Useful and necessary?

Yesterday, June 18, 2015,  the Justice and Security Committee of the Dutch Second Chamber held a debate on the need for gender registration.A parliamentary majority last week voted to do away with the requirement of it “where possible”. The minister promised to work to reduce the level of registration.

In an apparent global first, Dutch government agrees on the aim of abolishing gender registration where it is not needed in the public sphere. The debate – with only liberal and progressive parties present – was held in an open and understanding, solution oriented atmosphere, where the minister of Security and Justice said “Every minority counts for me”, thereby restricting the reason for the measures to the trans* and intersex population.

The Members of Parliament that were present all referred to the annoying and sometimes invalidating examples of having to show a gendered ID on the train when not looking like the conductor expects from your gender marker. Or buying a drink in the bar, looking young, showing your ID and then be publicly laughed at for not looking masculine enough. Initially used as examples of the trouble the wrong gender marker brings, he examples are now taken as an indication the trouble any marker can bring and led to the question whether there is any need for the controlling company or state institution to know the person’s gender or genital layout.

Parties insisted it should be possible for the individual to choose whether to be addressed by gender (and which then) or not. A motion by Groen Links (the Dutch Greens) to abolish gender registration on the birth certificate was met with surprise and lack of understanding: parents want their child to be registered with a gender! The idea that gender registration at birth was never meant to please parents but served a greater interest to be able to call the able-bodies men to arms, never really led to the conclusion that this measure is antiquated and ripe for striking, since we don’t have compulsory attendance anymore. Abolishing this most fundamental registration of all, appears to be a bridge too far. Understandable since few convincingly advocate for a less patriarchal society.

The minister’s argument calling for civil society to change the behaviour of commercial entities in gendering customers was not generally met with agreement. Groen Links was adamant in telling the minister that the state should practice what it preaches and propagate the principles of the law.

While the debate was very open, it became clear during the interventions that there were no clear thoughts on what is meant by sex or gender registration, or what constitutes a legitimate need. Classical examples are issues like labour equality between men and women, mama carcinoma research, prison service, population research. Whilst the concerns are serious and without addressing lead to several important political deficiencies, none of these examples are adequate for arguing the need of registration preservation. Medical issues should be regarded by body type, having certain physical characteristics like which reproductive organs, which chromosomes, familiar anamnesis, as also the medical world actually does not have one definition for what they call sex. Most other issues can bes checked on the basis of self-identification. The example of prisoners also requires social role, not gender marker in some ID document. The fear for ‘predators’ is misplaced and naive, as if in same-sex facilities no harassment takes place, and as if lack of gender marker automatically ‘abolishes’ all social gender roles. With a bit of creativity a solution for everything can be found.

Politics by the way is not opposed to introducing a gender neutral option in registration, some are pretty much in favour even. But in case they want to do this in the birth registry, they may case more trouble than they foresee.

Concrete demands by the  MP’s present are: research the need for gender registration on all levels, make registered data available on need-to-know basis (and exercise scrutiny in that). The minster is wiling to take care of some short-term solutions and wants to start research into the consequences of removing the requirement of gender registration.. Voting for the proposed measures is expected in two weeks.

New webinars in June 2015

trans rights are human rights

And so are intersex rights!

Between 16 and 20 June 2015 Vreerwerk will again organise a series of webinars on transgender and intersex developments on the human rights level. We will hold three webinars of two hours on the following themes:

  1. Recent developments in the European trans* and intersex theatre. Where do they stand rights-wise? What can we learn from them to advance our national cause?
  2. How can you use the UN to engage your government? What can we learn from good practices on both trans* and intersex?
  3. How to use the Yogyakarta Principles of human rights on sexual orientation and gender identity and expression (SOGIE) issues in national advocacy?

The costs are 89 (incl VAT) euro per webinar, 239 (incl. VAT) for all three.

