TRANSITIONAL STORIES: CONSTRUCTING BIOLOGY AND CULTURE IN A TRANSGENDER CLINIC Riki Lane La Trobe University, Bundoora, Australia
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ABSTRACT
People who change gender fascinate academic and popular discourse about sex and gender. Central here is the search for a cause in biology or culture. Most sociological investigation of trans people rejects biological explanation. It is social constructionist and concentrates on how people “do” or “perform” gender. Three stories or narratives have been proposed that arise from different types of trans experiences – migrating, oscillating and transcending. These different narratives entail different relations of biology and culture around sex and gender. Some biological researchers and many trans people support a biological explanation for trans people’s experience. Recent work in social and biological disciplines points towards ways to utilise both biological and social constructionist inquiry. Informed by interviews with clients and clinicians at a transgender clinic, the connections between the three types of trans stories and attitudes to a biological aetiology are explored and implications for trans health care and legal change are discussed.
1
INTRODUCTION
Why do some people who live in the ‘other’ gender surgically and hormonally change their bodies? This question confounds and fascinates academic and popular discourse about sex and gender, challenging ideas about the relationship between biology and culture. Sociological investigation of sex and gender has been informed by trans (see appendix) people’s experience for 40 years (Garfinkel, 1967) yet debate continues. Part of a broader research project on the relationship between trans politics and the processes of constructing scientific knowledge proposing a neurological cause for transsex, this paper explores the narratives of professionals and clients at a gender clinic. After briefly examining theoretical frameworks that outline three narratives for trans people’s experience, it considers how the biological aetiological paradigm is mobilised in these narratives. A central problem here is the relationship of biology and gender. Sociological approaches are generally social constructionist and reject biological explanation due to its reactionary consequences historically. However, some biological researchers and many trans people support a biological explanation for trans people’s experience, and these arguments have been used in struggles for rights. Recent biological inquiry has shifted towards a “new materialism” which stresses diversity instead of conformity, non-linearity and selforganisation instead of linear causality, and contingency instead of determinism (Myra J. Hird, 2004). In biological gender theory, Diamond (2005) argues that nature throws up a wide range of gender and sex variants, which are modified by experience. Seeing a dialectical, reflexive relation between human activity and “nature” drives an appreciation
of sex/gender as simultaneously biological and social which can help develop an approach that can utilise both biological and social constructionist inquiry.
2
DISCUSSION
2.1
THE SOCIOLOGY OF TRANS
Trans sociology comes from 3 main traditions: symbolic interactionism and ethnomethodology (Richard Ekins & King, 2006; S. J. Kessler & McKenna, 1978); queer theory (Butler, 2004; Wilchins, 1997); and from radical feminism (Raymond, 1994; Shapiro, 1991). I will not discuss the third tradition, with its negative assessment of trans people as agents or dupes of patriarchy. In a famous study which showed how a trans woman convinced others that she was a natural woman, Garfinkel (1967) developed the idea of gender as a social practice (Hirschauer, 1997) and defined the “natural attitude” to gender. Kessler and McKenna (1978) followed: by studying how transsexual people consciously manage the process of establishing “gender attribution”, they sought to illuminate the everyday, usually unconscious, processes by which all people construct or “do” gender. While sympathetic to trans people they saw gender reassignment surgery (GRS) as reaffirming binary gender. They preferred a non-surgical approach, where “men with vaginas” and “women with penises” challenge prevailing gender norms (Rubin, 1999). Ekins and King (1999) developed concepts of trans “body stories”. It is not a big step from “doing gender” to Butler’s idea of “performing gender”. Butler (1990) adds a Foucauldian emphasis on regulatory heterosexual norms in gender – which simultaneously enforce gender roles and create opportunities for resistance - and treats drag as an analogy for a subversive appropriation of gender. Butler later described the desire for a biological explanation of transsex as a “fabulous release from the anxieties and ambivalence that go with being sexed” but the price is to “sacrifice everything that is dynamic and important about the categorisation of sex and its possibility of being revised and reworked’ (More, 1999). She celebrates transgender as transgressive, but worries that ‘passing’ transsexuals reaffirm binary gender (Butler, 2004 64-74). As with Kessler, incongruous bodies seem to pose a more cogent threat to gender norms than transsexual ones. These traditions reverse the positivist assumption that social gender arises from biological sex, instead seeing gender as the primary force in how we see sex difference. Both have influenced the emerging discipline of transgender studies. Prominent activists such as Bornstein (1994) and Wilchins (1997) take up the idea of transsex as a process which does not arrive at disappearance into the new gender. Recent sociological work on transgender has produced three-way typologies of paradigms, roughly summarised in table 1. Table 1 Sociological typologies of trans
