Anti-diagnosis of gender

In recent years, there has been some debate about the Gender Identity Disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), and in particular whether we have any good reason to refer to it In the book, or rather, we don't really have many good reasons to keep this diagnosis anymore. On the one hand, those in the LGBTQ community who want to preserve the diagnosis argue that it certifies a condition and opens up the possibility of using various medical and technological means to change it. Also, insurance companies will cover some of the very high costs of a sex change if they deem the change "medically necessary." For these reasons, it is important not to think of gender affirmation surgery or hormone use as "surgery of choice." Though one might say that it is a choice, even an exciting one with profound reasons, the choice must be a medical one because of the question of who pays for the insurance. What exactly are medical options? This question will no doubt give us some food for thought, but for the purposes of making my point, I think it's important to distinguish between two situations; diagnostically determined options and non-diagnostic decided options. In the latter case, the choice to change includes some or all of the following: choosing to live as another gender, undergoing hormone therapy, finding and proclaiming a new name, ascertaining a new legal status for one's gender, and undergo surgery. It would seem that the option of such a change is medically acceptable if it is recognized by psychological or medical practitioners as necessary, that is, if they believe that the absence of the change would produce distress, maladjustment, and other forms of suffering. The support and forgiveness of the workers, because they always care about people's health and happiness. This "diagnosis" can work in several ways, but one of the ways it can and has worked (especially in the hands of transphobic people) is as a tool for pathologizing.

To be diagnosed with Gender Identity Disorder (GID) is to be considered sick, disgusting, wrong, out of order, perverted, and as a consequence of the diagnosis, "patient" is treated with a certain stigma. As a result, some radical psychiatrists and trans people have argued that this diagnosis should be dropped entirely, because transgender is not a mental disorder and should not be considered a mental disorder, and trans people should be treated as a mental disorder. with a practice of self-determination, a practice of autonomy. Thus, on the one hand, the diagnosis is still considered valuable because it facilitates the transition in an economically viable manner; on the other hand, it is firmly opposed because it continues to should be considered as one of the many possibilities for self-determination of gender as a mental disorder.

From the brief sketch above, we can see that in this debate there is a balance between those trying to win the rights and financial support (which is what they are arguing for) and those trying to root transgender practice in a notion of autonomy. There is a tension between people. We may hesitate for a moment and ask whether these two views are really in opposition. After all, one might say — and it has been said — that this kind of diagnosis helps to secure the right to insurance benefits, medical care, and legal status, which in effect serves what we call For the concept of "transgender autonomy". After all, if I want to change, I can certainly use the diagnostics to help me achieve my ends, and the realization of this purpose is an exercise of my autonomy. Indeed, it could be argued that no one can achieve autonomy without the help or support of a group, especially if that person is making a difficult choice that requires courage, such as gender transition. But if this is the case, we have to ask whether this diagnosis is necessarily part of the 'support' that individuals need in order to exercise their right to self-determination about their gender. After all, many of the assumptions of this diagnostic are detrimental to the exercise of autonomy. The form of psychological assessment it takes assumes that the person being diagnosed is affected by certain forces that they do not understand. It assumes that these people have delusions, anxieties. It assumes that certain gender norms are not being properly represented and that there is a glitch or failure. It makes assumptions about fathers, mothers, and what normal family life is and should be like. It assumes a language of correction, adaptation, and normalization. It insists on maintaining the gender norms that exist in the world today, and tends to pathologize any form of gender production that does not conform to existing norms (or to some dominant fantasy about the substance of existing norms). This diagnosis is forced on people against their will, notably against the will of many, especially young queer and trans people.

Thus, the debate looks extremely complex. And, in a way, those who want to keep the diagnosis do so because it helps them achieve their purpose, and thus their autonomy. And those who want to get rid of the diagnosis do so because doing away with it could lead to a world where these people are no longer seen as pathological and thus can powerfully improve their autonomy. I think we can clearly see here that there are limits to any such notion of autonomy; these notions assume that the individual exists alone, independent of social conditions, independent of social instruments. Autonomy is actually a way of living in this world within the constraints of social conditions. Social tools such as the diagnostics mentioned above can be empowering but also restrictive, and in many cases, both functions work simultaneously.

On the surface, it might seem that we have two different attitudes towards autonomy, but it should be noted that this is not just a philosophical question that can be answered in an abstract way. To understand how these views differ, we must ask how this diagnosis is treated in practice. What does it mean to deal with it in life? Does it mean that it helps someone's life, helps them achieve a life that feels worthwhile? Does it mean that it gets in the way of some people's lives, shames them, and, in some cases, leads to suicide. On the one hand, we should not underestimate the benefits of this diagnostic approach, especially for trans people with limited financial means and no health insurance support. For them, without this diagnostic, their purpose would not be possible. On the other hand, we should not underestimate the coercion of pathological diagnostics, especially for young people who may lack the critical resources to resist such coercion, and in these cases, diagnostics have great if not intentional murder. lethality. Sometimes he murders souls, sometimes he is a factor in suicide. Therefore, it can be seen that this discussion is crucial, and it is ultimately a matter of life and death. Diagnostics mean life to some and death to others; a boon of entanglements to some and a curse of contradictions to others.

To see how these two positions, as we understand them, arose, let's consider first how this diagnosis was constituted in the United States, and second, its history and current use. A gender identity disorder diagnosis must meet the DSM-IV definition of gender identity disorder. The last revision of its definition occurred in 1994. However, in order to complete a diagnosis, in addition to psychological testing, there needs to be a "letter" from the therapist providing the diagnosis, attesting to the patient's ability to better live with their new gender identity. The 1994 definition was the result of several revisions. For this definition, we probably need to consider the following two things to get a better understanding of it: In 1973, the American Psychiatric Association (APA) stopped diagnosing homosexuality as a disorder, and in 1987, the association decided to remove the earlier Another legacy of the definition is "ego dystonic homosexuality." Some have argued that the GID diagnosis inherits something from earlier homosexual diagnoses and thus serves as an indirect way of diagnosing homosexuality as a gender identity issue. In this way, the definition of GID continues the homophobic tradition of the APA, just in a less explicit way. In fact, conservative groups that seek to "correct" homosexuality, such as the National Association for Research & Therapy of Homosexuality, say that if you can be sure a child has GID, you're 75 percent sure The child was expected to become gay as an adult; the outcome was clearly perverted and unfortunate to them. Thus, the GID diagnosis is, for the most part, a diagnosis of homosexuality, and the disorder focus attached to it indicates that for them homosexuality remains a disorder.