When interested send an e-mail to vreerwerk@xs4all.nl and we will get back to you as soon as possible. Or fill this form:

Sex and gender domino

April 2015 is for trans* and intersex human rights in Europe a rather fortunate month. On the legal level that is. It still rains trans murders and suicides, not to speak of other atrocities. Which – cynically maybe – show precisely what we need that legislation for.

I want  your attention for two cities in two countries for two different important advances. The first town is Valletta, on Malta. The other is Geneva in Switzerland. And then for two more where no less important stones fell in Oslo, Norway and Strasbourg, France. Continue reading

World Health Day 2015

The United Nations have labelled April 7 World Health Day. A day to pay explicit attention to health issues. Since our focus is trans* and inter*, or differently (and more universally) put: gender identity, gender expression and sex characteristics, this is what we will look into.

Luxury

For transgender persons, or trans* people, or gender variant/diverse people, having a good health is often a luxury they cannot afford. Because they are not recognized as a group in need of specific health care (or even health care at). In many parts of the world including enlightened Europe, wishing to adapt your body’s sex characteristics is a frowned upon phenomenon. Both the general public and the medical sector may despise you for your needs.

World Health DayInsurance

The next issue is getting the health care covered by insurance. Of the countries that provide health care to relieve the plight of trans* people, most cover maybe the ‘basics’ and then still often on extraneous conditions. These so-called basics are not by definition what the trans* person asks. Because being trans* does not only concern those people who need to ‘switch’ genders for their well-being, but every trans* person who is in need of any health care to increase their well-being with their gendered and sexed body. Some people may need hormone replacement therapy because their natal sex hormones don’t agree with them. Some need to only get rid of (the largest part of) their breasts. And given the choice, the percentage of trans* women that insists in getting rid of their original genitals is not that high. In the Netherlands only 12% of the whole trans* population (estimated at 2 to 3% of the population) decides for medical assistance. Communication from Spain indicates a similar percentage.

Fate

In most countries doctors don’t agree with prescribing hormones or doing surgery upon a patient unless a psychologist has done a thorough assessment of the care user’s mental health and observes the presence of “Gender Identity Disorder” or “Gender Dysphoria”. That process of establishing the diagnosis can easily aggravate the presupposed dysphoria (a word that actually refers to severe depression, and by virtue of that is not a good term). When left to the discretion of a prejudiced medical profession, that has no good understanding of sexual orientation and gender identity (and expression) phenomena, they will try to explain things away, but not legitimize the existence of gender diversity. The higher the level of morals conservatism, the higher the chance trans* people will meet this fate and only can progress medically assisted gender transition with a diagnosis of severe mental disorder.

Standards

Also in the progressive Netherlands you cannot easily enter medically assistance with gender transition. Where the Standards of Care for transgender health care states that informed consent is the way to go, the Amsterdam gender team still insists in a lengthy psychological evaluation and in case you may encounter practical trouble (intensifying ‘dysphoria’, growing life problems for non conforming ..) they may prolong evaluation or when already on HRT, suggest you to lower the dosage. As if that were the issue. Doing so leads to iatrogenic increase of mental instability. Which in turn leads to a decrease of the patient’s health.

Assessment

Another issue that weirdly is coupled to a trans* person’s health, is Legal Gender Recognition and the preconditions for that. In Europe 33 countries require psychological or medical interventions before recognizing a trans* person’s wish to change their gender assignment; 19 still require sterilization and genital realignment. Only two states in the world give the possibility to change one’s gender assignment with no strings attached: Argentina, and Malta. Denmark comes next, but still requires a half-year wait (and being over 18 y.o.). Everywhere else, where there are regulations, psychological assessment is the least invasive requirement, also in the Netherlands. Only two to three countries take trans* people seriously. And only one of these has provisions for a non-male/non-female reassignment.

