The Shameful Trans Bill Is The Result Of Decades Of Medical Discrimination

The blatantly regressive Transgender Persons (Protection of Rights) Bill, 2016 that was recently passed in the Lok Sabha violates the very idea of the self-determination of one’s own gender identity. The occasion of the Bill’s passing was rightly called a “black day” by Dalit transgender rights activist Grace Banu.

Firstly, the Bill has a disappointingly poor definition of the word transgender. Moreover, it permits trans people to be jailed for begging with sentences ranging anywhere from six months to two years. Also, far lighter punishment is to be dished out for raping or assaulting a trans person than for doing the same to cis women. As if that were not enough, the bill also does away with the idea of reservations for trans people under the garb of providing “equal opportunities” for all sexes. This does little to ensure access to education and employment for trans people, while at the same time criminalising begging as a means to earn one’s livelihood.

But perhaps the most egregious aspect of the bill is its suggestion to set up a district screening committee in order to determine whether one truly embodies the gender identity they identify as. This screening committee is supposed to be comprised of “a Chief Medical Officer, a psychiatrist, a social worker, and a member of the transgender community.

To the average cis person, this may not seem like a big deal. After all, it’s better to have people from the medical establishment oversee a process as complicated as transition, right? Quite the opposite happens to be true.

The truth is that trans people and the medical establishment have had a long and complicated history. In the psychomedical discourse concerning trans people, the latter have rarely occupied the position of the speaking subject; instead, they have been objectified by the medical gaze. The medical and psychiatric establishment has a long history of playing gatekeeper and acting as the final arbiter of what counts as a properly gendered body that is intelligible according to cultural norms. To demonstrate this, I would like to draw on Sandy Stone’s pathbreaking essay which paved the way for transfeminism: “The Empire Strikes Back: A Posttransexual Manifesto”.

How Did Being Trans Come To Be Seen As A Disorder?

It was in 1980 that trans people were first pathologised in psychomedical literature, with “transsexualism” being granted the status of an official “disorder” by the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM – III). Trans individuals fell under the diagnostic label of what was then called ‘gender identity disorder’. The consequences of this kind of pathologisation are far-reaching as the stigma of mental illness only worsens the image of the trans person as a social deviant. It was only this year that the WHO decided to no longer classify being trans as a mental illness – a small victory.

But prior to 1980, work had already been done in order to arrive at a diagnostic criteria. Leslie Lothstein, in his 1970s study of ten ageing trans people (whose average age was 52), derived the conclusion that trans people as a ‘class’ “were depressed, isolated, withdrawn, schizoid individuals with profound dependency conflicts. Furthermore, they were immature, narcissistic, egocentric and potentially explosive, while their attempts to obtain [professional assistance] were demanding, manipulative, controlling, coercive, and paranoid.

In another study comprising of 56 trans people, “the results on the schizophrenia and depression scales were outside the upper limit of the normal range. The authors see these profiles as reflecting the confused and bizarre lifestyles of the subjects.”

The studies were carried out with a limited class of subjects and using questionable methods. As Sandy Stone rightly points out, “Such results might have been considered marginal, hedged about as they were with markers of questionable method or excessively limited samples. Yet they came to represent transsexuals in medicolegal/psychological literature, disclaimers and all, almost to the present day.

To sum things up in short, much of the psychomedical literature on trans people was written by non-trans persons on the basis of dubious studies. But nonetheless, the narrative unfolding in this literature was one every single trans person had to conform to in order to be certified as being “truly” trans and given medical access to hormones. As Sandy Stone points out, one of the fundamental questions that arise here is “who is telling the story and for whom?”

No Such Thing As ‘Brain Sex’

One of the first books written on trans people was “The Transsexual Phenomenon” by German-American endocrinologist and sexologist Harry Benjamin in the ‘60s. Today, Benjamin’s book is criticised for its neurosexism (the idea that ‘male’ and ‘female’ brains have fixed differences) and gender essentialism (the idea that gender and gender roles are innate and biological). Much of the narrative surrounding trans people being “trapped in the wrong bodies” arises from Benjamin’s idea that trans people possessed different brains from cis people and that there was a mismatch between their brains and their assigned gender. The problem with this should be evident as it suggests that there are brains that are intrinsically either ‘male’ or ‘female’—and that people exhibit behavioural traits based on this. Not only is this extremely essentialist, it also erases the existence of non-binary identities. Today, the idea of ‘brain-sex’ has been thoroughly debunked.

Neurosexism and gender essentialism were not the only problems with Benjamin’s book. Perhaps the biggest problem (and no doubt the biggest aid to the clinics) was how it set up the criteria in order to determine “true” trans people. The traits required by Benjamin were as follows:

  • Social transition is completed.
  • Insufficient relief from hormone therapy.
  • Immediate need or desire to undergo some form of gender reassignment surgery.

