In the Life: Ep. 1807, "Gender Revised"

[Michael Billy] Coming up on "In the Life", an update on the controversy surrounding Gender Identity Disorder. Without a doubt we're in a dilemma because we on  the one hand need the diagnosis. On the other hand the diagnosis facilitates abuse and misperceptions of transgender people. [Billy] A Conversation With... transgender activists Mara Keisling and Paisley Currah. [Mara Keisling] I am very optimistic that the Employment Non-Discrimination Act is going to pass. [Billy] And we celebrate Easter with the Sisters of Perpetual Indulgence. All this and more on "In the Life". [Announcer] "In the Life" is funded in part by: the H. van Ameringen Foundation; Arcus Foundation; Newpol Foundation; the Estate of Richard W. Weiland; Gill Foundation; and these funders; and by the annual support of In the Life members like you. ["In the Life" theme music] Welcome to "In the Life", I'm Michael Billy. The American Psychiatric Association's Diagnostic and Statistical Manual, or DSM is the Bible of mental illness. Among its nearly 300 entries is Gender Identity Disorder, a diagnosis applied to every transgender person who enters the healthcare system, a classification that is necessary to securing vital treatment but that for some carries an undue stigma. Tonight on "In the Life", producer and former host Catherine Linton examines the controversy raging over whether or not Gender Identity Disorder will be included in the next edition of the DSM. 10 years ago for "In the Life", I traveled to Toronto, Canada to interview Dr. Kenneth Zucker, head of the Child and Adolescent Gender Identity Clinic at Toronto Centre for Addiction and Mental Health. [Catherine Linton] Dr. Zucker works primarily with children under the age of 10 who've been given that diagnosis of Gender Identity Disorder, defined as a mental disorder. His therapies and positions on gender-variant children were highly controversial then as they are now. [Linton] Dr. Zucker has stated that his goal in treating children is to make them more content in their biological gender and one of his methods for diagnosis and treatment is toy play. [Kenneth Zucker] Well if you study the toy play of boys and girls or dress up play, there are very substantial differences between boys and girls. [Woman] Here's a Ken doll. Is that a boy doll or a girl doll? [Child] A boy. [Woman]  Put this skirt on this doll. [Woman] Now is it a boy or a girl? [Child] A girl. [Woman] How come it's a girl? [Child] Because it has a dress! [Man] Boys don't put on girls clothes? [Child] No! [Man] Can girls put on boys clothes? [Child] No! [Man] What would happen if you put on a dress? All the girls and all the boys will laugh at me. [Linton] For years, Dr. Zucker has come under fire from activists and many experts for practicing what they see as reparative therapy for gender-variant children and for his view  that adult transsexualism is quote, a bad outcome. So imagine the surprise when last May the American Psychiatric Association announced the appointment of Dr. Zucker as chair of the work group assigned to examine the Gender Identity Diagnosis in the virtual Bible of mental disorders, the Diagnostic Statistical Manual. [impact noise] As soon as the news about the DSM subcommittee,  you know, hits the, hit the public, it was just instantaneously spread across the internet through all these networks of transgender people from one part of this country to the other. I found out through a email blast that had begun when people were sending out the information of who had been selected. I immediately was sort of taken aback by the selection of Kenneth Zucker, you know being - you know he's kind of like the boogeyman to me, in a way. Seemed alarming to me that they would select a person who I think has historically not had our best interests at heart. When people found out that this was who was going to be in the leadership of the revision process there was an explosion of activism. [chanting] Hey hey. Ho ho. Transphobia has got to go. I think it took the APA very much by surprise. [Linton] The APA released a statement immediately defending its selection of the committee. But to understand the trans community's concern over the committee and the potential revision of Gender Identity Disorder, is to understand the importance of the Diagnostic Statistical Manual and the history of GID. The DSM is used worldwide. It's certainly the standard for psychiatric diagnosis in the United States. [William Narrow] It's also used by a lot of other agencies particularly the federal government, the FDA, the NIH. [Linton] Insurance companies also look to the DSM. [Narrow] Insurance companies and also the publicly-funded insurance programs Medicare and Medicaid also use the DSM diagnoses as the standard for reimbursement for psychiatric treatments. [impact noise] [Linton] Gender Identity Disorder was first introduced into the DSM Version III in 1980, seven years after the gay community celebrated the removal of homosexuality