Malta

Laws and regulations can have an important effect on trans and inter* persons’ well-being. They regulate the conditions for legal gender change, for medical assistance: which interventions are available at all, which ones are insurance funded? For intersex (or inter*, because it can also be an identity and those more ‘intergender’ and the asterisk in both inter* and trans* indicates a vastness in possibilities). Only one state in the whole world, one state out of more than 192 states, prohibits explicitly that sex characteristics get adapted to a social ideal of having genitals clearly distinguishable as male or female. Everywhere but in Malta this is still legal, and standing practice.Human Rights Also for Intersex PeopleProgress

Engaging in these usually non-consensual surgeries is a gross violation of a person’s dignity and personal autonomy. Intersex genital mutilations – usually performed on minors – equals forced sterilisation of women for belonging to the wrong ethnic group (forbidden by the European Human Rights Court en the UN!). When asked a paediatrician they sometimes agree that in the past many errors have been made, but nowadays medical science is so much better that the results are incomparable with the sorry state of technique and results of twenty-five years ago. By using that argument they still deny people their right to bodily autonomy, to decide for themselves about their body. They preclude being OK with those genitals (or gonads or chromosomes), with their body and their life.

Power

The health of a person considered physically or mentally deviant is the explicit object of power play, of medical, psychiatric and legal paternalistic laws and practices. That goes against the most basic rights and that alone already is pretty bad for one’s health.

Redress for lifelong trans discrimination

A Buenos Aires court yesterday recognized the lifelong institutional violence, stigma and discrimination of a 60 year old trans woman in Buenos Aires during all of her life. The judge called it “Existential discrimination”. The woman was granted lifelong living wage as a reparation for all the violence. This is a necessity, because there is no justice without social economic justice being applied.

In the process the Yogyakarta Principles on the application of human rights law to sexual orientation and gender identity have been used extensively. A key role was played by Principle 20 on the right to effective remedies and redress. This elaboration of human rights law goes further than the regular use for legal gender recognition or the right to health and freedom from forced medical interventions. As do human rights in general.

Pink LAvender drawing of a woman looking in a hand mirror

The beneficary wants to stay anonymous. and four other 40-plus women are awaiting the decision in their cases. The case was brought on by the Mesa Nacional por la Igualdad, the Federación Argentina LGBT and the Asociación de Travestis, Transexuales y Transgénero (Attta). It was supported by the LGBT Ombudsoffice of the capital.

This case is the first in its kind to get a positive result. In 2013 Swedish trans people who underwent coerced genital surgery under the old law, tried to sue the state for this but the case got dismissed. They hope to now stand another chance.

This news comes from an e-mail by Mauro Cabral of GATE and an article on Infojus Noticias in Argentina. An update will be provided when there is more news.

Christelijk hoogleraar pleit voor wachten en conversietherapie

Afgelopen zaterdag14 februari 2015 verscheen er een opiniestuk in het Nederlands Dagblad, krant van conservatief christelijke signatuur, over transgenderkinderen. Dat staat bol van de misvattingen. Het stuk zelf is te vinden op nd.nl/opinie. Ik behandel de grootste problemen eruit.

In zijn opinieartikel d.d. 14-2-2015 schrijft professor Boer over transgender en genderdysforie. Daar zitten een aantal misvattingen in.
Als eerste dit: transgender is de identiteit en genderdysforie is de courante medisch-psychiatrische diagnose. Genderdysforie wordt gezien als een complex van aanhoudende klachten, die gepaard gaan met de innerlijke overtuiging niet tot het toegewezen geslacht te behoren en anders te willen leven, veelal in de rol van het andere geslacht. Transgender is ook geen spelen, maar een anders-zíjn. En het is geen stoornis, maar een genderidentiteit. Daarom moet genderdysforie ook verdwijnen uit handboeken als de Diagnostic and Statistical Manual, het handboek van psychologen en psychiaters.
Het idee dat genderdysforie door familiare of ontwikkelingsfactoren beïnvloed wordt, zoals de heer Boer stelt is een verzinsel, een vooroordeel. Conversietherapie waar hij op zinspeelt, is door onder meer de World Professional Association for Transgender Health (WPATH) en de American Psychological Association als onmenselijk, onwenselijk en krenkend gekwalificeerd.

