Take a look, if you will, at the composite featured image.  There’s a story behind this picture.

It’s from my second module in a PowerPoint series titled The Transgender Peoples.  At the end of each module I include some “Discussion Points” to raise awareness and get people to exchange ideas.

Part of that story pertains to the previous frame showing a picture of friends in the support group Transgender San Francisco (TGSF) almost 2 decades ago.  I ask the question, “What kind of lives do you think these people live?”  Answers often include such things as “drag queen”, “escort”, and an array of menial positions.  The true professions of these people include: a nurse, a construction estimator, a manager, a physician, a supervisor, a CEO, and a paralegal.

They all held important positions in their respective firms.  The question underscores human presumptions about transpeople and their societal worth.  I then post this frame which typically leaves the room silent.  The person to whom I refer in this frame was Janis Ryan, then Secretary of TGSF.  She was a cross dresser.  She was proud of her status as “transgender”.  Out of hundreds of members, she was the one to welcome this writer to San Francisco and to console me with friendship after rape.  She did her best at information booths on trans issues, genuinely an exemplary example of trans citizenship.  She died in October 2001, and was understood to have been starving.

Consider also the seated figure.  She described herself as “bigender” back then.  Indeed, she could cross between male and female roles with ease and without fanfare.  She wasn’t exactly “gender non-conforming” because in either role she conformed very effectively.

To this writer’s knowledge, only one of the people in this photo transitioned.  Yet by the “scientific” definition of “transgender”, only that one person would be defined as “transgender”.  The rest are excluded, though might be considered “trans*” (some have removed the asterisk) to follow a broader “umbrella term” without universal acceptance.  What distinguishes this growing disparity and how it came about needs to be understood.

 

“SCIENTIFIC” SUBJECTIVISM AND THE VEIL

The “scientific” definition of “transgender”, as it has been promoted, states the following:

“‘Transgender” refers to having a gender identity that differs from one’s sex assigned at birth.”¹

But how scientific is this definition?  Could and should it be refined?

What can be considered “scientific” must follow conventions of the Philosophy of Science, most particularly with the development of theory based upon proven hypotheses concerning observed and measured phenomena.  Those proofs must involve the use of Mathematics in some way.  Without numbers, you don’t have a science.

That’s a problem when it comes to gender identity.  How do you measure gender identity?

It recalls the philosophical problem called the “Veil of Perception.”  To understand the concept, consider this analogy:

“A friend works in an office behind a closed door and you are the only means of his communicating with the outside world.  You have gained a right of admittance to his front desk to report on what’s happening on the outside.  Your friend trusts you.  But does your friend know with certainty that what you report is true?  He does not.”²

Corresponding to that, your friend represents consciousness the mind.  You as messenger represent the senses.  The “Veil of Perception” denies that our senses can tell us with certainty that the world we see outside is real or true.  After all, it could all be just a deception like The Matrix.

If we question what goes on outside our own heads, can we be so sure about what goes inside the head of another person, presuming, of course, we accept that that mysterious other is indeed a being like ourselves?  Not really.

What we do instead is trust our own intuitions, producing forms, or mental constructs upon which we test a priori ideas we may have concerning the other in a synthesis, much in the spirit of Immanuel Kant in his Critique of Pure Reason.³

It’s a presumption built upon Cartesian Foundationalism, trusting in what’s “indubitable” within an accepted modal reality like our judicial system does in which cases must be proven “beyond a reasonable doubt.”⁴

When it comes to measuring gender identity, the best we can do is measure the relative pain of gender dysphoria much as do medical assistants who ask a patient on an “Owie Scale” of 1 to 10 how much pain they feel.  It’s a subjective measure.  But it’s the most effective tool one has.  While we have statistics regarding transpeople, those statistics don’t by themselves make a diagnosis either.  They require something else beyond one’s internal sense of gender.