from the manual. Few took notice at first but almost immediately many were being treated for GID. [Dylan Scholinski] I have a copy of a handwritten note from my doctor, you know, stating that I had Gender Identity Disorder present since grade three. [Scholinski] We had one 15-minute meeting and that was my primary diagnosis. And this coincidentally is just as Gender Identity Disorder is invented and the first edition without homosexuality. [music with driving beat] [Linton] When Daphne Scholinski was 15-years-old she  suffered severe depression due to multiple issues. When her parents went to a therapist for advice they were told they had one option: to lock her in a psychiatric facility. But rather than being treated for depression, gender became the immediate focus of the doctors. It was like this barrage of just constantly, you know, like dripping water on my forehead over and over and over again. "You're wrong, you're bad, you're ugly. And you're crazy." [Linton] Daphne, now Dylan, would spend three years locked up and treated for Gender Identity Disorder. As more stories like Dylan's got out with the help of books like "Gender Shock" and Dylan's own, "The Last Time I Wore a Dress", the  LGBT community began organizing and demanding the removal of the diagnosis from the DSM. But that unified demand was cut short when the diagnosis was revised in the 1994 release of the DSM-IV, suddenly pitting the interests of gender-variant children against access to health care for adults. [Scholinski] When they combined GID in children and transsexualism into one diagnosis it created a major rift within our community after having gained so much momentum in movement towards change.  It took our focus off of the psychiatric system and on to each other. Children and adults are quite different. Because although the diagnosis in adults presumes a good degree of stability that that person who has gender dysphoria will remain gender dysphoric for a long time. With children that's not necessarily the case so it's very difficult to lump all of them together. [Linton] While many recognize how the diagnosis can be damaging to children, many adults require the GID diagnosis to attain access to certain health care. Outright removal, some are concerned,  could threaten this access. [Mara Keisling] A lot of transgender people need transgender specific care. In order to be allowed to access that care and to have that care paid for by private or public insurance plans, it's necessary for there to be a diagnosis on which to base the treatment. We must have some sort of medical diagnosis and there's just no question about that. It would be devastating, would be disaster. [Linton] The trouble for many is that GID is classified as a psychiatric illness, which for many, like Dr. Christine McGinn, who works primarily with transgender patients still carries the potential for stigma or discrimination. It is a double-edged sword. Because, you know myself as a personal story, every time I apply for privileges at a hospital, I have to fill out an application and they specifically ask me if I have any psychiatric diagnosis. So although I had to go through the therapy process to get my surgery, I don't feel as if I have a psychiatric illness and I'm quite functional [laughs]. It saddens me every time, frankly, that I have to fill that out. The way that the diagnosis, as it stands now, is harmful is that it actually is saying that their gender identity  is disordered, when in fact what's disordered is their brain identity and phenotypically how  they present or their body is incongruent. The primary concern about the GID diagnosis is that it  pathologizes from a mental health perspective, a medical condition. If something can be fixed with a physical transformation, then it shouldn't be categorized as a mental health condition. [Linton] The challenge then for the revision process for the DSM-V working group is how to potentially reform GID and address concerns over treatment of children, stigmatizing language, and adult access to health care. [Jaime Grant] I think that the APA is working with the disease concept, right? They're medical folks, they're psychiatric folks and we don't think gender identity is a disorder. So, we'd like to see it removed from the DSM but only with the assurance that trans people and gender non- conforming people can get the services that they need. Without a doubt, we're in a dilemma because we, on the one hand, need the diagnosis. On the other hand the diagnosis facilitates abuse, mistreatment,  and misperceptions of transgender people. There's definitely things that can be done to, to improve the way the diagnosis is worded to mitigate some of the potential for misuse  and stigma. That's gonna help a lot. [Linton] However many advocates for GID reform, even removal, are  still very concerned about the review process and potential revision. Oh I think everybody's terrified right now. I don't think anybody's watching, just watching cautiously. I think that people are