Transgender Identity, Community & Empowerment
Pauline Park, Ph.D.
Chair
New York Association for Gender Rights Advocacy (NYAGRA)

Social Sciences Open House
Marymount Manhattan College
17 October 2013

I would like to begin by thanking Prof. Manolo Guzmán for being instrumental in bringing me here to speak at the Social Sciences Open House today. This is my very first visit to Marymount Manhattan College and I’m absolutely delighted to be here and to have the opportunity to talk about transgender identity, community and empowerment with you today. And in fact, I’ve entitled my talk “Transgender Identity, Community & Empowerment” because it seems to me that those are three of the crucial elements in our task as we seek to make the social sciences fully inclusive of transgender as a topic and transgendered and gender variant people as faculty, staff and students.

My perspective is informed by work in the academy both in faculty and staff positions and of course as a student as well as work in the community, most intensively with Queens Pride House, which I co-founded in 1997, and the New York Association for Gender Rights Advocacy (NYAGRA), which I co-founded in 1998. Queens Pride House is the only LGBT community center in the borough of Queens, and we offer support groups — including a transgender support group — free mental health counseling for members of the community, and other services; we are just completing our first funded advocacy program which focused on advocating for members of the community — especially transgendered women of color — who are victims of police harassment and brutality.

In 2009, NYAGRA published the first directory of transgender-sensitive health care providers in the New York metropolitican area; and while directories of this kind have been posted on-line for cities such as Los Angeles, Boston, and Minneapolis-St. Paul, the NYAGRA directory was the first such directory in the United States ever published in a print edition; we are updating it continuously as we identify more transgender-sensitive providers in the area and it is now available on-line as well at nyagra.com.

NYAGRA is a co-founding member of the coalition seeking enactment of the Gender Expression Non-Discrimination Act (GENDA), the transgender rights bill currently pending in the New York state legislature, and I represent NYAGRA in that coalition, as I did in the coalition that secured enactment of the Dignity for All Students Act (DASA) in 2011. The Dignity Act came into effect this July and prohibits discrimination and bias-based harassment in public schools throughout the state of New York. I mention safe schools legislation in the context of this discussion because the New York State Dignity legislation includes a comprehensive list of ‘protected categories,’ including race, religion, ethnicity, and disability as well as sexual orientation and gender, defined to include gender identity and gender expression. Safe schools legislation such as DASA can help move us out of a purely ‘identitarian’ conceptual framework, which can be limiting.

It should be obvious — but may not be to everyone — that making higher education more LGBT-inclusive must also mean tackling the problem of bullying and bias-based harassment in elementary and secondary schools, since so many LGBT students drop out of school because of such bullying and never make it to college; that is especially true of transgendered students, I would essay, based on anecdotal evidence (in the absence of any comprehensive study of the problem).

In addition to the work I do on behalf of NYAGRA in the legislative arena, one other important component of my work is transgender sensitivity training; I’ve conducted sessions for a wide range of social service providers and community-based organizations, ranging from one-hour workshops to full-day trainings. A small part of my training work has been with academic institutions, focused on issues related to transgender inclusion — including, for example, gender-neutral housing, which has become a major issue on many campuses.

One of the biggest issues for transgendered people both on campus and off is access to health care, which is why I co-founded the Transgender Health Initiative of New York back in 2004. THINY (as we call it) and its members have worked tirelessly to try to open up health care to members of our community in New York, who face significant impediments to accessing quality health care, just as they do throughout the country.

In 2006, I co-facilitated a series of trainings for St. Vincent’s Hospital, which was one of the largest hospitals in New York City, and a hospital with one of the largest transgender patient populations. Sadly enough, St. Vincent’s went bankrupt last year and closed after failing to resolve a situation in which the hospital had accumulated over a billion dollars in debt. Sad, too, because these were the first transgender sensitivity trainings for any major hospital in the city and they were as much of an eye opener for us as they were for the nurses, techs, and other health care professionals we trained. Participants ranged from hostile to indifferent to open-minded to genuinely supportive  in short, a microcosm of society and its attitudes towards the transgendered. Only a few of the nurses were openly hostile and even (in at least two cases) somewhat disruptive. But most of the nurses and other providers we did trainings for at the very least listened politely.

The real problem was the lack of both knowledge of the challenges facing transgendered people as they try to access health care as well as the lack of sensitivity on the part of some of these providers. With regard to the former — lack of knowledge — one of the big problems facing our community is that among those who think about transgender access to health care —and there are far too few who think about this issue at all — most imagine that the main challenge we face is accessing hormones and surgery. While that is a challenge, the biggest challenge for transgendered people really is accessing healthcare for all of those medical issues unrelated to gender transition.

