The year of the pathological T (Part 1)

I am not sure if this new year became any more auspicious, at least for the Chinese, with Valentine’s Day coinciding with the arrival of the Year of the Tiger (see pic above). Chinese astrologers I heard on TV, however, said that this will not be a good year for relationships. The same feng shui experts reassured people that what they say is merely a prediction based on horoscope analysis, numerology and whatnot. One’s destiny will still clearly be in one’s hands. So those who are romantically involved this year will be able to avoid break-ups and end-of-affair scenarios by simply working hard on their relationships.

Talking about relationships, there is one that I think is in need of a full divorce: transsexualism and its pathological version in the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association (APA) also known as Gender Identity Disorder (GID). GID was first introduced in the DSM III in 1980, a good seven years after homosexuality was removed from the APA manual. Ever since, transgender advocacy groups have been fighting to get GID taken off the DSM and transsexualism out of the International Classification of Diseases (ICD) of the World Health Organization (WHO). While there are rumors that the WHO will reclassify transsexualism (from a mental to a medical condition) when it publishes ICD 11 in 2014, the APA came out with proposed revisions (PR) to GID, on 10 February 2010, making it clear that the fight to depathologize transsexual identity is far from over.

Rereading the PR, I just realized, being a student and teacher of language, that the new version of GID, which will be called Gender Incongruence (GI) in the DSM 5 slated to come out in 2013, is actually an exercise in linguistic trickery. The PR is below:

Gender Incongruence (in Adolescents or Adults)
A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by 2 or more of the following indicators:
1. a marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or, in young adolescents, the anticipated secondary sex characteristics)
2. a strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or, in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)
3. a strong desire for the primary and/or secondary sex characteristics of the other gender
4. a strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)
5. a strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)
6. a strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)

Subtypes
With a disorder of sex development
Without a disorder of sex development

According to the Workgroup tasked to revise the Sexual and Gender Identity Disorders section of the DSM, on the strength of A alone, a GI diagnosis can be made. On first blush, the PR seems actually like an homage to the last 30 years of transgender rights advocacy because it recognizes the stigma attached to the word disorder which many trans people have been fighting against and so therefore eliminates. It also recognizes the problems that a birth-assigned sex can pose to people especially those who will reject and abandon it, partially or completely, later in life. Lastly, the PR recognizes that gender can no longer be viewed as a binary system. Instead it is a spectrum and a person can actually identify as male, female, in-between or otherwise—a reality that trans advocates have been calling people’s attention to all these years.

But at the same time that the PR accommodates the logics of transgender advocacy, it also suggests the possibility of a clinical syndrome, in this case GI, being attributed to people who fight their gender demons by wearing the clothing of the gender not assigned to them (i.e., crossdressers) or people who reject the binary system (i.e., genderqueers) or those who altogether identify as a gender not assigned to them (i.e., transsexuals). GI here becomes, in fact, the pathological version of transgender.

I hope I am mistaken in my analysis. If not then at least there is some hope, for the PR also gives potentially GI people a way out by using a phrase that we, transgender rights activists, have all been rallying against: the tyranny of our assigned gender. The Workgroup assumes that gender, in the first place, must be assigned. And this is usually the province of medicine and the law. Doctors declare that a baby is either a boy or a girl and the law notes by recording the declaration in the baby’s medical records and birth certificate. This is why the struggle for transgender/transsexual rights have revolved mostly around amending the original gender assignment (and therefore name) in legal documents because our identities are anything but that. This is also why many of us have been calling for the eradication of gender markers in our identity papers knowing full well the oppression that those markers can bring to those who outwardly do not match them.

This latter rallying cry reflects what Phyllis Frye, long-time trans activist, said about the birth-assigned sex being merely predictive. Your assigned gender may or may not be your destiny. With gender issues intersecting with racial, economic, cultural, social, and political issues, the issue of gender assignment at birth is something that has become peripheral in the struggle for transgender human rights. With the imminent publication of the DSM 5, it is probably something that needs to be revisited and be placed front and center in our advocacy work, something along the lines of: STOP GENDER ASSIGNMENT AT BIRTH NOW!!!