1 2 3
(R. Ekins & King, 1999) body stories (E&K) migrating oscillating transcending
(S. Kessler & McKenna, 2000) meanings of trans (gender) (K&M)
(M. J. Hird, 2002) modes
change as in ‘transform’ moving across as in ‘transcontinental’ going beyond gender as in ‘transcutaneous’
authenticity performativity transgression
Type 1 is the traditional, and still dominant, transsexual narrative of being ‘trapped in the wrong body’ – permanently crossing the gender binary (E&K), changing the body to fit the felt gender (K&M) in a framework assuming the reality of immutable morphological
sex (Hird). This narrative usually cites a biological basis and a desire to disappear into the other gender. This essentialist self-belief has strongly informed biological and medical researchers. Type 2 is the cross dresser or ‘transgenderist’ narrative – moving back and forth (E&K) or combining elements of the two (but still only two) genders (K&M), in a framework of discursively produced performative gender reality (Hird). Type 3 is narrative of the transgender activist, eg Bornstein’s “gender outlaws” (1994) – moving to a third space (E&K), where gender cannot be clearly attributed or ceases to exist (K&M) in a purposeful violation of the naturalisation of gender (Hird). Using these narrative frameworks helps organise sociological investigation, assisting understanding of how people position themselves in relation to the disciplinary pressures of academic discourses and social institutions. The disciplinary frameworks of psychiatry and sociology produce different ways of viewing trans people’s stories. However, both frameworks are trying to theorise the relation of biology and culture.
2.2
NARRATIVES AND AETIOLOGY
Transsex has a rich history of failed psychological and biological theories. Currently, the dominant biological paradigm has prenatal hormones causing male or female brains. This theory has many highly contested prerequisite beliefs, e.g. there are major male/female brain differences. The most prominent proposal is that a hypothalamic nucleus - the BSTc - is a gender identity centre (Zhou, Hofman, Gooren, & Swaab, 1995). A sex reversed BSTc produces a “brain sex” different to bodily sex, so transsex people have “intersex brains”. However, the male/female difference in BSTc size appears after puberty, which undermines the case for pre-natal causation (Chung, De Vries, & Swaab, 2002). This story is very influential - widely cited in academic literature, on trans resource sites and in an important court decision to allow a trans man to marry: “ the brain sex theory does not seem to be competing…, but rather is providing a possible explanation of what is otherwise inexplicable” ("Re Kevin," 2001 para 253). However, many clinicians and researchers disagree, arguing for multiple pathways (Pfäfflin, 2006). This paper utilises the sociological ideas of three types of trans narrative to illuminate how participants position themselves in relation to biological discourse and participate in constructing these discourses. It looks at how people at one gender clinic position themselves in relation to the biological aetiological paradigm by analysing semi structured qualitative interviews with two trans people who had been through the clinic ‘Ben’ and ‘Michelle’, and four clinicians – psychiatrists ‘Veronica’, ‘Peter’ and ‘Bernard’ and speech therapist ‘Kate’. The interviews were focussed on the biological story and its impacts on clinical practice and trans peoples lives. The interviews are a small sample and only allow preliminary interpretation. All participants thought biology played a role in trans aetiology, but differed widely on its significance, with Michelle and Veronica supporting it strongly, Bernard, Pater and Kate seeing complex biology and society interactions, and Ben seeing aetiology as the wrong place to focus. 2.2.1 THE MIGRATING NARRATIVE Psychiatrists tend to valorise the migrating story in assessing the patient’s suitability for GRS. Historically, psychiatrists’ role has been to ‘gate keep’ access to GRS – granting it to the transsexuals (migrating) and denying it to the transvestites (oscillating). The transsexuals are usually divided into two groups, mainly based on when they transition: group 1 in their teens or 20s; and group 2 when older, often after having raised children. These categories are challenged by the growing visibility of ‘transcending’ trans people. and there is a shift towards a non-pathologising model of gender variance which accepts partial bodily change and gender positions between/other than male and female (Lev, 2004). Money’s (1972) arguments for a psychological basis for gender identity are still reflected in some psychiatric approaches to transsex. However, there has been a turn towards biological explanation.