The way some groups like this conceptualize the relationship between GID and homosexuality is very problematic. If we think that GID depends on the persistence of gender characteristics of the opposite sex, that is, boys have "feminine" characteristics and girls have "masculine" characteristics, then the assumption here is that boy characteristics cause desire for women, while girls have "masculine" characteristics. The characteristics of the male will trigger the desire for men. The assumption in both cases is heterosexual desire, that is, the assumption that opposites attract. But, almost, this is declaring that homosexuality should be understood as gender inversion, and that it is heterosexual, albeit an inversion, in terms of "sexuality". According to this way of conceptualizing it, it is rare for a boy with boyish characteristics to develop desires for other boys, and it is equally rare for a girl with girlish characteristics to develop desires for other girls. So 75% of people diagnosed with GID would only be identified as gay if we understand homosexuality in terms of gender inversion and sex in terms of heterosexual desire. Boys still want girls and girls still want boys. If 25 percent of those diagnosed with GID don't become gay, that would seem to imply that they don't fit the gender inversion model. However, because the gender inversion model only understands sex as heterosexual, it seems that the remaining 25% are homosexuals, that is, those who do not fit the homosexuality as heterosexual inversion model are gay. Hence our somewhat tongue-in-cheek claim that 100% of those diagnosed with GID are gay!

While this joke is irresistible to me simply because it would alarm the National Association for Gay Research and Treatment, let's be clear, we're taking it a little more seriously. How the picture of sex and gender is wrongly portrayed by those in the mountains. In fact, the relationship between gender identity and sexual orientation is ambiguous at best: we can't predict what kind of gender identity a person will have based on their gender, and we can't predict which desire direction TA will eventually love and pursue. While John Money and other so-called trans positionalists argue that sexual orientation follows gender identity, we are making a big mistake if we think that gender identity determines sexual orientation or that sexual orientation necessarily references a previous gender identity. mistake. As I've tried to point out, even if we think there's nothing wrong with "feminine" and "masculine" traits, it doesn't mean that "women" are attracted to "men" and "men" are attracted to "women". of attraction. We can only come to this conclusion by adopting an exclusive heterosexual model to understand desire. And actually. That matrix can distort some of the queer transgressions in heterosexuality, for example, when a effeminate hetero man wants a effeminate woman so that the two can be like "girls together" "In that way. Or when masculine heterosexual women want to see their boyfriends as both boys and girls. The same queer transgression occurs in gay and lesbian life, such as the combination of butch and butch to create a gay man in a characteristically lesbian mode. And, like I mentioned above, bisexuality cannot be viewed simply as two heterosexual desires, with the female side wanting a male object and the male side wanting a female object. Passing over like that is as complicated as anything that happens in heterosexuality or homosexuality. These kinds of transgressions happen more often than is generally believed, and it makes fun of the trans positionalist claim that gender identity is a bellwether of sexual orientation. In fact, sometimes the split between gender identity and sexual orientation—the delusion of the transpositionalist model itself—is, for some people, the sexiest and most exciting.

Homophobic researchers' approach to the disorder acquiesces to the claim that homosexuality is an impairment caused by sexual change, while most importantly pointing out that it is not a disorder, and there are complex connections in trans-gender life , some of which involve cross-dressing, some may involve living as another gender, still others may involve hormones and surgery, and more often, one or more of the above. Sometimes this means a change in the so-called object choice, but sometimes this is not the case. A person can be a trans man and desire a man (i.e. be a gay man), or a person can be a trans man and desire a woman (i.e. be a straight man), or a person A person can become a transgender male and experience a range of sexual orientation changes. These changes constitute a specific life history and narrative. Such a history cannot be defined by a category, or it may only be temporarily defined by a category. The history of life is the history of becoming, and categories sometimes act on the process of change to freeze it. Changes in sexual beliefs may be a response to a particular spouse, whether transgender or not, people do not always emerge as coherent heterosexual or homosexual, and the meaning and experience of being bisexual can change over time, Form a specific history, reflecting a specific experience.

A diagnosis of gender identity disorder requires that a person has been more or less age-stereotyped; gender can only be diagnosed when it has stood the test of time. You must demonstrate that you have a long-standing desire to live as a person of the other gender; it also requires you to demonstrate that you have a long-term realistic plan to live as a person of the other gender. In this sense, the diagnosis seeks to treat gender as a relatively permanent phenomenon. For example, if you walk into a clinic and claim that you realized what you wanted to do just because you read Kate Bornstein's book, and you didn't really realize it before that—it won't be accepted. If only because your cultural life has changed, through written communications, through activities and clubs, seeing that certain ways of life are possible, and your own possibilities presented to you with a clarity that never existed before, this diagnosis The law also does not recognize these changes as grounds for being transgender. If you're transgender, to get support for this diagnosis, you can't say that you think the norms that determine what is a viable life are variable and that new cultural forces have broadened those norms in your life range, so people like you can do very well as a trans person living in a supportive community, and it is the changing public norms and this supportive community that make you feel trans is feasible and desirable, and in that sense you cannot directly support the idea that changes in gender experience are the result of changes in social norms. Because doing so would violate Harry Benjamin's normative rules about gender identity. In fact, like the GID diagnosis, the rules assume that we all more or less "know" gender—"male" and "female"—what the norms are, and all we need to do is figure them out Whether these specifications are embodied in this or other examples. but. What if the norm no longer describes our situation? What if they were merely clumsy descriptions of other people's experiences of gender? And, if the norm of this diagnosis assumes that we are all eternally constituted in one way or another, what happens to gender as a mode of change? When we bend to norms in order to gain the rights we need and the status we want. Are we just frozen in time, more compliant and more harmonious than we would like?