In addition to this, Benjamin’s book differentiated between people who were supposed to be “truly” transgender, and those who were ‘transvestites’ (the latter being defined as people who were turned on by dressing in the opposite gender’s clothing). Benjamin’s definition of the “true” trans woman, for instance, was someone who was only attracted to men, exhibited overly ‘feminine traits’, didn’t feel sexual attraction towards women, and experienced deep genital dysphoria. Anyone deviating from this narrative was considered to be delusional.

In simple terms, Benjamin and the medical establishment’s idea of ‘woman’ was essentially a patriarchal stereotype—passive, docile, and perfectly capable of assimilating into a society that upheld heteropatriarchal norms.

(Mis)Managing Gender Dysphoria

NPhoto by Brent Stirton/Getty Images for the GBC.

In the ’60s, the then newly-opened gender dysphoria clinics (which were based on academic research of the time) refused to perform surgery on demand because they couldn’t risk giving into the demands of “sociopaths”. One such clinic—the Stanford Gender Dysphoria Clinic—even took on the role of being a “grooming” school where trans women were kept under surveillance and made to learn to behave in a way that was “truly” female. And since the clinics did not really have a fixed diagnostic criteria, it was necessary to construct the category of the “transsexual” (which was the term used at the time) in order to regulate access into the clinic. In practice, this meant that a trans person had to fit into a preconceived medical notion of who they were supposed to be, based on the behavioural traits they exhibited.

For instance, Christian Hamburger, one of the most prominent endocrinologists of the time, recommended HRT for only those trans women who were not excessively ‘masculine’. According to Hamburger, if a trans woman getting access to HRT only results in an androgynous appearance, then this wouldn’t be “harmonious”.

The gender dysphoria clinics started testing the suitability of the first trans candidates for surgery and found that their behaviour perfectly matched with what Benjamin had described. It took the medical establishment a long time to realise that the reason so many trans persons matched Benjamin’s profiles was because Benjamin’s book had also been read by the trans community and they knew what kind of behaviour was expected of them in order to get medical access to transition.

As Sandy Stone states, “The criteria which the researchers developed and then applied were defined recursively through a series of interactions with the candidates.”

She continues, “Concomitant with the dubious achievement of a diagnostic category is the inevitable blurring of boundaries as a vast heteroglossic account of difference, heretofore invisible to the ‘legitimate’ professions, suddenly achieves canonization and simultaneously becomes homogenized to satisfy the constraints of the category. Suddenly the old morality tale of the truth of gender, told by a kindly white patriarch in New York in 1966, becomes pancultural in the 1980s. Emergent polyvocalities of lived experience, never represented in the discourse but present at least in potential, disappear; the berdache and the stripper, the tweedy housewife and the mujerado, the mah’u and the rock star, are still the same story after all, if we only try hard enough.”

In other words, the psychomedical literature concerning trans people is largely an account where trans people themselves have no speaking voice or agency.

When You Stop People From Speaking Their Truth

What real-life consequences did this have? Thanks to the psychiatric and the medical establishment, only one kind of trans narrative was considered valid. A devastating effect of this can be seen in the early days when the John Hopkins program approved only 24 out of over 2,000 applicants for Gender Confirmation Surgery (GCS).

Trans people are a heterogenous group of people–just like every other group of people. But thanks to the medical establishment, trans people who strayed from the established narrative had their voices and their histories erased. The acknowledgement of trans lesbians for instance has only happened recently.

In 1989, sexologist Ray Blanchard came up with the term “autogynephilia” for those he termed to as “non-homosexual transsexuals”—that is, trans women who were attracted to or sexually desired women. Autogynephilia was defined as “a man’s paraphilic tendency to be sexually aroused by the thought or image of himself as a woman.” This is a move that blatantly pathologises sexual desire felt by trans women. Even cis women experience sexual desire and it is common for many cis women as well to imagine themselves in sexual scenarios. Why should trans women be penalised for it? Today, “autogynephilia” as a theory has mostly been debunked, but that didn’t prevent it from denying medical access to countless trans people who strayed from the medical narrative.

To give yet another example, for a long time, trans people were asked a question in clinics: if they could be the gender of their choice in every way except for their genitals, would they be content? Now there can be several answers to this. We know today that there are many trans people who do not experience genital dysphoria. And yet, only one answer was considered to be “correct”.

Even what is considered to be “gender dysphoria” today is widely contested. While some trans people do fit the traditional narrative of experiencing discomfort with their genitals, there are many others who experience dysphoria differently. Taken together, dysphoria can describe a diverse set of experiences ranging from the traditional experience of discomfort with one’s body or appearance to symptoms of depression, anxiety, stress, insomnia and personality disorders.