very concerned that they're going to throw in more pathology. Some of the fears around the DSM-V is based on history. From the beginning of GID to the, its current state, it's become  a more dangerous diagnosis that, rather than a safer one. And to go and put Kenneth Zucker in  charge of like the next inception of it just is terrifying because you could just imagine, you know,  that the next level is like - how can it get worse? We'd of course like, you know, a better DSM. We'd like a more open process. We'd like a committee that reflects the practice and the movement that the psychiatric community has made in the last 20 years. The DSM-V will not be released until 2012. And as of now, the APA has not expanded the working group but promises the process will at some point  be opened up for review. And regards to concerns over treatment have appointed a diverse group to examine treatment practices for GID. The APA also encourages people to visit their website to follow any developments on the revision of the DSM-V. ["In the Life" theme music] ["In the Life" theme music] Tonight's Conversation delves into everyday  issues that face the transgender community. Mara Keisling, executive director of the National Center for Transgender Equality and political theorist Paisley Currah discuss the future of the Employment Non-Discrimination Act and how legislation designed to protect trans people from discrimination in public spaces is currently under attack from the religious right. [Paisley Currah] So Mara, you are the founding executive director of the National Center for Transgender Equality and I know you work in the national level, the federal government level. What other kind of levels do you, does NCTE work at? We've tried our hardest to focus on federal policy. [Currah] Mmm-hmm. I should say federal policy or issues of national significance. [Currah] Mmm-hmm. [Mara Keisling] What's happening now is the radical right has decided that they're losing the marriage battle. I think, you know, they know they won Proposition 8, but they know they won by the skin of their teeth and it'll never happen again. [Keisling] And they're looking now at another way to keep attacking LGBT people. And another way to raise money, another way to fill the pews. Of attacking transgender ordinances that have been passed. As, as you know as somebody who used to keep track of this stuff very very carefully, when it was happening one every couple months. [Currah] Heh, right. [Keisling] Now that there's just such a flood of victories it's a little harder but 12 months or so, whenever one of these ordinances is passed in a city or a state, the radical right people who pay attention to these things and are looking for a new fight, depending on the jurisdiction, what the rules are, try to get these things on the ballot to be repealed. And what they do, what, what they believe is their best argument, which is totally fabricated in their minds, is that transgender women such as me will somehow be a threat to your little girl in the bathroom despite there being not a single case in 30 years of these laws being on the books, not a single case of this ever happening. [Keisling] They're using this and, and we saw it in Montgomery County, Maryland where they did some really horrible ads about men sneaking into locker rooms to molest children. And in Colorado when a Public Accommodations Law was passed there, Focus on the Family did some work to try to get Governor Ritter not to sign it. And again used these "men in dresses in the bathroom with your little girl" scare tactics. I mean the argument they're making is, "this will allow people to use the wrong bathrooms," which it doesn't. None of these laws do that. [Currah] Well it's interesting because most of these laws either have guidelines or we hope that they'll be interpreted to mean that people in these jurisdictions with these specific non-discrimination laws have access to the bathrooms that, you know, are in accordance with their gender identity. And what's interesting I think, is that the assumption is that transgender people don't exist. That transgender people are in fact, frauds. That transgender women are actually only men in dresses who want to harass women in bathrooms. And the child thing, I think, is a new wrinkle. They used to say just like men in dresses going into women's room- rooms to harass women. I remember running into a trans woman from New Jersey and having a conversation. And she was just very funny and she's like, "Yeah, yeah, exactly. I went to therapy, I did hormone treatment, surgery, electrolysis, just so I could go to the women's bathroom and harass women. Like that was the easiest way for me to sexually harass women is to go through all those - you know, to transition." And it's just like from, from trans community's perspective is just totally absurd but, I think from the right wing's perspective, it's just a sense that trans people don't really exist. They're just frauds, just men in dresses, who are - and I