Although we need a stronger critique of this diagnostic - when I refer to the diagnostic text itself. I'll dwell on some of them—but calls to abolish sex reassignment surgery are misplaced if we don't first create a system in which the cost and legal status of sex reassignment surgery is guaranteed. That is, if the diagnosis is a tool for gaining profit and status now, it cannot simply be abolished without first finding other durable ways to achieve the same result.

An obvious response to this dilemma is to insist that we should deal strategically with the diagnosis, and that we can then reject the truths it espouses, that is. Rejecting its portrayal of transgender while at the same time exploiting the diagnosis purely as a tool, a way to achieve an end. We can then conform to this diagnosis ironically or jokingly or half-truthfully, while mentally thinking that transgender desire, or the determination to fulfill it, has nothing to do with being “pathological.” However, we must also question whether compliance with this diagnosis leads, more or less consciously, to a person who ends up internalizing some aspect of the diagnosis as either mentally ill or abnormal, or both. Both, although we only want to use this diagnostic method purely as a tool.

The reasoning in favor of this latter view is particularly important, and it has a lot to do with children and youth because. If we ask who is capable of maintaining a purely instrumental attitude to this diagnosis, we find that such individuals are mostly shrewd and perceptive adults who have other words to help them understand who they are and what they are. want to be something. But do children and adolescents always have the ability to distance themselves from this diagnosis so as not to succumb to it?

Dr. Richard Isay cites the effects of the diagnosis on children as the primary reason for its removal, writing that the diagnosis itself "may damage the self-esteem of a child who is not mentally ill and cause emotional damage." There is a perception that in childhood many young gay boys gravitate towards so-called female behavior, preferring their mothers' clothes and refusing to engage in rough and strenuous activities. Isay accepts this view, but also believes that the problem here is not the traits themselves, but that "parental warnings about these behaviors had a detrimental effect on the boy's view of himself". His solution is to teach parents to support what he calls "atypical gender traits." Isay's point of view is an important contribution in many ways, and one of the obvious ones is that. It rejects a language of pathology and calls for a reimagining of the phenomenon: he refuses to elevate typical gender traits to the level of psychological normality, or to treat atypical traits as abnormal. Instead, he substitutes a language of typical and not for the language of normal and not. Physicians who opposed Isay's view not only insisted that the disorder was a disorder, but that the persistence of gender-atypical characteristics in children was a "psychopathy." While insisting on this pathology, they also display a paternalistic focus on the afflicted, talking about how such a diagnosis is necessary for insurance benefits and other entitlements. indeed. They capitalized on the articulate need for health insurance and legal support among the poor, working class, and middle class trans ideals, and they not only used that need to support keeping the diagnosis on paper And also use it to support their view that this is a disease that must be corrected. So even though the diagnosis is presented as a tool for transgender purposes, it still (a) instills a sense of mental illness in those who receive the diagnosis and (b) reinforces the diagnosis The right to pathologize trans desire (c) may be used by well-funded research institutions as a rationale for confinement of trans desire to the realm of mental illness.

Other approaches have also been proposed to lessen the pathologizing effects of this diagnosis and free it entirely from the grip of the mental health profession. Jacob Hale argues that such matters should not be left to psychologists and psychiatrists. He believes that the question of how to get medical and technical help should be a matter between the client and the doctor. He argues that a person can go to a doctor and ask for various remodeling surgeries, or, in some other cases, take the appropriate hormones; no one is going to ask you a bunch about what early fantasies you had or what games you played as a child question. We don't need to provide proof of mental stability if we have breast reduction surgery or menopausal hormone therapy. And when a person wants to gender transition. Their need to enlist the help of a mental health professional forces a patriarchal structure into the process and undermines the kind of autonomy on which the claim of rights is based. In this case, there are specialized therapists who worry about whether you can fit psychologically into an established social world that is characterized by the majority conforming to accepted gender norms. But the therapist won’t ask if you have the courage or community support to live a post-trans life when the threats of violence and discrimination against you are at their height. The therapist doesn't ask if this gendered life is helping to create a world where gender is less restrictive, or if you can afford to do so. The therapist won't predict whether your choices will lead to postoperative regret. Although the persistence and tenacity of your desires are tested, few pay attention. What happens to these persistent, tenacious desires if the social world, and the diagnostics themselves, degrade them as mental disorders.

I suggested at the beginning of this chapter that the arguments one uses for or against this diagnosis depend in part on how one views the conditions of autonomy. In Isay's theory, we can see his view that this diagnosis not only undermines children's autonomy, but misidentifies their autonomy as pathological. And in Hale's point of view. We can see that this diagnosis takes on a different meaning when it is no longer used by mental health professionals. However, we still face the age-old question of whether medical professionals without special training in mental health use mental health criteria to make decisions similar to those made by mental health professionals. But if Hale is saying that in order to redefine the diagnosis it is necessary to turn to general practitioners so that it no longer includes any mental health criteria, then he is advocating a diagnosis, or It is advocating not to have any diagnosis, because the expression of DSM-IV must not be without mental health standards. To answer whether switching to general practitioners is a good thing, we must ask whether medical professionals in general are up to the task, or whether the world of progressive therapists gives us a better hope of passing Diagnosis on the path of humanity and success. Although I don't have a sociological answer to this question, I think it's something we must consider before we judge whether Hale's proposal is sound. The greatest benefit of his point of view is that he regards patients as customers exercising consumer autonomy in the medical field. This autonomy is assumed, and at the same time it is the ultimate goal and meaning of the transition process itself.