Transgender is een genderidentiteitsontwikkeling die, zoals bij iedereen, al jong begint. Sommige mensen weten al met twee-drie jaar dat hun gevoel niet klopt met wat ze om zich heen zien. Veel volwassenen die dat als kind zo hebben ervaren, hebben in de tussentijd veel trauma’s opgelopen doordat ze niet konden zijn wie ze zich ten diepste voelden. Vanuit het idee het beste voor het kind te doen, is het beter wél in te gaan op de wens van het kind tot verandering, dan het te dwingen in een identiteit die het niet heeft en zeker niet door dwang zal verkrijgen.

Over de fuik van een behandeling: juist door open te kunnen zijn over wie men is en zich niet anders te hoeven voordoen (bijv. een homoseksueel leven leiden als idee van dichtst haalbare optie), voorkom je foute keuzes. Het blijkt dat het aantal “spijtoptanten” statistisch niet significant is (<1 procent) en uit onderzoek onder meer dan duizend transgenders door een kliniek in New York die met informed consent werkt, blijkt dat er nul mensen zijn die spijt hebben.

Nederlands dagblad

In tegenstelling tot wat de heer Boer suggereert, draait het helemaal niet om de medische behandeling. Om de mens te kunnen worden die je je voelt, hoef je alleen maar des stappen te zetten die jij voelt. Daarbij hoort veelal een wijziging van het juridische geslacht ter (betere) reflectie van de beleefde identiteit. En soms ook medische interventies, waartoe hormoonbehandeling behoort en eventueel operaties. Maar dit alles is niet wat de trans-persoon tot de man, vrouw of anderszins gegenderde persoon maakt die men zich voelt. De beleving van de gevoelde identiteit erkend krijgen is een mensenrecht. En zowel het gedwongen worden tot medische interventies teneinde het lichaam aan te passen omdat de wet dit vraagt (in Nederland gebeurt dit gelukkig niet meer), als het niet kunnen aanpassen van het lichaam, zijn schendingen van de mensenrechten. Internationale verdragen stellen duidelijk dat men het recht heeft op erkenning voor de wet en dat ongewenste medische interventies gelijk staan aan wrede en ongebruikelijke behandeling.

Juist omdat de hormoonbehandeling en de eventuele operaties niet de kern van een transitie zijn, worden pubers helemaal niet geopereerd. In plaats daarvan krijgen zij puberteitsremmers aangeboden zodat ze in alle rust kunnen nadenken over wat zij met hun toekomst willen. Het kenmerk van de puberteitsremmers is juist dat er niets onomkeerbaars gebeurt. Met zijn brief zet de heer Boer de lezers van uw krant dan ook op het verkeerde been: hij suggereert dingen die gewoonweg niet gebeuren.
Ik hoop vurig dat degenen die naar de heer Boer zijn verwezen een hulpverlener vinden die meer respect heeft voor hun identiteit.

J. Vreer Verkerke
bestuurslid Transgender Europe
mede-oprichter Transgender Netwerk Nederland

Trans suicide as a ground against childhood diagnosis

Invisible for the lay audience advocates and medical establishment fight a struggle for the acceptance of gender diversity in children. The recent suicide of Leelah Alcorn in Ohio gives a very clear argument for depathologisation and against a childhood diagnosis for “gender incongruence” Continue reading

Puro miedo

El principal motivo para defender el modelo actual vigente de atención sanitaria a las personas trans* es “proteger al paciente”. Protegerles contra arrepentirse. El médico que les atiende quiere estar seguro de que el paciente al que trata no está actuando de forma impulsiva. Aunque se puede entender el miedo, la solución a este no es la adecuada.

