previous example about prejudice. Replace housewife with women, construction worker with 'non-homosexual' MtF transsexual, and hit (violent act) with sexual act. That is, 'non-homosexual' MtF transsexuals are viewed as being more extreme in their sexual acts than women are in their sexual acts. I suppose the prejudice that comes with classifying MtF transsexuals as men was such "common sense" for sexologists that they felt no control group was necessary? Had Blachard and other sexologists been more sensitive, their work might have been published without such an obvious and easy-to-correct methodological flaw.


It's somewhat surprising to think about the mental health community as so insensitive to their transsexual clients and research participants. Afterall, by their choice of career, they have sought to help transsexuals. Many of them do and it would be a mistake to construe this essay as an attack on the mental health community. Yet, as the above examples illustrate, there is also a great deal of insensitivity embedded in this help. It's an insensitivity that is so commonplace, and so embedded in the way they think, that it is banal. Some GID researchers will describe us as fundamentally our biological sex. They talk about our gender atypicality as something that is wrong with us. In their research, they always seem to look for what is bad about us, never what is good. And when we don't fit the theories of GID researchers, they impugn our motives as a devious part of our 'pathology.' The root of the mental health community's sensitivity for transsexuals is their desire to help. The root of the mental health community's insensitivity for transsexuals is also in their desire to help. In particular, by classifying transsexuality and transgenderism as mental illnesses, they make who we are something bad. This is very different from the way they help the gay and lesbian community.

If a man walks into a therapists office very depressed because he is attracted to men, the therapist diagnoses him with depression. Afterall, "depression" is the name of his suffering. The therapist does not diagnose his problem as "homosexuality." Yet when a depressed pre-transition transsexual seeks to transition, they are diagnosed with a label about who they are, "Gender Identity Disorder" rather than a statement about how they are suffering, "depression." This way of labeling transsexuals is more profound that a code-number for insurance. It sets up an entire, insensitive way of viewing transgenderism. Transgenderism becomes viewed as the problem, rather than part of who were are, for better or worse. To begin to understand one another better and to advance our scientific understanding of atypical-gender, I hope the mental health community will remove "Gender Identity Disorder" and "Transvestic Fetishism" from their lists of mental illnesses.

Seeing how the transgendered and mental health community treat each other with insensitivity deeply touches me from multiple perspectives. I'm a transsexual and I'm a psychology graduate student. As a transsexual, I read the clinical psychology literature about us; I'm always disheartened by the way we're portrayed. I feel like we're viewed by much of the clinical research in very simplistic terms and more like lab-rats than true persons. Every day I'm designing experiments and running studies to try and understand how children grow and learn. My participants constantly amaze me. I'm truly in awe of children. What they teach me during my studies pushes me to dig deeper into the issues surrounding child development. I only wish those researchers studying transsexuals could and would experience the same awe when looking at the lives of their participants too.