But this raises new questions: How should we conceive autonomy in this debate? Does revision of the diagnostic itself provide a path to bypass the tension between those who wish to eliminate it and those who wish to retain it because of its instrumental value (particularly those with financial difficulties)? What about deadlock? There are two different concepts of autonomy in this debate. Those who are outright against this diagnosis are likely to be individualists, if not libertarians, while those in favor of its retention tend to recognize the material conditions required for the exercise of liberty. Those who worry that the diagnosis may be internalized or that it is harmful argue that the diagnosis damages the psychological environment for autonomy, and that this damage has already been done, and that among young people , a higher risk of compromised self-awareness and harm.

Autonomy, liberty and liberty are all interrelated concepts. They also imply certain kinds of legal protections and rights. After all, the U.S. Constitution guarantees the pursuit of liberty. It can be asserted that it is discriminatory to restrict transgender individuals' freedom to exercise that identity and practice it. Paradoxically, when insurance companies differentiate between "medically necessary" and "elective" mastectomies, they actually devalue the very concept of freedom. The former type of surgery is considered to be performed not by one's own initiative, but by a medical condition. The most common of these is cancer. But even that statement doesn't properly describe the choices an informed patient can make about how to deal with cancer. Because, sometimes, possible treatments may include radiation, chemotherapy, Arimidex, including excision, and partial or total mastectomy. Women can make different choices about treatment based on how they feel about their breasts, how they think their cancer has progressed, and the range of treatment options available. Some women may do anything to keep their breasts, while others will give it up without much difficulty. Some people may choose reconstructive surgery and make certain choices about the intended breast, while others will not make similar choices.

Recently, a butch lesbian in San Francisco was diagnosed with cancer in one breast. After discussing with doctors, she decided to undergo a complete mastectomy. She thought it would be a good idea to have the other breast removed, as she hoped it would minimize the chance of recurrence. Since she does not have a strong emotional attachment to her breasts, this choice is less difficult for her: breasts have no central place in her self-understanding of gender and sexuality. Her insurance company agreed to pay for one mastectomy, but they were concerned that the other mastectomy was an "elective surgery" and if they paid for it, it would set a new record for insurance coverage of elective gender affirmation surgery. precedent. The insurance company both wanted to limit the customer's autonomy in medical decisions (which was treating the woman as wanting to have her other breast removed for medical reasons) and to ignore the basis for autonomy in gender-affirming surgery Status (which is identifying the woman as transgender). Meanwhile, a friend of mine who was recovering from a mastectomy was trying to understand the possibilities of her reconstructive surgery. Her doctor referred her to trans clients because they could educate her about the techniques and their aesthetic benefits. Although I don't know of an alliance between breast cancer survivors and transgender people, I sense that a movement could easily emerge whose main demand is for insurance companies to recognize autonomy in making and maintaining first and Status among secondary sexual characteristics. I would like to point out that this all seems less incomprehensible if we consider aesthetic surgery as part of the human practice of maintaining and cultivating primary and secondary sexual characteristics for cultural and social reasons. I don't think men who want to increase their penis size and women who want to enlarge or reduce their breasts don't need to get a certificate from a psychiatrist first. Of course, it's interesting to think about it in light of existing gender norms, why doesn't a woman who wants to reduce her breasts need any psychological proof, but a man who wants to reduce the size of his penis needs such proof? We don't assume that women who use hormones and men who use Vigara are mentally abnormal. I suspect that this is because these practices are normative in that they seek to enhance what is "natural," adjust to accepted norms, and sometimes even confirm and reinforce traditional gender norms.

The butch, who is almost transgender, wants to have both her cancerous and non-cancerous breasts removed; she understands that she wants to obtain the right to mastectomy. The only way to get cancer in the other breast, or to subject your sexual desires to medical and psychiatric scrutiny. Although she does not identify as transgender, she knows that if she presents herself as transgender, she will be able to receive a GID diagnosis and thereby qualify for insurance benefits. Sometimes insurance companies can pay for reconstructive breast surgery. Even if this surgery is one's own choice. However, mastectomy is not included in the list of elective surgeries reimbursed by insurance companies. In the insurance world, it's understandable for a woman to want smaller breasts, but it's seen as unreasonable if she doesn't want them. The idea of not wanting breasts made one wonder if she still wanted to be a woman. This would seem to suggest that butch's desire to have a mastectomy is not a health-conscious thought, unless it's a sign of a gender identity disorder or dictated by some other medical emergency

But why do we treat these choices as choices, no matter how we think about their social significance? Society doesn't think it has the right to stop a woman from enlarging or reducing her breasts, and we don't think penis enlargement is a problem unless it's being performed by an illegal practitioner and screwed up by him. If a person announces that he will cut or grow his hair, or go on a certain diet, that person will not be sent to a psychiatrist unless the person is at risk of developing anorexia. However, if we understand secondary sexual characteristics as various physical indicators related to gender, these practices are actually daily habits for cultivating secondary sexual characteristics. If these physical characteristics "indicate" gender, then gender is not the same as the means by which it is indicated. Gender is understood through these symbols that indicate how gender should be read or understood. These bodily signs are cultural means of interpreting the gendered body. They are bodily in themselves and function as symbols, so it is not easy to distinguish what is the "material" truth about the body from what is its "cultural truth. I am not saying that purely cultural symbols create physical body, but merely to say that the body is sexually difficult to read without these symbols, which are both cultural and material and cannot be reduced.

So, what claims about autonomy do these various perspectives on DSM diagnoses of gender identity disorder employ? How do we conceive of autonomy to find a solution to the debate about whether to preserve or eliminate this diagnostic? Although it is clear that not everyone diagnosed with GID will or would like to be transgender. Regardless, they were all influenced by the use of the diagnostic for transgender purposes, because its use actually strengthened its status as a useful tool. That's not a reason to stop using it, but it also speaks to a certain risk and some implications. An emphasized diagnosis may have undesired or unforgiving effects for its users. And, while it may serve an important need for an individual and provide identity and financial security for transition, it may also be used by medical and psychiatric institutions to extend their understanding of transgender, gay, and lesbian and the pathologizing effects of bisexual populations. From an individual perspective, this diagnosis can be seen as a means of enhancing personal expression and decision making. Indeed, it can be regarded as one of the basic mechanisms that a person needs in order to effect the transformation for the better in life, and it provides the basis for flourishing of a person as an embodied subject. On the other hand, the method also has a life of its own, and it can be degraded by the stigma attached to, or rather emphasized by, the diagnosis. Making life harder for those who suffer from pathological treatment and those who lose certain rights and freedoms (such as child custody, jobs, housing). While it would certainly be best to live in a world free of such stigma and diagnostics, the world we live in is not so wonderful. Moreover, a deep skepticism about the mental health of people who transcend gender norms structurally shapes much of the psychological discourse and the psychological, medical approaches to gender as well as the legal and economic institutions that determine human status and eligibility for financial assistance and medical benefits.