Muchas de las preocupaciones que tienen los médicos respecto a las personas trans* vienen del miedo y de la ignorancia. Preocupación de perder el trabajo y también de perder la autoridad. Preocupación de que la gente vaya a arrepentirse, se responsabilice directamente al médico y se le acuse ante un tribunal disciplinario, hecho traumático para el propio profesional, que puso todos sus empeños//sus esfuerzos al servicio del paciente. El no haber aprendido nada sobre este tema durante la formación en medicina, psicología o psiquiatría se traduce en la incomprensión por parte del profesional hacia la persona trans*. Todo el conocimiento que se pudiese aprender sobre el tema se va adquiriendo: solo en el 2012, la conciencia social progresó un poco tras la adopción de una nueva nomenclatura para asuntos trans* así como la entrada en funcionamiento del nuevo DSM-5.

Un paciente trans* no necesita una protección diferente a la que obtiene un paciente cis (no trans*). Así como un paciente francés no necesita más protección que un paciente sueco. En caso de que un médico tenga alguna preocupación sobre la salud mental de un paciente, es éste el problema, no el ser trans*. La pregunta que se tiene que hacer el profesional debería ser la siguiente: “si hubiera venido un paciente preocupado por su apendicitis o por su cáncer de pulmón, ¿lo mandaría a ver al psicólogo para obtener un certificado de capacidad mental o lo aceptaría sin más? El hecho de que algo esté culturalmente connotado no me parece una razón de peso para solicitar una intervención extra.

preocupacion

Asimismo, todo el mundo tiene el derecho a equivocarse, aunque pueda sonar cínico. Es bastante probable que la persona trans* no esté muy segura saliendo del armario. La identidad así como los deseos evolucionan. También las personas homosexuales o bisexuales muchas veces no se sienten emocionalmente seguras con la idea de salir del armario. Solamente se atreven cuando aparece la figura del amante, aunque de un tiempo atrás son conscientes de ser diferentes. Ell*s no tienen que pasar por un psicológico, ya no se les considera enfermos desde años. Se pueden arrepentir de no salir del armario, casarse o no, tener hij*s o no. ¿Quién sabe si saldrá bien siempre? Esto se aplica también a las personas trans* que tenemos el derecho de equivocarnos. El estado o el entorno médico no tiene el deber de protegernos de nosotros mismos. La gente que quiere tener hij*s, ¿tienen que ir al psicólogo o al sexólogo? ¿Se les preguntan si están seguros? ¿Se investiga si serán buen*s padres? ¿Se envían a los futuros esposos a un consejero matrimonial para asegurar la estabilidad y la longevidad de su amor?

La preocupación de que decidiéramos por nosotros mismos y sin la intervención profesional que hubiera asistido a la persona trans dubitativa, proviene del miedo y la ignorancia. En primer lugar, el previo consentimiento informado tiene que ser un requisito, Con psicólogo o sin psicólogo, si el paciente no entiende de qué se trata, cuáles son los riesgos y las consecuencias de su decisión, el proceso acaba ahí. En segundo lugar, no sería la primera vez que un psicólogo se ve involucrado cuando un paciente se somete a un tratamiento invasivo. Pero no tod*s l*s pacientes que van a someterse a un tratamiento oncológico necesitan apoyo psicológico//necesitan pasar por la consulta de un psicólogo

Cuando nuestra sociedad deje de tener miedo de personas trans* será cuando nuestro sufrimiento disminuya de forma considerable. Al fin y al cabo esel mundo que nos rodea el que nos da tantos problemas. Y nosotr*s como parte de este mundo sentimos que no es bueno ser trans*, comportarse fuera del de la dicotomía de género. Por eso, deja de tener miedo y súmate a la revolución. No somos más que una amenaza de su status quo. ¿Y qué?

¡Gracias a Irene Alcedo para el ayudo linguistico!