Despite various MRI and other brain scan studies being done in various trans studies, we haven’t established conclusively that we can diagnose gender dysphoria with an MRI.  We aren’t at the point in which we can tell a patient whether they have gender identity issues on a scan, whether that patient confirms it or not.⁵

Corresponding to the inexactness of this view, a whole school of thought has arisen.  This view developed by a party referred to here as “Subjectivist”, has also propagated the following ideas, even to the point of militancy:

1. Gender is an internal construct of one’s relationship to sex and societal norms concerning it.
2. Gender dysphoria as described in the Diagnostic and Statistics Manual, Version V (DSM-V), is self-diagnosed.⁶
3. Medical gatekeeping is inappropriate and should be abolished, delegated to an option not related to transition.
4. Medical gatekeeping should be replaced with treatment on the basis of “informed consent.”
5. Gender dysphoria alone defines the transgender.
6. Gender non-conforming individuals are separate from transgender individuals, despite the fact that they fit the “scientific” definition of “transgender”.
7. “Transgender” pertains to the transsexual only.
8. The word “transsexual” is a pejorative.⁷
9. Perceptions others have concerning a person’s gender are irrelevant.

 

THE RISE OF PERCEPTIONISM

In 1993, a remarkable trend began in San Francisco.  We read from the document primarily compiled in 1994 by Dr. Jamison Green titled, Investigation Into Discrimination Against Transgendered [sic] People:

“In spring 1993, the Lesbian/Gay/Bisexual Advisory Committee of the Human Rights Commission [not to be confused with the Human Rights Campaign which had no part in these proceedings] seated Kiki Whitlock as the first self-identified transgendered [sic] member. The Committee then organized the Transgender Task Force as a subcommittee chaired by Ms. Whitlock, and charged it with coordinating educational presentations. Over a period of eight months, representatives of the transgender community gave a series of presentations to the Committee. These presentations demonstrated to the Committee the diversity and depth of the transgender community, and the extent of the discrimination affecting it. On February 24, 1994, the Commission voted to amend the Advisory Committee’s name to add the word Transgender, and also voted to hold a public hearing to investigate discrimination against the Transgender Community.

“The public hearing, held May 12, 1994, was attended by Commissioners Abrahamson, Daddio, Davis, Fong, Jaber, Lazam, and Rynerson, Commission Director Lee, Robert Oakes representing the Office of Mayor Frank Jordan, Supervisors Terence Hallinan and Kevin Shelley, and representatives of the City Attorney’s Office, the Human Resources Department, Department of Public Health, Department of Social Services, Police Department and Sheriff’s Department. The purpose of the hearing was to investigate the extent of discrimination against the transgender community and to permit the community at large to air its views regarding the need for protective legislation to alleviate the victimization and exploitation of transgendered [sic] people.”⁸

The appointment of Kiki Whitlock occurred in the same year as the passage of Municipal Proposition L, in which voters willed that transpeople should enjoy civil rights protections, though these protections were limited to practices in the City and County of San Francisco.

Much of the testimony presented in this document from the May 12 hearing emphasizes that the transgender experience is distinct from that of gays and lesbians, and that frightening levels of discrimination on the basis of transgender status demands public action.  Dr. Green wrote the following, much of which articulate a similar view articulated today:

“From the very limited studies that have been done to date, it’s estimated that 1 to 3% of the world’s population is transgendered. [sic] Gender dysphoria, defined as “persistent discomfort and sense of inappropriateness about one’s assigned sex,” may occur in milder forms, and transsexualism is characterized by a profound and persistent crossgender identification. This is not easy to sustain in the face of ridicule and threats of or actual physical harm. But transgendered [sic] people do sustain it because to do otherwise is to live a lie, and sometimes they die in the streets for it.

“Most people experience their gender identity as being the same as their physiological sex regardless of their sexual orientation. We have been culturally conditioned to believe that gender and sex are the same thing. The terms are used interchangeably, but in fact they are very different. Sex is the type of genitals we have— male or female; sex is something that we do with our bodies when we engage in intimate physical relations with another person. Gender is the expression of masculinity or femininity, which is a sense of self, a reflection of spirit or soul, and which is perceived by others using numerous social signals that have nothing to do with one’s sex or sexual orientation. When people hold the conviction that gender identity or presentation and physiology must be the same, their reaction to an individual who contradicts that conviction is confusion, agitation, [and] even rage. When we use terms like sex “roles” or gender “roles,” our language subtly conditions us to doubt the authenticity of a person’s self-expression.