However, from the perspective of freedom, we need to make an important point: what specific form freedom takes depends on the social conditions and social institutions that govern human choices-it is important to remember. Some claim that transition is, or should be, a matter of choice, an exercise of freedom. These people are right, of course, and they are right to point out that the obstacles imposed by the psychology and psychiatry professions are paternalistic forms of power through which a basic human freedom is suppressed. Beneath these views emerges a liberal claim to gender transition. Richard Green, president of the Harry Benjamin International Gender Dysphoria Association, is a strong supporter of transgender rights, including the rights of transgender parents. He thinks on this issue. This is a matter of personal freedom and privacy. He cites John Stuart Mill who writes that he "arguably argues that adults should be able to do with their own bodies as long as it does not harm others. Therefore, if a third-gender, transgender, or imminent amputation If people can continue to assume social responsibility after surgery, then their pursuit of surgery is not a social business. Although Green made what he called "philosophical" arguments, he also mentioned that we should also Consider who should foot the bill, and whether society has an obligation to pay for a procedure that is seen as an exercise of individual freedom.

I found that, apart from discourse from the Christian Right movement, there wasn't much research being done in this field. When it comes to gender identity disorder, the Christian Rights Movement says we should embrace it wholeheartedly, saying, "Don't take this diagnosis away from me! Please make me sick!" Of course, there are many Psychiatrists and psychologists insist that gender identity disorder is a disease. George Rekers, a prolific and well-funded professor of neuropsychiatry and behavioral sciences at the University of South Carolina, whose research combines acerbic political conservatism with efforts to strengthen and extend access to the diagnosis. His focus seems to be primarily on boys, boys growing up, and men who are becoming strong fathers in heterosexual marriages. He also attributes the emergence of gender identity disorder to the breakdown of families, the loss of a strong father figure that occurs in boys, and the subsequent "unease" that this reportedly causes. This is evident in the discussion of his work: it cites the 1994 DSM conclusion that 75 percent of young people with gender identity disorder will become gay as adults. Rekers has published many studies that Filled with "data" from empirical research. Although quite controversial, he sees himself as a scientist, an empiricist, and, he characterizes his opponents, ideologically biased. He writes, "A generation Already deluded by radical ideologies about the roles of men and women, what we need are actual studies of men and women: these men and women should be good examples of affirmative masculinity or affirmative femininity". The purpose of the study" was to demonstrate the benefits of a clear distinction between gender norms and deviations from those norms "on family life and on culture more generally." Likewise, Rekers notes: "Preliminary findings that have been published show Positive Curative Effects of Religious Conversion on Healing Transsexuality...and the Positive Curative Effects of the Church on Repentant Homosexuals. "He seems to be relatively unconcerned about girls, which seems to me to be entirely indicative of his intense preoccupation with patriarchy, his inability to see what various women might bring to the various assumptions he has about patriarchy. The threat of manhood. The fate of masculinity attracted the attention of this study because, as a fragile and fragile construct, masculinity needed the social support of marriage and a stable family to find its way. Indeed, in his It seems that masculinity itself is not stable, but needs to be protected and supported by various social forces. This shows that the function of masculinity itself depends on these forms of social organization, and it has no connotation other than that. No matter what, there are always people like As bigoted and vitriolic as the Rekers, they not only want to preserve the diagnosis but strengthen it, and their political rationale for strengthening it is so conservative that the structures that support normalcy can be strengthened.

Ironically, it was these very structures of support for normalcy that created the need for this diagnosis in the first place, including its benefits for those who needed to rely on it to implement a transition.

The irony, then, is that those who suffer from this diagnosis also find that they have no way out of it. The fact is, in the present circumstances, one has reason to fear that it would be very bad to remove the diagnosis, perhaps so that people could no longer benefit from it. Maybe, the wealthy can shell out tens of thousands of dollars for the cost of a female-to-male conversion (including double mastectomy and penis reconstruction), but most people, especially poor working-class trans people, will pay Can't afford such a bill. In the United States, socialized medicine is largely seen as a communist thing. At least in the United States, it is difficult to get the government or insurance companies to pay for these medical procedures without first establishing that there are serious, well-tested medical and psychiatric reasons for transgendering. For them to do so, it is necessary to establish that conflict exists. Identify the existence of great pain, the continual desire to be of the other sex. And this person must first experiment with cross-dressing all day long to confirm whether it can be predicted that this person will adapt to the life after adaptation. status. In other words, as Foucault said, one must submit to a controlling machine that makes the exercise of freedom possible; one submits to labels and names; one submits to encroachment, one submits to intrusion; one One is bound by the standards of normality; one is tested. Sometimes this means that a person needs to become intimate with these criteria and how to present themselves in order to be a credible candidate. Occasionally, a therapist finds himself in a predicament. Asked to give a letter to the person they want to help, but at the same time. And they hate that they have to write this letter in the language of the diagnosis to help their client create the life he wants.

In a sense, the normative discourse surrounding this diagnosis takes on a new lease of life: it may not describe the patient who uses this language to his advantage; Faith of a therapist who cannot sign his name and let him go. Approaching this diagnosis strategically involves a range of individuals who use language that does not represent reality and do not fully believe what they say. The price of using this diagnosis to achieve one's purpose is that one cannot put into words what one really thinks is true. One pays the price for freedom, sacrificing one's right to use what one considers one's true language. That is to say, a person gives up another kind of freedom while realizing one kind of freedom.

