The Future for Gender Variant People

Gender Variance is an issue that has been extensively researched for many decades. Despite the existence of gender-variant individuals in every culture and throughout time, many people are unaware that diversity in gender expression and sexual formation is a naturally occurring phenomenon. Gender variance confronts widely held assumptions that children born as males will act like ‘boys’ and children born as females will act like ‘girls’. This imposed stereotypical stigma has affected gender variance negatively. As time has changed and new research is exposed, the future for gender variance is expected to change many aspects of societal norms (Clamson, L., Diamond, M., Riley, E., Sitharthan, G., 2013). The current and future objectives are to contribute to information, resources and curriculum development in the education of professionals, schools, parents and the community in supporting gender variant people.
According to Riley (2013), the needs of gender-variant people as identified by parents, transgender adults and professionals can be represented by the acronym H-A-P-P-I-N-E-S-S. These needs are: to be Heard; to be Accepted; to have Professional access and support; to have Peer contact; to have access to current Information; Not to be bullied, blamed, punished or otherwise discriminated against; to have freedom of Expression; to feel Safe; and to have Support. Riley’s representation of a gender variant person’s needs is broken into three main components: The feel of acceptance and to be heard, resources, and support.
The feeling of acceptance for a gender variant person is the beginning of change. This begins with being heard. This need allows a gender variant person permission to discuss gender with their family and friends, creating an environment that provides them with a safe and comfortable environment for the interaction. “Transgender adults described their suffering due to being unable to share their concerns and feelings about their gender in various ways, as reflected in the following comments from the data: ‘I thought if I told anyone they might put me away in some mental institution. I dared not even tell anyone’” (Understanding Truth & Gender Diversity, 2011, web). Being heard allows a gender variant person to have freedom of expressions to be accepted where they are valued, respected and loved unconditionally by family and friend and being referred to in the preferred gender (Clamson et al, 2013). Acceptance in a household environment creates a safe place for a gender variant person. A safe place for gender variant people is where they will not be bullied, blamed, punished or discriminated against (American Psychiatric Association, 2013).
Resources for a gender variant person is a big component whereas information is accessible. The availability of resources is a way for gender variant people to better understand who they are and what might help them to become more comfortable with the acknowledgement that gender and sex is different (Clamson et al, 2013). Dr. Mustanski (2013) who wrote Resources for Parents of Gender Variant Children, highly recommends any gender variant person or a family or friend of a gender variant person to come to Impact: The LGBT Health and Development Program website for resources. Mustanski highly encourages this website to better understand gender variance and alternatives to helping or adapting to the changes a gender variant person may make. Additional resources are in the Report of the APA Task Force on Gender Identity and Gender Variance (2009), written by American Psychiatric Association (APA). This Report of the APA Task Force provides an in depth analysis and direct resources to help gender variance in all aspects possible for better understanding themselves.
Support is the key component for a gender variant person (Clamson et al, 2013). According to Recognizing the Needs of Gender-variant Children and Their Parents (2013, web), “The need for support includes the need for proactive intervention compromising emotional and physical support from professionals, family, friends, peer, educational, community, financial, legal and governmental support”. Support from professionals includes counseling and medical practitioners with the knowledge and expertise to recognize gender variance people and provide necessary means in helping them. Family, friends, peer and community support provides a safe place for gender variant people, allowing the freedom of expression without being “bullied, blamed, punished or otherwise discriminated against” (Riley, E., 2013, web). “November 20th is the national Transgender Day of Remembrance that is a day to honor those who have lost their lives for daring to live openly” (Antonia, 2013, web). Educational support entails the education that sex and gender are two different pieces that define a person and the gender a person decides to take role of. Financial, legal and government support entitles gender variant people to have access to the needs and resources for transition of gender with protection and security of the same rights as a non gender variant person.
Although there is no real cause of the conflict of a person to have a mismatch in their gender and sex, researchers continue to explore this area. The future for gender variant people very inconclusive at this time but the research continues for the best interest of gender variant people (Clamson et al, 2013). The continuing exploration is for hope to find a cause or better treatments to those whom are diagnosed such as contributing to information, resources, and curriculum development in the education of professionals, schools, parents, and the community in supporting gender-variant people. Ultimately, gender variant people seek for is social acceptance without hiding their true gender.