The dominant narrative reported by the clinicians’ clients was “I was born in the wrong body”. For example, Michelle expressed the biological story common in the migrating narrative: I really don't know…I don't have any real scientific knowledge. It is more of a gut feeling…Because it makes no sense...it’s a stupid thing to do, its ridiculous… What would drive you to that...It must be something biological that is driving it probably something in the brain. While the long established psychiatrist Veronica had the strongest belief in a biological basis, she thought it was genetic and the brain sex theory was “rubbish… I don’t believe in an intersex brain… The brain isn’t sexed, the person is.” Psychological factors were at most a trigger of a biological predisposition. Bernard, who is new to the field, agreed that: “... the closer they report these gender differences to birth…the argument becomes a stronger one that perhaps there is a genetic [or biological] basis”, but also argued that “I don't really distinguish between biological or genetic, psychological or social aspects… they are all connected.” Peter described the BSTc study as “an interesting finding and that is all it is. It is not scientific proof”. He saw multiple pathways to transsexuality, with a biological basis more likely for the group 1 transsexuals who most strongly express the migrating narrative. He gave some support to child rearing factors based on his client’s experiences “depressed mothers and absent fathers” of trans men. While their views varied on the strength of the BSTC or other biological stories, all clinicians and Michelle agreed that: the biological story was more likely true for people with the traditional migrating narrative; and wide acceptance of a biological aetiology would lead to greater social tolerance and improved lives for trans people. “People are happy to accept a plausible sounding scientific based reason for something that is perplexing” (Michelle). As expected, the biological arguments were strongly mobilised in these stories, while other factors were modifiers or triggers. 2.2.2 THE OSCILLATING NARRATIVE People with oscillating narratives are identified in the psychiatric categories as having a high risk of post-surgical regret. There was little discussion of these stories, except to note that most people with this type of story were excluded by filtering processes because the clinic was set up to assess for GRS, only those seeking the “extreme of surgery” (Bernard) would continue. However, Michelle had met people living in an oscillating state and described a more social aetiology. Looks like a mess to me… they’ll have difficulties in their workplaces. Or they probably don’t work, or they are very secretive and they live a split life. [They are] experiencing …social discomfort…not really the same [as] a transsexual person... In some cases, it is as much a sociological, a social thing. [But] they can develop – they get sucked into the [cross dressing] club scene… new members…are literally cowering…their behaviour ramps up really quickly...Within months they were in [the clinic] slamming their fists on the table … that environment allows their feelings and thoughts and fantasies perhaps to develop. (Michelle) Michelle worried that some of these people made a mistake in transitioning. The psychiatric categories are not strictly maintained here, as there is a “one-way” (Kate) continuum from oscillating/transvestite to migrating/group 2 transsexual stories: “They can start off as cross-dressers and …in time, fulfill all the criteria for … transgender
treatments” (Peter). The stress on criteria indicates the constraints of the psychiatric disciplinary framework and the centrality of the gate-keeping role in interpreting patient’s stories. However, Bernard argues that “To some extent, it can be seen as a lifestyle choice”, indicating an openness to other narratives than a biological determinist one. The shift from an oscillating to a migrating story is constructed as favouring a non-biological aetiology, in contrast to the support for a biological aetiology for the group 1 transsexuals. The tension of living a life oscillating across two genders, and thus always in violation of the