Perhaps this leads us to a better understanding of the difficulty of autonomy posed by this diagnosis, of how freedom is seen as determined and expressed in certain social ways. There is only one way to acquire the means by which this transformation begins, and that is, to learn how to express yourself in a discourse that is not yours, which obliterates itself in your self-expression, denies the The language you really want to use to describe who you are, how you came to be, and what you want out of life. While negating all of this, the discourse conveys a promise (if not blackmail), promise says. If you agree to fake yourself, you have the chance to have the life you want, the body and the sex you want. And in the process, you actually endorse and endorse the power of this diagnosis over more people in the future. Anyone who supports the right to choose and opposes this diagnosis must deal with the huge financial consequences of his decision for those who cannot afford the medical resources available. And their insurance (if there is such an insurance) will not support this choice in what is considered an elective treatment. Even when local regulations are passed that allow city workers who pursue such treatments to be insured (as in San Francisco now), people still have to pass diagnostic tests, so of course the choice comes at a price, and sometimes, the The price is truth itself.

In light of this, it seems that if we want to support the poor and the uninsured in this area, we must support efforts to extend insurance coverage by accepting diagnostic domains endorsed by the AMA and APA and codified in DSM-IV. To depathologize everything related to gender identity and to have elective surgery and hormone therapy covered by insurance as a legitimate set of elective procedures seems doomed simply because most medical, insurance and legal practitioners The use of gender-altering technology is only supported if what we're talking about is a barrier. It is useless to emphasize that man has a strong, legitimate claim. There are claims that are both theoretically plausible and claimable on insurance companies; claims that this transformation enables a person to realize certain human possibilities: possibilities that allow life to flourish, or It is said that this will bring a person out of fear, shame and paralysis into a state of increased self-esteem and the ability to form strong bonds with others, or. This transformation can help relieve great pain, or help fulfill the basic human desire to acquire a certain physical form that expresses a fundamental sense of self. However, certain gender identity clinics, such as the one at the University of Minnesota run by Dr. Walter Bockting, do make such a point and offer a choice for those willing to make a choice on the issue—whether living as a transgender or transgender person. , or become a third gender, or consider jumping into a transition process that doesn’t see results and doesn’t necessarily have results – offers support in treatment, but even this clinic offers insurance companies DSM-IV compliant Material.

Exercising freedom through strategic treatment of the diagnosis also creates a degree of unfreedom, because the diagnosis itself devalues the self-determination of those it diagnoses. But paradoxically, it also sometimes strengthens these people's capacity for self-determination. When used strategically, when the diagnosis implicitly subverts its assumption that the person being diagnosed has fallen into a state of inability to make a choice, its use can subvert the purpose of the diagnosis. On the other hand, in order to pass the test, one must submit to the language of the diagnosis. Although the diagnostic's stated purpose is to know whether a person can successfully live according to the norms of the other gender, it seems that the real test proposed by gender identity disorder is whether a person can conform to the language of the diagnosis . That said, it may not be whether you can conform to the norms of the other gender, but rather whether you can conform to the psychological discourse that dictates what those norms are.

Let's take a look at the language. The section on Gender Identity Disorder in the DSM clearly states at the outset that there are two parts to this diagnosis "The first is "there must be a strong, persistent transgressive-gender identity". I guess this is not easy to determine, Because identification does not always manifest itself like this: some aspect of hidden fantasy, part of a dream or unformed structure of behavior may remain. However, the DSM requires us to be a little more positivist in our study of identification. , argues that we can tell what identities are going on in a given person's spiritual life through the interpretation of behavior. Transcendence-gender identity is defined as a "desire" to be another gender, or "insistence that I am another gender". The "or" in this sentence is worthy of attention, because it means that a person may have the desire to be another gender—we will not explore for the time being what "another gender" is What. And by the way, it seems to me that there is no clear answer to this question - while at the same time not necessarily insisting on being that gender. These are two separate criteria. They don't have to appear together ...so. If there were any way of asserting that someone had this "desire to be," even if they did not insist on it, it would provide solid evidence for concluding that gender identity was occurring. And, if there were being the "persistence" of the other gender, then this can be used as a separate criterion which, once met, is sufficient to conclude that a transgression-gender identity is taking place. The speech act of one gender; this insistence is seen as a way of verbally expressing one's claim to the other gender, of ascribing that gender to one's own head. Therefore, the "wanting to be" or Certain expressions of "insisting that I am" are excluded as evidence of this claim. "This desire must not be simply because of the cultural advantages of being the other gender". Now, let's pause For a moment, because this diagnosis assumes that we can experience gender regardless of the cultural benefits of being a certain gender. Is this possible at all? If our experience of gender occurs in a sense In the cultural matrix, if the meaning of gender is relative to a wider social world, can we connect the experience of "gender" with its social meaning-including the way power operates in these meanings? Separate them one by one? "Gender" is a word that can be applied to people in general, so it is very difficult to treat my "gender" as something extremely specific. Since this is the case, then in general, the problem It's not just about "my gender" or "your gender," but how the category of "gender" transcends one's use of it. So, it seems. To feel sexuality outside of this cultural matrix , and it is impossible to understand this cultural matrix in addition to the benefits it may provide. Indeed, when we think about cultural advantages. Whether or not we act for such advantages, We all have to ask whether what we do is good for me; that is, whether it advances or fulfills my desires and pursuits.