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The Controversy of Gender Variance

For decades, there have been many controversies about what is normal and what is abnormal when it comes to human sexual behavior (Halgin, 2013, p. 47). In the past, homosexuality was regarded as a mental disorder but later disregarded in the Diagnostic and Statistical Manual of Mental Disorder (DSM) (Herek, 2004, p. 6). With the deletion of homosexuality in the DSM, the concept of Gender Identity Disorder (GID) arose in the DSM-IV. Now with the name change from GID in DSM-IV to Gender Dysphoria in DSM-V, the debate continues (Halgin, 2013, p. 47). Traditional Values Coalition argues that gender variance should be viewed as a mental disorder and implies that transgender people have psychological problems who need help rather than societal approval (Halgin, 2013, p. 48). On the contrary, Kelly Winters argues that “diagnosing gender variance as a mental disorder has imposed the stigma of mental illness and sexual deviance upon people who meet no scientific definition of mental disorder” (Halgin, 2013, p. 48). In agreement to Winters’ argument of gender variance, many people are falsely diagnosed “due to the DSM failing to distinguish the intrinsic distress of gender dysphoria from that caused by external societal intolerance” (Winters, p. 48).

According to the American Psychiatric Association (APA, 2013, web), The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals in the United States. “It is intended to be applicable by clinicians and researchers of many different orientations (e.g., biological, psychodynamic, cognitive, behavioral, interpersonal, family/systems). ‘Making a DSM diagnosis’ consists of selecting those disorders from the classification that best reflect the signs and symptoms that are exhibited by the individual being evaluated (APA, 2013, web). This implies that anything “diagnosable” within the DSM is a mental disorder regardless of the name or title given, resulting in the stigma being imposed upon gender variant people.

According to the DSM, Gender Dysphoria is diagnosable in the DSM by the following base components:

A marked incongruence between one’s experienced/ expressed gender and assigned gender, of at least 6 months’ duration, as manifested by certain criterion (APA, 2013, p. 453).

The condition is associated with clinically significant distress or impairment in social, school, or other important areas of functioning (APA, 2013, p. 452).

Although the change of Gender Identity Disorder changed to Gender Dysphoria in DSM-V is to avoid stigma and ensure access to insurance coverage that supports mental health for individuals who see and feel themselves to be a different gender than their assigned gender (APA, 2013, web), they fail conceptually. The failure is due to the section of “supporting mental health” because gender variant people are not mentally ill. The DSM “does not acknowledge the existence of many healthy, well-adjusted transsexual, and gender variant people or justify why we are labeled as mentally ill” (Winters, 2013, p. 55). According to Winters (2013, p.48) the DSM fails to distinguish the intrinsic distress of gender dysphoria from that caused by external societal intolerance. For example, a survey of nearly 6,450 transgender and gender nonconforming people was conducted by the National Center for Transgender Equality and the National Gay and Lesbian Task Force.  This survey found that as many as 63 percent of respondents experienced some form of discrimination due to bias about their gender identity. The discrimination included the loss of a job, bullying and even physical and sexual assault. As many as 41 percent of respondents reported they had attempted suicide — a rate 25 times higher than that of the general population (Glicksman, 2013, p.36). In Glicksman’s finding, it is easy to conclude that the stress imposed to these transsexuals is caused by the external societal intolerance; inadequately diagnosable to criterion B of Gender Dysphoria.

Although there is no real cause of gender variance, there lacks to be research in the difference of the” intrinsic distress of gender dysphoria from that caused by external societal intolerance” (Winters, 2013, p. 48). The exploration is for hope to find a cause or better treatments to those whom are gender variant without being diagnosed. Gender Dysphoria being diagnosed due to the DSM criterions can be falsely diagnosed due the evidence that Criterion B is leveraged toward significant distress or impairment in important areas of functioning, which is not by the individual but due to societal norms.