don't even know what they say about transgender men. Like, what, we want to go into men's bathrooms and harass men? [laughs] [Currah] I mean it does play on everybody's fear - or not everybody's - but people's fear. Like people want to have privacy, safety, security, like wherever they are, but also in the restrooms. The folks who don't have it are often transgender people. [Currah] Like there's the - people who - trans people are at risk when they, you know, use restrooms or gender non-conforming people, they're the ones who really need safety and security and privacy. But it does kind of play on those fears. And like breastfeeding moms and, and, and parents changing diapers ever - and people in wheelchairs. Everybody wants like, a safe, clean, un- hassle free bathroom experience. And the existence of a transgender rights law is not gonna make that worse. What makes, what makes  people's bathroom experience, you know, better or worse is just these basic issues of safety and security. And trans people need the safety and security, probably even more. Well Paisley, you know - 2008 there was a lot of coverage of the story of Thomas Beatie, who I think a lot of the world knows as the pregnant man. And with reproductive technologies just being created all the time and, and developed further, trans people are going to have more and more options. And I think the public just has to understand that we're like everybody else just trying to do the best  we can with the options that are available to us. And that's to, I think a lot of trans people, that's really the moral of the story. It was one person's story, or one couple's story and what they  were trying to do was... have a family. What I thought was interesting was the media coverage of that one individual's reproductive life and the relative lack of coverage of like the huge  issue that face transgender communities in the debate over the Employment Non-Discrimination Act. [Currah] So lots of folks in America became aware that there was a transgender man who was pregnant, very few knew that all the kind of parliamentary maneuverings about cutting gender identity from the main non-discrimination bill going on in Washington. So the article was talking about, like why focus on that and not getting into thinking about a really important policy issue  that affects like so many more transgender folks in the, in the U.S. [Currah] Maybe this is good segue into figuring out what's going to happen now because no one I think knows better than you do. That's my idea. With the new version of the Employment Non-Discrimination Act are people going to be able to - is these American public ready to include transgender people in the, in the bill? I am, I'm optimistic that the DSM revisions are going to go the way they need to go. I'm very optimistic that the  Employment Non-Discrimination Act is going to pass in the next maybe couple, you would say, the next two years just to be safe. Maybe as early as this year. But trans people and allies all over the country are doing the work to educate the public, to educate policymakers, to educate their therapists. [Keisling] You know it's interesting one of the things we used to talk about, you know ten years ago, is how transgender people had to educate their health care providers. [Currah] Mmm-hmm. [Keisling] Whether it be a therapist or a mental health provider or a physical health provider. And I think more and more people are finding health care providers - still there's a lot of folks in particularly rural places where  this isn't true, but in big cities now you ask around you can find some, some caregivers who are, are really trans supportive and trans competent. And that's helping with all the policy work we're doing. It's helping with the DSM revisions now. [Currah] Mmm-hmm. [Keisling] And that's all because thousands of trans people are out there stepping out and stepping up. ["In the Life" theme music] When you think of nuns, what comes to mind? Black flowing habits. Strict Catholic school rules. You probably don't think of men and painted faces or silver lame, but the Sisters of Perpetual Indulgence defy all expectation with their unapologetic brand of humor. Since their first appearance in San Francisco on Easter Sunday in 1979, the Sisters have used the power of parody and their irreverent wit to educate, entertain, and raise money for local charities. [indie rock music] [Sister Jezabelle] We are 21st century nuns. [Nun with microphone] But I tell you a little bit about what it takes to become a Sister. You start as an aspirant and you aspire for a couple of months. [Barbi Mitzvah] We use the term ministry very loosely because my ministry is making someone laugh, putting a smile on somebody's face, and raising money for groups that cannot. We have Sisters that are very spiritual. We do a lot of outreach work in hospices and hospitals. We all touch at different aspect of community and that is our entire ministry. [Nun with microphone] Once you're done aspiring,  you start