Some vulgar analyzes suggest that trans men exist simply because it is easier to be a man than a woman in society. But these analyzes do not ask whether being transgender is easier than living with a perceived biological sex—that is, a sex that “consistent” with the sex you were born with. If social advantage dominates this choice decision unilaterally, then forces in favor of social conformity may win. On the other hand, there are those who assert that if you want to wear a bright red scarf and tight skirt on the street at night, the advantages of being a woman are greater. This is clearly true in some parts of the world, although biological women, cross-dressers, trans women all have certain risks in common on the street, especially if any of them are being treated as prostitutes . Similarly, one could argue that, in general, there are more cultural advantages to being a man if you want to be taken seriously in a philosophy seminar. But some men have no advantage if they can't join the discussion. In other words, being a man is not a sufficient condition for a person to join the discussion. So I'm wondering if it's possible for us to want to be a certain gender without thinking about the advantages that might come from doing so, because the cultural advantages it brings would also be that it gives someone with certain desires And the advantage that someone who wants to be able to take advantage of certain cultural moments.

If gender identity disorder diagnostics insist that the desire to be or persist in another gender must be assessed without regard to cultural advantage, it may be that the diagnosis misunderstands the involvement in the creation and maintenance of such desires some cultural forces. The diagnosis of gender identity disorder, then, must respond to the epistemological question of whether we can perceive gender outside the cultural matrix of power relations. In this cultural matrix, relative advantages and disadvantages are only part of it.

This diagnosis also requires the existence of a "constant discomfort" with the gender assigned to oneself; it is at this point that the phrase "something is wrong" intervenes, the assumption here being that people can and do have a Sense of Fit: A feeling that this gender is right for me. At the same time, I would have, could have, a sense of comfort, and, if it was the right norm, could have that comfort. It's important to note that this diagnosis assumes that gender norms are relatively fixed, and the problem is making sure you find the right one that makes you feel comfortable and comfortable with your gender. There must be evidence of "pain" in the diagnosis—yes, pain. And if there is no "pain", then there should be "flaws". Here, it's natural to ask where these claims come from: pain and handicap, inability to function in the workplace, inability to do certain daily chores. This diagnosis assumes that a person feels pain, discomfort, and discomfort because they are the wrong gender, and that conforming to another gender norm would make them feel better if it was feasible for the person many. But this diagnosis does not ask whether gender norms it sees as fixed are problematic, whether they create pain and discomfort, whether they impede a person's ability to work, or whether they are A source of pain for many. Nor do they explore the conditions under which they can provide a sense of comfort, a sense of belonging, or even a place where certain human possibilities for one's future, life, and happiness can be realised.

This diagnostic approach attempts to establish a set of criteria for identifying Transgender people, but in articulating those criteria, the diagnostic approach is extremely rigid about gender. Here's how it describes gender norms in strikingly simple terms: "Among boys, a transgressive-gender identity is manifested in a marked preoccupation with traditionally feminine activities. They may have a preference for wearing girls' or women's clothing, perhaps Improvise something similar using materials at hand when materials are scarce. Towels, aprons, and kerchiefs are often used to represent long hair or skirts." This description seems to be based on a history of collecting and summarizing observations; boys have been seen Do it, report it. And others did, and these reports were collected, and generalizations were made based on these observations. But who is actually observing and how is this observation being done? We don't know that. And, although we are told that among boys this identification is marked by fascination with "traditional feminine activities," we are not told what exactly constitutes this mark. But it seems to be important, because this "flag" will determine what observations are chosen as evidence for an argument.

In fact, everything that follows from this statement seems to be against the statement itself, because according to these accounts, what these boys do is a series of substitutions and improvisations. We're told that they may have a preference to dress as a girl or as a woman, but we don't know if that preference manifests itself in the actual cross-dressing. All we have is a vague notion of a "preference" which may merely describe an assumed mental state or inner tendency, or which may be inferred from practice. This latter point seems open to various interpretations. we are told. One of their practices is improvisation, taking what is on hand and turning it into women's clothing. Women's clothing is called "real clothing," which leads us to conclude that the materials used in these boys' improvisations are, if not unreal or "fake," then not authentic or comparable to real women's clothing. relevant. “Towels, skirts, and scarves are all often used to represent long hair or a dress.” So there is a certain imaginative play here, and an ability to transform one thing into another through improvisation and substitution. In other words, there is an artistic practice here, which can hardly be named simply as a simple act of conforming to a certain norm. Something is made, something is made from something else, something is tested. And if it's an improvisation, it's not fully choreographed.

While this description further insists that the boys are obsessed with "stereotypically female-type Barbies"—here referred to as "Barbies"—and "female fantasy characters," we are not told, What place does Barbie and fantasy occupy in the construction of gender identity. Certain genders become the locus of fantasy, or so-called stereotypes become the source of fantasy, and several relationships to that stereotype may be involved. Likely This stereotype is obsessed because it is shaped by multiple factors; that is, it becomes the site of some conflicting desires. DSM assumes that the Barbie you play with is who you want to be, but maybe you just Want to be her friend, her rival, her lover. Perhaps you want to be all of these at the same time. Perhaps, you and she have made some kind of swap. Perhaps playing with this doll is an impromptu expression of a complex set of tendencies Behavioral scenarios. Perhaps there is something going on in this game other than simply following a norm. Perhaps the norm itself is being played, explored, or even broken. If we want to propose and explore these If it's a problem, you need to think of games as a more complex phenomenon than DSM.