The History of Gender Variance

On June 28, 1969, at Stonewall Inn, marked history for its three-day riot between lesbians, gays, bisexuals and transsexual (LGBT) and the New York Police Department. This riot began with the police intruding into the LGBT “safe house” and the LGBT community fought back (PBS, 2011), making this the turning point for the LGBT’s first movement for freedom. Sylvia Rivera “was one of those outcast femmy boys and butchy girls… who was a veteran of Stonewall,  joined the new Gay Activists Alliance (GAA) and began working furiously to pass a gay rights bill in New York City” (Wilchins, 2002). Wilchins (2002) addresses in her writings that although Rivera’s commitment to the GAA was to help and protect the LGBT community, the transgender community was eliminated, leaving Sylvia to start the Street Transvestite Action Revolutionaries, or STAR. Throughout all of Rivera’s efforts, the transgender community continued to live in the shadows and was neither unseen nor spoken of, until Gender Identity Disorder surfaced in the DSM-III in the 1980’s. The point is, the transgender community has gone through a lot of trials and tribulations throughout the history of their gender variance; which is now less stigmatized due to the many revisions, leading to the DSM V.

The history of Gender Identity Disorder began in 1957 when John William Money studied the sexual consciousness about disorders of sex development and advocated the concept of gender.

“Thereafter the disparity between anatomical sex and gender identity was referred to as the psychopathological condition of gender identity disorder, and this was used for its diagnostic name when it was introduced into DSM-III in 1980. However, gender identity disorder encompasses a spectrum of conditions, and DSM-III -R categorized it into three types: transsexualism, nontranssexualism, and not otherwise specified. The first two types were subsequently combined and standardized into the official diagnostic name of ‘gender identity disorder’ in DSM-IV” (Zasshi, 2012).

“The exact cause of gender identity disorder is not known, but several theories exist. These theories suggest that the disorder may be caused by genetic (chromosomal) abnormalities, hormone imbalances during fetal and childhood development, defects in normal human bonding and child rearing, or a combination of these factors” (WebMD, 2010). Although the causes are unknown, according to L. Fleming Fallon, Jr. in the Encyclopedia of Mental Disorder, (2012), DSM-IV-TR diagnoses are as follows:

-A strong and persistent cross-gender identification

– Repeatedly stating a desire to be, or insistence that he or she is, a member of the other sex.
– Strong preference for wearing clothes of the opposite gender. In boys, displaying a preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing.
– Displaying strong and persistent preferences for cross-sex roles in make-believe play or experiencing persistent fantasies of being a member of the other sex.
– Having an intense desire to participate in the games and pastimes that are stereotypical of the other sex.

– Persistent discomfort with his or her sex or having a sense of inappropriateness in the gender role of one’s birth sex.

– The disturbance is not concurrent with a physical intersex condition, such as hermaphroditism in which a person is born with the genitalia of both male and female.

– The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The transition from Gender Identity Disorder in DSM-IV to Gender Dysphoria in DSM-V in terms of diagnosis is not different, just more clarification. The DSM not only determines how mental disorders are defined and diagnosed, it also affects how people see themselves and how we see each other. “DSM-V aims to avoid stigma and ensure clinical care and access to

insurance coverage that supports mental health for individuals who see and feel themselves to be a different gender than their assigned gender” (APA, 2013). This change is due to respecting the patient and ensuring access for individuals who continue to undergo hormone therapy, related surgery, or psychotherapy or counseling to support their gender transition. “Ultimately, the changes regarding gender dysphoria in DSM-V respect the individuals identified by offering a diagnostic name that is more appropriate to the symptoms and behaviors they experience without jeopardizing their access to effective treatment options (APA, 2013).

Although there is no real cause of the conflict of a person to have a mismatch in their gender and sex, researchers continue to explore this area. The exploration is for hope to find a cause or better treatments to those whom are diagnosed. Had Sylvia Rivera been alive today, she would have seen all her efforts worthwhile, because her main concern is to de-stigmatize the transgender community. Her wishes is for the community to accept and have resources to help those whom are born with the mismatch, which can be found in DSM-V.