 

Reading between the lines

International Day for Trans Depathologization, interview with Mauro Cabral, co-director of Global Activists for Trans* Equality

The news announces it this way: “For the first time in history, the World Health Organization (WHO) will throw out transsexuality from the chapter on ‘Mental and Behavioral Disorders’”. But (full) depathologization of gender diversity still seems a remote point on the horizon. What is good and what is better? We asked a key activist who helped create the Argentinian Gender Identity Law, a model for global policy. Mauro Cabral is co-director of Global Action for Trans* Equality (GATE), where he coordinates an international initiative to reform the Eleventh Edition of the International Classification of Diseases (ICD).

After two years of deliberation and pressure from depathologization activists, WHO recently removed the current diagnosis of “transsexualism” from the Mental and Behavioural Disorders chapter of its online [beta edition, transl.] version of the ICD-11, replacing it with a new category of “gender incongruence” in a new chapter on Sexual Health. Does this mean that trans people are not pathologized in the proposed classification? What does it mean, to “depathologize”?

For many trans advocates, depathologization is an emancipation struggle. The terminology itself also is contested. For some, it means full access to rights without any diagnostic requirement; for others, depathologization means eliminating diagnosis and medicalized control over individuals’ bodies. There are tensions among advocates around the role of medicine in defining diverse trans experiences and around ownership of the body. Does the need for surgery and hormones represent a radical prosthetic incorporation with medicine as the tool, or does it express conservative forms of technological expropriation of the body in alienating times of biocapital?1

Mauro Cabral summarizes it this way: “From one perspective, depathologization looks in a way like a Moebius band: striving for the maximal personal freedom seems to put the masking of biomedicine as regulatory principle for transition on the line; settling for less personal freedom risks perpetuation of current biomedical dogma, which diagnoses the wish to transition as personal and political pathology.”

There was a consensus in activism that transsexuality should no longer be considered as a mental illness by 2012. Now it is 2014, and this dream is still unmet. Is everything lost?

You are right. The world in which identifying as a gender different from the one assigned at birth is considered pathological did not end. However, in that time both the Diagnostic and Statistical Manual of Mental Illness (DSM) and the ICD went through an intense process of revision and reform.

What does this new version [of DSM] entail?

First, we need to clarify that, categorically, any diagnosis in the manual of mental disorders is by definition a mental disorder. Now they renamed “gender identity disorder” with an older clinical term of “gender dysphoria.” Where the previous diagnosis pathologizes trans people just for who they are, the “new” category can be seen as a step forward, because it puts the clinical focus on the trans specific experience of (the) suffering and stops when this disappears. In all the world materially or symbolically governed by the DSM and its codes, trans people stay trapped in one form or another of mental illness, and we continue to be cataloged as sufferers.

We need to remember that diagnosis in the DSM Manual is still a conditio sine qua non in many countries in the world, to access rights, like legal recognition and physical medical interventions. For example, the “treatment” for diagnosed suffering, that are still seen under this mark, and never as a biotechnologically mediated self expression.2

And in the case of the ICD reform?

The ICD Working Group called together by the World Health Organization agreed to reduce the scope of the diagnosis and proposed to scrap the current mental diagnostic categories that affect trans people, including “gender identity disorder” and “transvestic fetishism,” among others. This is fundamental: they finally recommended to remove any mention of trans issues in the chapter on mental health disorders. They also proposed new categories in a new non-psychiatric chapter on Sexual Health, including “gender incongruence of adolescents and adults,” and “gender incongruence in childhood”.

In what sense is the new category “gender incongruence” better than the previous?

Gender identity disorder” is such a damaging diagnosis that almost any replacement category would be at least a bit better. In that sense, “gender incongruence” also avoids diagnosing trans people just for who they are, paying attention to the discomfort that the incongruence could cause between the gender identity and how it is embodied. However, obviously, you can only pathologize incongruence by implicitly invoking a cissexist ideal of (bodily, identitary or expressive) congruence. Also, incongruence is taxonomically linked to suffering and congruence is linked to happiness, with medical approval enjoyed by the congruent, but missing for the others. In other words, it is proposed that identifying as a gender different from the one they gave us at birth stops being a disorder (mental or otherwise), but now the possibility of living our gender in a non stereotypical, dissident, incongruent way could be in danger3.