According to the DSM-IV, you can tell if girls have a transgressive gender identity by the arguments between them and their parents about what exactly to wear. They have a clear preference for boys' clothes and short hair, their friends are mainly boys, they express a desire to be boys, and, oddly enough, "they are often mistaken for boys by strangers". What I'm trying to figure out here is how evidence of a person's paschal-gender can be established by a stranger identifying him as a boy. It was as though casual social appointments were taken as evidence, as if the stranger knew the girl's psychological makeup, or as if the girl had solicited questions from the stranger. The DSM went on to say that the girl "may have asked to be called by a boy's name". But even so, it seems that she was first called as a boy, and only after being called that, wanted a name that would confirm the validity of the title. Once again, the language provided by the DSM contradicts its own assertion, as it wants to be able to refer to transgressive gender identity as part of gender identity disorder and as a psychological problem that can be cured. In its imagination, each person has a relationship with their "assigned gender", and that relationship is either an uncomfortable painful connection or a very comfortable, peaceful relationship. But even the notion of "assigned gender"—that is, the gender "assigned" at birth—implies that gender is socially produced and relayed, not just as a It is a private perception that comes to us, and a social category assigned to us. This social category surpasses us in its universality and power, but at the same time exemplifies itself in the locus of our bodies. Thought-provoking Yes, the DSM tries to establish gender as a more or less fixed and regular set of norms, although it also continually gives us evidence to the contrary, even as if it is against its own purpose. Just as those who perform improv In the same way that boys in alternative activities do things that don't conform to established norms, girls seem to understand something about social assignment, what happens if someone refers to them as a boy, and what that makes possible. I'm not sure if the girl who captured this lost but well-placed query provides evidence for some kind of pre-set "block". Rather, it just points to the way gender is formed through assignment, opening up for reassignment possibility, and this stimulates her sense of agency, play, possibility. Boys play with the scarf as something else; they are already familiar with this world of props and improvisation. Like them, girls grasp the other They are exploring the possibility of being called by their own names in the context of the social world. They are not simply providing evidence for their inner psychological state, but are doing certain behaviors, even practicing, and This practice is crucial to the creation of gender itself.

As many psychiatrists do, the DSM offers a certain discourse on compassion, suggesting that life with such mental disorders produces pain and unhappiness. On this topic, the DSM has its own way of saying that "in young children, suffering is manifested through displeasure at their assigned sex." Here, it seems that the only displeasure is caused by an inner desire, Not because of the fact that such children lack social support; that they are diagnosed and pathologized by the adults with whom they confide in unpleasantness; that gender norms set the dialogue for expressing unhappiness. The DSM sees itself as diagnosing a distress that needs to be alleviated; at the same time, it argues that "social pressure" can lead to "extreme isolation in such children." The DSM does not address suicide, although we know that peer pressure on transgender adolescents can trigger suicide. The DSM doesn’t talk about the danger of death or murder, which happened just a few miles from my home in California in 2002; transgender Gwen Araujo wore a dress to a teenage party. Her body was found in the Hilla Hills; she died of beatings and asphyxiation.

We live in a world where violent death and suicide are still real problems. The resulting distress is clearly not yet part of the diagnosis of gender identity disorder. After briefly discussing what has been euphemistically called "peer teasing and exclusion," the DSM comments that "children may refuse to attend school because of teasing or because of pressure to wear clothing that corresponds to their assigned gender." Here, the language of this text seems to hold. The pressure of social norms can impair everyday behavior. But in the next sentence, it declares that it is the person's own obsession with transgressive-gender desires that "interferes with daily activities" that has led him to social distancing; Responsibility for suffering is shifted to the individual. In a way, we find that social violence against trans youth is euphemistically called teasing and pressure, and that the resulting pain is reframed as an inner problem, a sign of obsession, of self-indulgence; That is, it is all seen as the result of these desires themselves. Indeed, is the "alienation" mentioned here real? Is the helping group out of sight? And, is the presence of alienation a sign of pathology? Or, for some, is it the price to pay for expressing certain desires openly?

Most worrisome, however, is how the diagnosis itself acts as a social pressure to induce distress, to pathologize wishes, and to enforce regulation and control over those who express them in public. Indeed, one has to ask whether the diagnosis of transgender teens works like peer pressure, like an escalated form of teasing, like a euphemistic form of social violence. If we conclude that this diagnosis is what it is, how do we get back to the thorny question of what exactly does this diagnosis offer us? If part of the contribution of this diagnosis is a form of social recognition, if that is the form that social recognition takes, if only through this social recognition. If third parties (including medical insurance) can voluntarily pay for medical and technological changes, is it possible to completely cancel this diagnostic method? In a way. The dilemma we ultimately face has to do with the conditions that limit social recognition. Because even if we are deluded by the position of civil liberalism and understand it as an individual right, the fact is that individual rights can only be protected and enforced through social and political means. Insisting on a right is not the same as being able to exercise it, and in this case the only right recognized was "the right to treatment as a disorder and to medical and legal assistance to amend it". One exercises this right only by submitting to a pathological discourse, and in submitting to this discourse one also acquires a certain power, a certain freedom.

We can and must think that the diagnosis brings relief from suffering; at the same time, we can and must think that the diagnosis aggravates the very suffering which demands relief. Under current social conditions, gender norms are routinely expressed and deviations from norms are viewed as suspect: autonomy can only be a paradox. The state pays for gender reassignment surgery, a wider group provides "transgender funds" to help those who cannot afford the expensive fees, and provides "funding" for individuals to pay for "medical aesthetic surgery." The movement to empower trans people themselves as therapists and diagnosticians has and will continue to help with this. These are all ways to get around a dilemma until it disappears. But if this dilemma were to eventually disappear, then the norms that determine how we understand the relationship between gender identity and mental health would shift dramatically, allowing economic and legal institutions to recognize that being a gender is a function of one's sense of personality, How important is the sense of well-being, how important is the possibility to grow freely as a life with a body. Not only does the individual need the social world to exist in a certain way in order to have a right to what he owns, but what he owns always depends from the start on what is not his own, that is, what is strangely deprived and dissolved The social condition of autonomy.

In this sense, in order to fulfill ourselves, we must first dissolve ourselves, we must become part of the larger social structure of "existence" in order to create ourselves, of course, this is the paradox of autonomy, when gender This paradox is exacerbated when norms begin to paralyze gender agency at different levels. Before these social conditions changed dramatically, liberty often required unfreedom, and autonomy was entangled with submission. If the social world—which is a symbol of our fundamental inautonomousness—has to change for the possibility of autonomy, then individual choice will prove to depend from the outset on the arbitrariness of none of us. under the conditions. And no one has a choice outside of a radically changed social world. This change comes from the increase of collective or decentralized behavior, which does not belong to any single subject: but one of the consequences of these changes is that it becomes possible to act as one subject.

Judith Butler, "Undiagnosing Gender", in Undoing Gender (Routledge, August 17, 2004)