“Transgender, in its broadest sense, means mixing elements of both genders, sometimes both sexes. The category covers cross-dressers, transsexuals, masculine women and feminine men. Victims of “gay bashing” are often singled out for their transgender characteristics, which is assumed to—but may not always—reflect an individual’s sexual orientation.”⁹

From this, the Human Rights Commission gave this as the second of their findings:

“That the term Transgender is used as an umbrella term that includes male and female cross dressers, transvestites, female and male impersonators, pre-operative and postoperative transsexuals, and transsexuals who choose not to have genital reconstruction, and all persons whose perceived gender or anatomic sex may conflict with their gender expression, such as masculine-appearing women and feminine-appearing men.”¹⁰

This version of “perceived gender” would have far-reaching implications for civil rights law in the State of California.  The same Human Rights Commission would enshrine this view in the 1998 document Compliance Guidelines to Prohibit Gender Identity Discrimination:

“’Transgender’ is used as an umbrella term that includes female and male cross dressers, transvestites, drag queens or kings, female and male impersonators, intersexed [sic] individuals, pro-operative, post-operative, and non-operative transsexuals, masculine females, feminine males, all persons whose perceived gender or anatomic sex may be incongruent with their gender expression and all persons exhibiting gender characteristics and identities which are perceived to be androgynous.”¹¹

This issue of “perceived gender,” as articulated by the Human Rights Commission, was the issue discussed in California civil rights cases from the time of the passage of AB 196.  This law, which modified the Government Code and championed by Theresa Sparks and then Assemblymember Mark Leno, redefined “sex” for the state as including “perceived sex.” It also added this to the Government Code:

“SEC. 2.  Section 12949 is added to the Government Code to read:

12949. Nothing in this part relating to gender-based discrimination affects the ability of an employer to require an employee to adhere to reasonable workplace appearance, grooming, and dress standards not precluded by other provisions of state or federal law, provided that an employer shall allow an employee to appear or dress consistently with the employee’s gender identity.”¹²

AB 196 made California the 4^th state (after Minnesota, Rhode Island, and New Mexico) to recognize civil rights as applicable to transpeople, and this has been fortified with even more sweeping changes in favor of transpeople in later years reflecting differences between sex and gender.  The strength of California trans rights thereafter relied upon the fact that the sex or gender one perceives, regardless of who may perceive it, is not a material fact in hiring, housing, and other practices. 

 

TENETS COMPARED

Let’s see how the 2 schools of thought compare:

1. The Perceptionist agrees with the Subjectivist that gender is an internal construct of one’s relationship to sex and attached societal norms but asserts that this must be evaluated in terms of reports of what is perceived and who perceives them.
2. The Perceptionist denies that gender dysphoria as described in the Diagnostic and Statistics Manual, Version V (DSM-V), is self-diagnosed, as diagnosis carries legal implications particular to the health professions, but that patients may suspect gender dysphoria like a patient can any disease.
3. Unlike the Subjectivist who desires to abolish medical gatekeeping, the Perceptionist regards medical gatekeepers as educators for the examination of issues related to transition and other matters, noting, as did Plato that the “unexamined life is not worth living,”¹³ and knowing that we often fool ourselves into believing unreasonably rosy expectations. However, the Perceptionist recognizes that profound abuses have taken place in the medical and psychiatric fields, some representing gross ethical violations, and some due to lack of training and the sketchiness of a still developing epidemiology.
4. Both Subjectivist and Perceptionist accept the idea of “informed consent.” The Subjectivist version of “informed consent” isn’t shared by the Perceptionist. To the Subjectivist, the internal pain of gender dysphoria is enough to demand transition and what may come with it.  The Perceptionist regards the applicability of transition only to those whose perceptions are shared not only by the patient, but where others echo similar perceptions, and that the radical procedures of transition would genuinely benefit the patient.  Unless these factors are taken into account, “informed consent” isn’t truly “informed”.  Consequently, psychiatric professionals are amiss if they fail to educate on these issues and that failure could potentially jeopardize medical licenses.
5. The Perceptionist defines the transgender by perceptions of gender that vary from one’s assigned birth sex, not strictly according to what a person feels. It doesn’t matter who perceives that variation, whether those perceptions are the patient’s or those with whom the patient interacts.
6. Whereas the Subjectivist excludes gender non-conforming individuals from what they call “transgender”, the Perceptionist has no trouble including them.
7. Whereas the Subjectivist regards only transsexuals as “transgender”, the Perceptionist regards the set of all transsexuals as a subset of the set of transgender people.
8. Whereas the Subjectivist may regard “transsexual” as a pejorative, the Perceptionist does not. The Perceptionist regards the Subjectivist version of “transgender” as divisive in its exclusion of those not transsexual.
9. Whereas the Subjectivist considers the perceptions of others as irrelevant, the Perceptionist takes them into account as indicative of a shared need of others in the broader trans community.