And that leads me to an important theme of my talk today. The ‘gateway’ diagnosis required to access to hormone replacement therapy (HRT) and sex reassignment surgery (SRS) since 1974 has been gender identity disorder (GID), introduced into the fourth edition of the Diagnostic & Statistical Manual of Mental Disorders (DSM IV), published by the American Psychiatric Association (APA). While GID is usually thought of as the diagnosis by which adult transsexual and transgendered people gain access to HRT and SRS, the true significance of GID is much larger. First, a change of legal sex designation — the ‘gender marker’ on identification documents that assigns us to either male or female sex — in most jurisdictions requires at the very least documentation of an intent to go for SRS, if not actually proof of completion of surgery (as is the case in New York City).

While there is no necessary connection between a change of legal sex designation and a change of legal name, in many if not most cases, transitioning transsexuals pursue these two changes simultaneously. The truth is that most transgendered people frequently or even consistently present in a gender that does not match their ID, which causes problems in a multitude of situations. Since 911, most large buildings in New York City require photo ID even to enter the building. And so the apparent discrepancy between ID and either ‘gender marker’ and/or gendered name and/or gender presentation in a photo can constitute a barrier to employment, housing, and public accommodations as well as to accessing health care and social services.

But if the apparent ’solution’ is to go for a change of legal sex designation as well as name, and if the former change – and in some cases, effectively, the latter – requires the diagnosis of GID; then in effect, the ability to access health care as well as employment, housing, and public accommodations requires a diagnosis of GID as well. I personally find it outrageous that transgendered people in the United States and elsewhere have to have themselves declared mentally ill in order to access health care or to get or to keep a job. We must commit to finding means by which transgendered people can access forms of medical intervention such as HRT and SRS without having to subject themselves to the degradation of being declared mentally ill simply by virtue of their gender identity. As I like to say, I do not have a gender identity disorder; it is society that has a gender identity disorder.

One small step forward was taken when the APA revised the GID diagnosis and renamed it ‘gender dysphoria’ in the DSM-V published earlier this year. But while the language of the diagnosis has been softened, the diagnosis still pathologizes gender variance as a mental disorder that needs to be corrected, and that diagnosis not only undergirds the Standards of Care (SOC) published by the World Professional Association of Transgender Health (WPATH) (formerly the Harry Benjamin International Gender Dysphoria Association) and the protocols for gender transition in this society, this diagnosis – what I call the GID ‘regime’ – constitutes the very basis for American society’s understanding of transgender. Even in relatively more sympathetic portrayals of transgendered characters such as those in “TransAmerica” and on “All My Children” and “Ugly Betty,” the discourse through which those characters are understood is a medical model of transsexuality that is fundamentally model that constructs gender dysphoria as deviance from a norm rather than recognizing transgender and gender-transgressive identity and expression as simply being a natural variance in a gender identity that is no more ‘disordered’ than conventional gender identity and expression. My own work as a transgender activist is informed by a feminist conception of gender and a commitment to challenging and dismantling the sex/gender binary that is at the root of our oppressionas women and as men as well as transgendered men and women. Our goal as a movement must therefore be nothing less than the transformation of society’s understanding of gender. And if we are committed to that goal, we must also be committed to dismantling the ‘GID regime’ that undergirds this system of gender regulation and control.

The influence of GID also extends into the sphere of public policy as well, impeding the fight for transgender rights. We have made enormous progress as a community and as a movement over the course of the last two decades, but while over 150 jurisdictions — including 17 states and the District of Columbia – now have enacted legislation explicitly prohibiting discrimination based on gender identity or expression, it is a sad fact that 33 states have no such protection in their state laws. However, every state has included disability in its human rights law, and it is that rubric that litigators are using to obtain legal redress for transgendered plaintiffs across the country, and they often win on that basis. But the argument that such litigators proffer usually follows along these lines: my client is mentally ill by virtue of his/her gender identity disorder or gender dysphoria and therefore is protected under state disability law. I should make clear that I have nothing but admiration for the hard-working lawyers who represent transgendered clients – often pro bono – with limited time and resources. And in those 33 states without explicit inclusion of gender identity and expression in state human rights law, appeal to disability by way of GID may well be the only practical way of obtaining legal redress for discrimination against a transgendered client. But I think we need to recognize how sharp the horns of that dilemma may be.

As a non-lawyer who works on legislation, I can tell you that the genuine happiness that I feel for the transgendered client who wins such a case is diminished by the realization that the victory for that individual undercuts the very arguments that we need to make in the legislative arena. Because it is precisely GID that gives the religious right and other opponents of transgender rights legislation their most powerful ammunition. So I would argue that we need to move from a ‘deviance’ model to a ‘variance’ model and from a construction of transgender identity as a mental pathology to a concept of ‘wellness’ in which transgendered and gender-variant people are viewed not as vectors of mental illness and disease but rather are recognized as contributors to society, including potential contributors to a transformation of society’s understanding of gender.

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