Trans YouTuber, writer and activist Zinnia Jones, for instance, writes, “My gender dysphoria primarily took the form of this indirect dysphoria, and I’ve spoken with many other trans people whose dysphoria also did not initially have a clear and unavoidable association with gender. Due to the lack of strong indicators that these “unwell feelings” are actually a matter of gender, it can take us quite a long time just to realize that we’re trans or that what we’re feeling is dysphoria. This can be so non-obvious that even as some of us do begin to explore the possibility of transitioning, we still might not make the connection that our unwell feelings are a symptom of dysphoria, or that transitioning is something that could help with this.”

But again, it was not until recently that these diverse experiences of dysphoria were accounted for by the medical community. And when it comes to India, these experiences are still not taken into account.

What The District Screening Committee Means In An Indian Context

The Indian medical and psychiatric establishment is really not up to date when it comes to queer issues – especially trans issues. There are still many psychiatrists who abide by the narratives set up by Benjamin or Blanchard, and deny trans people access based on the kind of narrative they represent.

In many places, trans people also have to present themselves as the gender of their choice for a certain period of time in order to eventually get access to hormones. This is known as RLE or the ‘real-life-experience’ test. If you are a trans woman, this essentially means having to present yourself as the cultural idea of what a “woman” is as opposed to who you truly feel you are. Therefore, you have to accept ‘feminine’ gender roles and present yourself – clothing, hair, makeup, etc – in ways that would be culturally accepted as being ‘feminine’. If, for instance, you’re a butch lesbian trans woman, you have no choice but to adjust to this in order to get access to hormones.

On her blog, Lisa Milbank, a radical trans feminist, accurately describes what the experience of RLE is like for most trans women: “For most transsexual women, going straight into RLE is not an experience of womanhood but an experience of public freakhood, composed of constant stares, transphobic harassment and potentially violence, without access to much of the (intensely double-edged) training given to cissexual women on how to survive this.”

Activists gather at Jantar Mantar, New Delhi, on December 28, 2018. Image Source: Samabhabona/Twitter.

Sometimes in India, if you do not fit the traditional trans narrative, the psychiatrist will often prescribe anti-depressants to “cure” you – because apparently, they really know what’s ‘wrong’ with you, and you don’t.

In the worst of cases, I’ve known trans friends who have been given shock therapy and have been molested by psychiatrists behind closed doors under the pretense of testing whether they really felt sexual attraction to men.

It seems to me that when it comes to queer people, the majority of Indian psychiatrists and the medical establishment are much more focused on curing a social “aberration” than trying to genuinely help anyone. Under such circumstances, setting up a ‘screening committee’ with mostly medical professionals is tantamount to an innumerable number of queer voices being snuffed out. In plain terms, it is an atrocity.


Summing things up, I would like to quote Sandy Stone once again: “‘Making’ history, whether autobiographic, academic, or clinical, is partly a struggle to ground an account in some natural inevitability. Bodies are screens on which we see projected the momentary settlements that emerge from ongoing struggles over beliefs and practices within the academic and medical communities. These struggles play themselves out in arenas far removed from the body. Each is an attempt to gain a high ground which is profoundly moral in character, to make an authoritative and final explanation for the way things are and consequently for the way they must continue to be. In other words, each of these accounts is culture speaking with the voice of an individual. The people who have no voice in this theorizing are the transsexuals themselves.

The medical establishment has a long history of theorising on trans people as totalised objects while at the same time denying them their voice and their autonomy. In a debate with Noam Chomsky in the early ‘70s, French philosopher Michel Foucault had said the following: “The real political task in a society such as ours is to criticize the workings of institutions that appear to be both neutral and independent, to criticize and attack them in such a manner that the political violence that has always exercised itself obscurely through them will be unmasked, so that one can fight against them.

Fast-forward by nearly 50 years, and these words seem to have gone unnoticed. For what else could explain the complete apathy of much of “the left” and “the progressive” establishment about the bill? If the left and progressive establishment in this country do indeed want to be allies to queer people, they need to do better than just offering token support for LGBTQ rights. They need to seriously engage with the political content of queerness, with the everyday realities of queer lives and start critically analysing the institutions–starting from the family to the medical establishment – that operate under the guise of being neutral, but which end up perpetrating untold harm on queer lives and bodies.

Lastly, one’s gender identity is a matter of bodily autonomy, and should absolutely be one’s own and no one else’s business. The government and the medical establishment have no business denying trans people their right to self-determination; if anything, these institutions owe trans people reparations.

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