In fact it’s in the psychiatric area where the mathematics should most readily take place in which treatment is based upon science and not an emotional state.  While no scale exists for intensity of gender dysphoria, we do have the Rules of Inference and truth tables applicable to Boolean Algebra and other areas of Discrete Mathematics that should govern the reasonableness of decisions.  It’s the stuff of Logic and psychiatric professionals need to make determinations with legal implications based upon logic in the light of the facts that continue to emerge from long range epidemiological studies and surveys.  We have numbers in terms of years of persistence and persistence is one of the criteria for considering a candidate for transition.  We also have a wealth of statistics applicable to medicine, legalities, and social work that didn’t exist in the 1990’s.  While none of these by themselves make a diagnosis, in the hands of a competent professional, reports concerning perceptions can be evaluated against these sets of data and reach for improvements in outcomes.

 In short, if a therapist can’t also be a well versed logician, the same shouldn’t be a therapist.

The meaning of “transgender” should correspond to its etymology: (Latin trans = “across” + gender).  In other words, there’s some manner of crossing the societally established lines of gender.  This could represent temporary changes in sex roles and appearance in the case of cross dressers; and changes in these and anatomy in the case of transsexuals.  Others may cross over in ways particular to them.

The Perceptionist definition may follow thus:

“Transgender’ refers any individual whose perceived gender identity or expression does not match the sex assigned to that person’s assigned birth sex.  Those perceptions may be internal to that individual, external from that individual, or both.”

 

IMPLICATIONS

The Perceptionist view confirms the approach the medical and psychiatric community has long taken with respect to transpeople.  If a patient identifies, presents, conducts, and is perceived by others to be one sex or another, the patient is that sex.  It’s like the popular analogy: “If it walks like a duck and quacks like a duck, it’s a duck.”

It’s similar to the approach taken by this writer’s endocrinologist who assisted in securing a temporary passport for surgery in Thailand:

“This patient has identified with the female gender since childhood.  She is psychologically normal.  Ms. Stuart self-identifies as female, and has undergone extensive treatment to irreversibly alter her gender form [sic] male to female. She presents as female, appears female, and identifies as female.  She lives full time in her target female gender.”¹⁴

More importantly, the Subjectivist must juggle definitions of “transgender”:  the exclusionary term based upon gender identity only, and the more inclusive “umbrella term.”  The Perceptionist does not.

When militant Subjectivists overly rely upon the former definition of “transgender”, some very ugly divisions result in the trans community.  Not a few cross dressers have expressed to this writer how they have felt ostracized from the trans community despite the fact that cross dressers have contributed much to the advancement of the trans community over the years.  Certainly, not all should transition and many feel no need to transition.  The transition of one does not invalidate the narrative of the one who feels no need to do so and all narratives are applicable to civil rights.

Assertions of Subjectivism in media have also led to mistreatment of masculine-appearing females and feminine-appearing males.  One who may be a tomboy does not need to transition and very likely will resent suggestions that she will, leading to rejection of the “transgender” term altogether, and potentially, the community associated therewith.¹⁵ Tomboy narratives are as valid as transsexual narratives and deserve the same level of respect.  The same is true for butch-dyke lesbians and impersonators of males and females.  Drag queens and kings should not feel compelled to separate from the trans community.

Unfortunately, one group, traditionally associated with the trans community and who has given much to its advancement has decided to go its own way.  In March 2007, intersex people in Australia declared themselves a “separate and distinct” people from transgender people and called upon the trans community to recognize their status as such, and we must honor this as allies.  This declaration, called the Darlington Statement, is now guiding a new movement to parallel that of the trans community.  This appears to have occurred at a time corresponding to the wide assertion of the Subjectivist definition:

3. The diversity of our sex characteristics and bodies, our identities, sexes, genders, and lived experiences. We also acknowledge intersectionalities with other populations, including same-sex attracted people, trans and gender diverse people, people with disabilities, women, men, and Indigenous – Aboriginal and Torres Strait Islander, Tangata Whenua – and racialised, [sic] migrant and refugee populations.