Anatomical Sex Vs. Gender Identity

            Transgender is an umbrella term for people whose gender identity is different from the sex and gender role they are assigned with at birth (Sonnie, 2000, p. 247). Transgender people do not necessarily want to have sex-reassignment surgery (SRS) but lives in their preferred gender. Transgender includes heterosexuals, homosexuals, and bisexuals. Transgender occurs as a disorder known as Gender Dysphoria, previously known as Gender Identity Disorder (DID). Gender Dysphoria is disapproved of society due to the misconception and education of a disorder that the transgender community experiences. Gender Dysphoria affects the transgender community and societies nationwide causing a lot of distress to and within the transgender communities. The transgender community can be viewed as a disgrace in society, human interest, and family values particularly due to the norm of religion, society, and personal reasons; a view that can be changed with the acknowledgement that transgender is not a decision, it is something an individual is born with. The more ways that transgender people are talked about in popular culture, academia, individuals’ awareness, knowledge, and openness about transgender people allows them and their experiences to grow because they are now part of the norm in our societies.

In order to understand Gender Dysphoria, one must know the difference between anatomical sex, gender identity, or self-identification. According to Definition-of.com (2013), anatomical sex is the apparent gender, male or female, of an individual based on physical sex characteristics. The American Psychological Association (2011) defines “anatomical sex is assigned at birth and is associated with the physical attributes such as chromosomes, hormone prevalence, and internal/ external anatomy. Self- identification is the psychological sense of being male or female ( p. 2)”. This refers to the socially constructed roles, behaviors, activities and attributes that a society considers as appropriate for males and/ or females. The differences between biological sex and self identity are the fundamentals of Gender Dysphoria and how Gender Dysphoria arises; furthermore, the understanding of the transgender community.

According to Sue, Sue, Sue,

GID is characterized by conflict between a person’s anatomical sex and his or her gender identity, or self-identification as male or female. GID involves the person experiencing strong and persistent cross-gender identification and persistent discomfort with his or her anatomical sex, creating significant impairment in social, occupational, and other important areas of functioning. People with this disorder do not choose to be born this way; they do not mentally decide their gender identity, rather emotionally bound to it. They hold a lifelong conviction that nature has placed them in the body of the wrong gender. This feeling produces a preoccupation with eliminating the “natural” physical and behavioral sexual characteristics and acquiring those of the opposite sex (2010, p.286).

Gender Identity Disorder is now changed to Gender Dysphoria with retrospect that a conflict between one self continues to be the issue. Gender Identity Disorder is changed because it was thought to be only for homosexuals; which was seen as a disorder, but this is not the case. Gender Identity Disorder includes homosexuals and heterosexuals. In addition to the change, the concept of homosexuality being a disorder, is no longer seen as a disorder, thus making this change. Also, as reported by the National Alliance on Mental Illness (2013), mental illness is a medical condition or conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others and daily functioning which make it confounding. Many transgender people do not experience their gender as distressing or disabling in any form or way, which also implies that Gender Dysphoria is not a mental illness. According to the DSM-5 (2013), “Gender dysphoria refers to the distress that many accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender. Although not all individuals will experience distress as a result of the incongruence, many are distressed if the desired physical interventions by means of hormones and/ or surgery are not available (p. 451)”. Another distressing or disabling issue for them is to minimize discrimination. Although there are Anti-discrimination laws in most U.S. cities and states, it does not protect them from gender identity or gender expression (APA, 2013, p. 3).

            In conclusion, the transgender community can be viewed as a disgrace in society because of the misconception of how transgender occurs. Transgender occurs to a disorder known as Gender Dysphoria. Gender Dysphoria is disapproved to society due to a misconception due to lack of knowledge and awareness of such a thing. Gender Dysphoria is the conflict between a person’s anatomical sex and his or her gender identity, or self-identification as male or female, which is not a mental illness. Identity conflict is not an issue a person chooses for themselves, they are born with it. The more ways that Gender Dysphoria is talked about in popular culture, academia, individuals’ awareness, knowledge, the openness and acceptance of the transgender community can grow and develop as every individual has the right to.