Why then not fight for eliminating any diagnostic mention once and for all?

The answer is both ground for pride and pain: only one country in the world, ours, Argentina, admits access to legal gender recognition and transitional health services without requiring a diagnosis, psychiatric or otherwise. Denmark recently enacted a similar policy, but only for legal recognition. This means that, in the rest of the world, people who need to have their legal registration or their bodily configuration changed will still need a DSM or ICD code to access these modifications (every time that access not only means authorization but also public or private health coverage). None of these considerations, however, justify the introduction of the category, “gender incongruence of childhood.” Resisting this classification is a focus of our efforts.

But why pathologize trans children?

The simplest explanation is that gender diversity in childhood is still culturally unacceptable, but the “rational” arguments are different. One focuses on the anxiety that daddies and mommies of children, who rebel against social expectations around their sex, may have. So children are pathologized as therapy for adults. Another argument emphasizes diagnosis to facilitate expansion, funding and publication of research on gender diverse children. This argument is both perverse and faulty. There are decades of research and publication on homosexuality, which has long been depathologized. A third argument asserts that diagnosis guarantees inclusion [of gender diversity topics] in education, in a world where sex segregation is so naturalized and depoliticized, and where, sadly, a diagnostic framework still is considered more effective than a human rights framework. Last, both the old and the new diagnoses are justified as providing an archive of clinical history.

What would the function of this archive be?

Inasmuch as the first biotechnological transitional intervention is the administration of puberty hormone blockers, there are [experts] who consider a childhood diagnosis necessary for immediate access to treatment. This position universalizes the need for diagnosis, based on a treatment that is only available in a couple of countries, and it naturalizes that need. Unsurprisingly, the “gender incongruence in childhood” diagnosis is defended precisely by those medical teams that provide the treatment. Even worse, this argument installs hormone treatment as common fate, imposing early diagnosis as a way of ensuring later transition. As medical policy experts like Sam Winter and Simon Pickstone-Taylor have stated: it is obvious that those arguments fail at the hour of tending to the two biggest necessities of the children: to grow up in a world that does not impose normative forms of masculinity or femininity on them through submitting them to a diagnosis, and the need for information, support and containment.

If they eliminate the diagnostic criteria that pathologize gender diversity in childhood, what would happen with those trans children that need special health care?

The ICD already contains and will keep, non-pathologizing codes, that permit access to assessment and professional support when needed, without any diagnosis of physical or mental disorder. In those circumstances where treatment is needed for depression or anxiety of the child (oftentimes produced by hostility and rejection around them), the ICD already contains general codes that cover the issues4.

Can intersex also be approached from a depathologization perspective?

Without a doubt, although the processes and the issues are different. Approaching intersex from a depathologization perspective affirms bodily diversity, which should never be seen as a pathology. It also means the careful work of distinguishing in every intersex body those characteristics that need medical attention from those that don’t. Depathologization activism must also articulate the irreversible consequences of pathologization, including the chronic pain, the sterility, the mutilation and the genital insensitivity, post-surgical trauma, fistulas, chronic infections, and metabolic changes caused by surgical removal of the gonads or pharmacological treatments tonormalizethe body. This is the register of how pathologization makes us ill.

What impact do terms of “disorders of Sex Development” have on the fight to depathologize intersex?

Since the mid-1990s, the intersex movement has disputed the jurisdiction of biomedicine over intersexuality. Even the medical terminology evidences bias and cruelty. At the end of the 19th Century, mythological hermaphroditism was redefined as a category for clinical use and accompanied by many pseudo-hermaphroditisms to expand diagnostic range. By the mid-1920s, a more specialized vocabulary emerged with terminology about intersex bodies, although the old terms still remained. The struggle and success of the intersex movement in the 1990s, to depathologize intersexuality and to appropriate, subvert, and transform diagnostic intersex terminology into a political identity was answered in a new pathologizing attack.