47. Intersex is distinct from other issues. We call on allies to actively acknowledge our distinctiveness and the diversity within our community, to support our human rights claims and respect the intersex human rights movement, without tokenism , or instrumentalising, [sic] or co-opting intersex issues as a means for other ends. “Nothing about us without us.”

48. We encourage all organisations [sic] and bodies that support the intersex movement to recognise [sic] this Darlington statement [sic].¹⁶

Clearly, the intersex community is doing what we in the trans community have collectively failed to do: address those issues particular to intersex people while giving undue emphasis to transsexual issues.

This writer returns again to the memory of the stalwart Janis Ryan.  Many died like Janis did, the one on the far right in my presentation.  She died proudly.  However, she would be excluded from being considered “transgender” by many people today.

This writer cannot with good conscience accept a systemic definition that betrays people like Janis who have given so much.  We must stand together in all our diversity, or the very idea of a trans community will continue to fragment into subgroups left to fend for themselves.  We began to see it in the Darlington Statement.  We may expect to see more in the future because the Subjectivist view has been widely embraced and change won’t happen quickly.

__________________________

REFERENCES:

Featured Image:  Frame 20 of Module II of The Transgender Peoples (2017 version) by Lynnea Urania Stuart

Except where otherwise noted, the author relies upon her own recollections and experience.

1. (n.a.) “The Psychology of Transgender: Eight questions for transgender expert Walter Bockting, PhD” American Psychological Association (November 19, 2015, accessed April 5, 2018) http://www.apa.org/news/press/releases/2015/11/psychology-transgender.aspx.
2. This analogy is a version taught in college Philosophy courses.
3. Kant, Immanuel. “Critique of Pure Reason” The Basic Writings of Kant (Modern Library, 2001) ISBN: 0-375-75733-3, pp. 70,71.
4. (n.a.)” Cartesian Foundationalism” (accessed April 5, 2018) http://spot.colorado.edu/~heathwoo/Phil100/descartes.html.
5. Lajos Simon,  Lajos R. Kozák,  Viktória Simon,  Pál Czobor,  Zsolt Unoka,  Ádám Szabó,  and Gábor Csukly; Lajos Simon, Lajos R. Kozák, Viktória Simon, Pál Czobor,  Zsolt Unoka,  Ádám Szabó, and Gábor Csukly Gaolang Gong, Editor. “Regional Grey Matter Structure Differences between Transsexuals and Healthy Controls—A Voxel Based Morphometry Study” NCBI (December 31, 2013, accessed April 5, 2018) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3877116/.
6. Helen Okoye, MD, MBA, MS-Epi. “Gender Dysphoria DSM-5 302.85 (F64.9)” Theravive (accessed April 5, 2018) https://www.theravive.com/therapedia/gender-dysphoria-dsm–5-302.85-(f64.9).
7. “Why is the term transsexual considered offensive lately?” Quora (4 answers accessed April 5, 2018) https://www.quora.com/Why-is-the-term-transsexual-considered-offensive-lately.
8. Green, Jamison, et al. Investigation Into Discrimination Against Transgendered [sic] People (Human Rights Commission, City and County of San Francisco, September 1994) p. 5. Reference
9. Ibid, p. 9.
10. Ibid, p. 41.
11. Human Rights Commission. Guidelines to Prohibit Gender Identity Discrimination; respecting San Francisco Administrative Code Chapter 12A, 12B, 12C; and San Francisco Municipal Police Code Article 33 (City and County of San Francisco, 1998), p. 3.
12. Leno, Mark. AB 196 (Chaptered August 3, 2003) http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=200320040AB196.
13. Plato Apology 38a5-6.
14. Letter from Richard S. Horowitz, M.D., F.A.C.P. to the United States Department of State, Los Angeles Passport Agency, September 18, 2007.
15. Lisa Selin Davis. “My Daughter Is Not Transgender.  She’s a Tomboy.” New York Times (April 18, 2017, accessed April 5, 2018) https://www.nytimes.com/2017/04/18/opinion/my-daughter-is-not-transgender-shes-a-tomboy.html.

Darlington Statement: Joint consensus statement from the intersex community retreat in Darlington, March 2017, pp. 3, 8. https://ihra.org.au/darlington-statement/