to perspire and you become a postulant. Once you're a postulant, you work on that for a while and you learn to put on makeup. We view our, our appearances as canvases. So this is the canvas, the blank canvas. We paint the canvas white first, and then we add our own interpretation of who we are. [Nun with microphone] After that you become a novice and after that you become a fully professed Sister. Everyone is so afraid of humor and laughter. This is a joke. I mean it's not mocking someone, but it's opening you up. It's the idea of the Holy Fool, the ancient idea that there's someone who stands looking completely absurd and gives you permission to say things completely true and honestly without any misperception or covering or avoidance or hypocrisy. [Nun] I, Sister Reyna Terror... [Nun with microphone] As a member in the Order, [crowd] As a member of the Order, [Nun with microphone] of the Sisters of Perpetual Indulgence, [crowd] of the Sisters of Perpetual Indulgence, [Nun with microphone] dedicate myself to public service [crowd] dedicate myself to public service, [Nun with microphone] social activism, [crowd] social activism, [Nun with microphone] and spiritual enlightenment [crowd] and spiritual enlightenment. Not all sisters originally wore white face, in the beginning. But Sister Atta Hanna Reese Bara did to protect her anonymity and over time it's become tradition. [Mary Timothy Simplicity] It's not every day you see a man in a nun's habit with clown makeup on. And that can be very jarring to those who don't understand it. [Simplicity] This was me last Easter when we did the Zombie Easter and so I decided to come as Saint Rita. [Mary Juanita High] The Sisters really started in 1979. And with a few guys wanting to do something a little different on an Easter Sunday and has grown into this organization of 500 plus nuns around the world. We were bored. And I had brought some Catholic nuns' habits from Iowa with me. We threw them on. We went out into the community, and the reaction was so strong, we decided to form a social activism, social service organization in San Francisco. The organization was formed with the intent of performing community service, performing theater, street theater and to educate the public on social and health issues. We realized right away that the nun's habit, contains a lot of social stigmas, all in one: gender issues, gender identity issues, and religious bigotry issues. So the habit to us is, is like a lightning bolt. I think one of the biggest misconceptions about Sisters is that people think we mock nuns but what I'm doing is I'm celebrating a very old vocation that women have carried for centuries. And all I'm doing is for this century, I'm taking it outside to the other side of the convent walls and I'm finding those people that wouldn't step into a church or a temple or a synagogue but who need just some loving touch and some care and some sensitivity. Putting a face on is definitely about respecting that tradition of the, the Sisters who've gone before me and made it, you know... made this a trademark in a sense. [High] This is a flag that Sister Phyliss rode an AIDS/LifeCycle with. AIDS hit the Order as hard as it hit every other organization. The Order in 1981 was about 20 people strong. By 1987 it had been reduced down to six. We did the world's first AIDS benefit  before the acronym AIDS was coined. AIDS really, in many ways allowed a spirituality to come out. You know, it took people to a place they hadn't been driven to before. So that by 1982, '83, '84 - that's probably one of the main focuses of the Order, is educating the public about HIV and AIDS, raising money to fight it, doing what they can to save as many people as possible. We do a lot of service in providing funds available. We provide grants. This last year we actually provided $85,000 worth of money out to our community here in San Francisco for bisexual, transgendered, gay, lesbian, healthcare, homeless, any kind of providing where there's a little bit underfunded here in the city. In San Francisco we raise over $200,000 a year. It's in direct ministry.  100% in, 100% out. We buy our own jewelry. We make our own wimples. So there's no overhead being a nun. There are three things the sisters do in my opinion: fundraising, fun raising and consciousness raising. And occasionally a good old fashioned barn-raising, if we have time. [laughs] Thank you for watching "In the Life". To learn more about the issues in tonight's stories and how they affect you, visit our website at inthelifeTV.org. You can also watch extended interviews, sign up for monthly airdate alerts, and download past episodes 24/7. I'm Michael Billy. Thanks for tuning in and please join us next month. ["American Girl" by Tom Petty] [Announcer] "In the Life" is funded in part by: the H. van Ameringen Foundation; Arcus Foundation; Newpol Foundation; the Estate of Richard W. Weiland; Gill Foundation; and these funders; and by the annual support of In the Life members like you. [logo music]