In 2006, a new classification was created, that reorganized the spectrum of intersex bodies into a taxonomy of “Disorders of Sex Development.” As intersex researcher Georgiann Davis argued, this label reestablished medical authority over that jurisdiction in dispute: our bodies. A central aspect for the depathologization of intersex today is resistance to the imposition of this vocabulary and its variations. For the intersex movement, there is an intrinsic relationship between nomenclature and treatment. Mirtha Legrand notes: “As they see you, so they treat you”. Advances in genetic and in fetal monitoring technology has extended the boundaries of medicalization to reach intersex embryos. They are often de-selected in preimplantation diagnostic procedures that promote selective abortion of intersex fetuses and prenatal drug administration to “prevent” the birth of intersex children.

Which are the political consequences of intersex pathologization?

Intersex activism itself is being psychopathologized and dismissed as a political symptom of disordered bodies. Because normalizing medical interventions usually take place in early childhood, intersex genital mutilation in infancy seems to infantilize the movement. In that way they mutilate our our capacity to be seen as adult activists with more than 20 years of experience in a sustained struggle. In spite of this oppression, the strong presence of intersex activism in regional and international human right systems has decisively contributed to the recognition of these medically unnecessary and non-consentual practices as forms of torture. Like medical abuse and forced, coerced or involuntary sterilization, these medical practices are violations of human rights.

What does depathologization mean for someone who like you lives the consequences of trans and intersex pathologization?

For years there was a prayer in the Spanish speaking world that affirmed:

My body, primary territory of peace”

I would like to able to subscribe to that, one day. Today is not that day. As long as this war continues (or as I live), what remains of this body is my primary battleground.

This interview appeared first in Spanish in the Argentinian newspaper Página 12, on the occasion of the International Day for the Depathologization of Trans Identities, October 18, 2014

1Hence the question on who owns the body: if exterior criteria are to define what may happen with your your body, are you still the owner, or is it more a complex of medical and capital actors with their interests – owning shares in hormone producing companies or because of their research being paid by pharmaceutical companies? [transl.]

2 Like the remark about prosthetic use of medicine, this hints to self determination how one’s body should look and using medicine as a technical solution to get there.
[transl.]

3Not every trans/gender diverse person wants, needs or can live a “happy congruent” life. If there is a right to self determination, this extends to choosing not to submit to practices meant to become more congruent with society. The right extends to dissidence.
[transl.]

4 These existing codes may be augmented with Z-codes, to clarify special needs of trans and gender diverse children (for example, when anxiety is caused by transphobic school bullying). [transl.]

Trans*, health and human rights

Trans people are seriously disadvantaged by not having accessible trans specific health care. As by not being able to access regular health care because of transphobia and discrimination. Vreerwerk keeps writing and talking about trans health and trans* people’s access to health care. Be it general health care or trans specific. With much discrimination – whether out of ignorance or willingly – trans people are disadvantaged.

Traditionally and unjustly, legal recognition issues and health trans(ition) related health care are strongly coupled.

We can show how to argue your case using human rights always is being forgotten or submitted to extraordinary requirements to be able to access health care, Vreerwerk offers lectures and workshops – live and on te web – in gaining a human rights background to patients’ rights, to getting your collective health rights.

Vreerwerk has experience in analysing the health rights situation for trans* and intersex people and can help people to advocate for their human rights with regard to good health care that does not discriminate. We are experienced in writing alternative health care standards and have been asked more than once to look at existing practices and advise on them.

We can show how to argue your case using human rights. Central questions here are:

  • What do human rights say about health care?
  • What is there on gender identity and expression in human rights?
  • What is “good health care” from a human rights perspective?
  • What systems and recommendations are there?
  • What should be in the package and why?
  • How to build local solutions?

Want to know more? Want to hire us? Mail vreerwerk@xs4all.nl