dominant discourses of gender, can be resolved by migrating permanently. While the source of the oscillating gender variance is perceived as cultural, the available treatment is the same. 2.2.3 THE TRANSCENDING NARRATIVE Sociologists tend to valorise the transgressive potential of the “transcending” story in the interests of social change. Sociological suspicion of the migrating transsexual desire to pass may overemphasise the structural constraints to conform to the gender binary and neglect individual agency, while championing of transcending ‘gender revolutionaries’ may make an opposite error. Rubin (1999 190-191) argues that academic work in trans studies needs to stay “attuned to trans subjectivity” recognising the “legitimacy of trans desires for authenticity or realness, while acknowledging the constructedness of our bodies and identities”. Rather than discounting many trans people’s desire for a biological explanation, Monro (2005 42) advocates a “gender pluralism” that allows for recognition of multiple gender identities in a move beyond “deconstruction of gender binaries towards reconstruction of a more diverse and …tolerant society” and “allows for the inclusion of both biological and constructionist approaches.” Ben, who takes a queer theory approach, expressed the transcending story of bodily modification without seeking to pass. He strongly criticised the clinic: whose process is quite conservative…stuck in the 70s…it is very deterministic... it doesn't accord with my experiential idea...that gender variance is a really broad category…people have all sorts of reason why they want surgery or they don't…there is a whole lot of variation in what [hormones] people take…what they are trying to achieve… People need to have the autonomy to decide what they want to do with their bodies …I don't think it can be a psychiatric assessment process, I don't think that works. When discussing aetiology, Ben is “not interested in the reasons. Could be biological, could be due to family origin, could be due to upbringing, but I actually prefer not to think about it,” but recognises that: There are probably links between hormones, prenatal hormones and people having… transgender…stuff. But, as far as the science goes there isn’t an established link... I don’t see the brain as this thing [where] hormones …predetermine things… His concern is not that biological argument is used, but the way it is mostly used to support ideas that gender is naturally binary – “everybody is either a real man or a real woman”. When biology is used differently, e.g. by Milton Diamond (2005), to argue that: Gender variance is biological – there are a huge range of natural variations… Nobody is really either one or the other…Therefore, people who are gender variant, who don’t fit physically into one or the other, or who want to change their bodies to be different gender or sexes are OK. That – I wouldn’t have a problem with that – that’s fine.
Ben’ story is quite complex – a social constructionist/performative disciplinary framework is reflected in an emphasis on autonomy and diversity in gender outcomes. People will seek a variety of differently gendered outcomes that are outside of the framework of binary gender. He rejects the importance of aetiology for his personal lived experience, yet does not dismiss the role of biology. Instead he calls for a change in the use of biological discourse from maintaining the gender binary towards respecting gender diversity. This narrative points towards a way out of the apparently intractable nature/nurture debates, towards an engagement between people working within the constraints of biological and sociological enquiry.
3
CONCLUSIONS
The migrating narrative, especially the group 1 transsexual category, is strongly associated with support for a biological basis; the oscillating narrative is seen as indicating a social aetiology, even when it develops into a group 2 transsexual migrating narrative; the transcending narrative sees supporting gender diversity as more important than discussing aetiology. There are significant implications, although no simple correlations, between the narratives, attitude to aetiology and questions of treatment, legal rights and strategies.
3.1
TREATMENT
All clinicians agreed biological research is inadequately convincing to guide treatment. If a reliable biological test was developed, they would still need to act to relieve the distress of patients who failed the test, but met clinical criteria. This reflects the disciplinary structures of psychiatry, which relies on codifying clinical symptoms into syndromes, and refers people with identified biological problem to other doctors (Bernard). Michelle thought research would produce evidence for a biological basis, which would benefit people going through transition. Veronica wanted well funded genetic research to provide a secure medical basis against religious critics of GRS. Kate and Peter saw social research as having more impact on their practice and society “Some clinicians …are starting to incorporate into their therapy...that its society that is constructing gender.” (Kate) Social research “is huge in terms of legal recognition of trans people… much more important than genetic research (Peter)”. Social changes in the larger discourses around appropriate gender roles are affecting the treatment options - living in the ‘other’ gender means something different in a less gender divided world. While there is great interest around the biological aetiology, and it has impacted on institutional legal changes, it appears that social inquiry is having a greater effect on shaping the medical and legal disciplines and discourses about trans experience.
3.2
RIGHTS AND LEGAL GENDER CHANGE
When posed abstractly, all participants agreed that trans people’s rights do not depend on aetiology. However, there were sharp differences on the concrete right for legal change in line with attitudes to aetiology. For Michelle and Veronica, who most strongly supported a biological aetiology and reflected the migrating story, legal gender change should only be available for people who undergone GRS, or had a very strong medical or other reason not to do so. All other participants said legal gender change should not depend on GRS either “because that clearly discriminates… people's ability to change their birth certificate should be dependent on their …identity as a certain gender” (Peter), or because “I don’t think we should have a legal gender.” (Bernard) Strong commitment to the migrating and biological sees the essential cultural marker of gender change as bringing the body into line with gender. Other perspectives give primacy to living in society, external appearance and internal identity over body change. Bodily modification becomes more optional than essential, to be negotiated differently by each trans person.
All participants thought that the biological case made in the Re Kevin case was weak: “international legal opinion of the trans area will say – great decision – on very shaky evidence (Peter); “[They] managed to get that past the judge?” (Michelle). However, while most thought any successful tactic was acceptable, Ben was critical of the biologically based strategy as one that reinstates trans people as normal in a binary gender system, pointing to recent Spanish legislation as an alternative that relied on human rights, not biology. Bernard worried that there are problems in a society which deals with difficult concepts by relying on “almost spurious” arguments. Both Peter and Bernard saw positive and negative sides: “there is a political movement afoot to push the biological cause… it could be a double edged sword. (Peter) These concerns express uncertainty about the movement of knowledge between disciplinary structures – when the caveats and qualification inherent in biological science disappear in the lawyer’s brief, what happens to the search for scientific truth? How can this highly disputed knowledge be accepted as orthodoxy? What happens if new research changes scientific opinion?
3.3
SUMMARY
Only preliminary conclusions can be made from this small study. The story of a biological aetiology for transsex is mostly deployed in support of the dominant migrating narrative, acting to provide a more secure position for those trans people who conform to the strictures of binary gender. Psychiatric discourse is divided on aetiology and relies on clinical criteria that are non-biological. Sociological and queer discourse tends to privilege the oscillating and transcending narratives as having more potential for social change and is nervous about the legal use of biological argument. However, reconceptualising biology as a source of diversity rather than mandating dichotomy opens up possibilities for deploying social constructionist and biological argument in tandem. In this approach the important political distinction becomes ‘respect diversity v maintain dichotomy’ instead of ‘biological v social aetiology’.
4
ACKNOWLEDGEMENTS
Many thanks: to the interviewees for giving me their time and energy; my supervisor Kerreen Reiger for giving invaluable feedback; and to my family for putting up with my distraction.
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REFERENCES
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Appendix TERMS AND ABBREVIATIONS Terms used in this field are highly contested. Except where specified, meanings in this article are as indicated below. Transsex or transsexual - people who seek to medically alter their physical sex characteristics from their birth sex Transgender or trans - the range of people whose gender expression differs from societal expectations for people with their birth sex. Bi-gendered – living sometimes as male, sometimes as female GRS – gender reassignment surgical and hormonal treatment Trans woman - a person born female who lives full time as a man, with any or no degree of surgical or hormonal modification Trans man – a person born male who lives full time as a woman with any or no degree of surgical or hormonal modification Transvestite - a person who has an inescapable need to wear the clothes associated with the gender that does not line up with their birth sex