In my last talk at the University of Santo Tomas (UST), the oldest Catholic University in the Philippines, with freshman Nursing students, I told them that in the future when they become Nurses, knowing the struggles that transsexual people have with their assigned gender, I hope that when they bring a newborn baby into this world, they will refrain from reflexively giving it a gender. Instead of saying It’s a boy or It’s a girl, they should just say that It’s a baby. The class laughed but I hope they did not miss the premise of my joke: that assigning a gender to someone is an issue of power.

In the first place, the new born is not consulted on the matter. In the second place, the act of assigning a person a gender at birth in fact compels that baby to embody that gender later in life. Transgender people are proof that not all people can or want to do so. So the solution to trans people’s problem seems so simple after all as the impending version of the DSM demonstrates. We must simply stop assigning newborn babies a gender. We should also start teaching people to raise children in gender-neutral ways. For if no gender assignment is done at birth, then how can people experience gender incongruence?

Three cheers for Canada

I woke up early on Saturday morning, 13 February 2010, to be able to catch the Opening Ceremony of the Olympic Winter Games in Vancouver on TV. I was not disappointed. It was everything that an Opening Ceremony should be: jaw-dropping, spectacular and above-all touching. The whole thing was a combination of animation, technology, art, song, dance and acrobatics. It paid tribute to Canadian history, geography and culture. I particularly liked the part where a giant bear made of pin pricks of light rose from the ground and floated on air for a few seconds. It was really a sight to see. It looked like a constellation, a mascot and an apparition all rolled into one (see pic above).

The grizzly bear is such an emblematic part of Canadian culture, that most if not all Canadians grow up learning what to do when a bear shows up in their proximity. I have family in Canada who, when they come home to the Philippines, somehow always end up mentioning ways to escape, fight off, or lose a bear when one does come around. It is a Canadian thing.

The love of my life, Carl is also from Canada so anything coming out of there has special appeal and meaning to me. This magnificent Opening Ceremony is one of those things. It made me feel so proud to have Canadian relatives and loved ones. There is really nothing like the Olympics to remind you of your humanity and the connections it engenders. I may have watched the Opening Ceremony in my living room at home but it did not take me away from feeling that I was sharing it with millions of other people around the world especially those seeing it live at the Olympic stadium. I knew too that above all I was also sharing it with my relatives and Carl. It is so heart-warming especially since Carl is such a patriotic guy. He loves his country very much. I can imagine how proud he must have been for this great Opening Ceremony.

So it was a little saddening to note that the Opening day was marred by tragedy. According to reports, a luger from Georgia crashed and died while doing a practice run at the luge track. Accounts say that the luge track is a bit tricky and now changes have been made to it to ensure that no other accident ever happens again till the Winter Games end in two and a half weeks.

I am confident that the Canadians will do everything in their power to make everyone safe from harm during the Games. This is not the first time they are hosting the Winter Olympics so it should be easy for them. Canada truly deserves praise for putting on a brave face during the Opening Ceremony and dedicating it to the luger who passed away. Three cheers for the Canadians and the Winter Olympics in Vancouver!

Gender Identity Disorder stays in the DSM V

In spite of a global campaign to depathologize trans identities, the American Psychiatric Association (APA) working group revising the Diagnostic & Statistical Manual of Mental Disorders (DSM) has decided to retain Gender Identity Disorder (GID) in the fifth edition of the DSM. The APA draft can be found here.

This for me is nothing but a grave abuse of power. I am glad that soon transgender human rights advocacy groups will come together to ensure a worldwide response to the tyranny of the APA.

In the meantime, the fight for depathologization continues.

Kids these days

Today I went to the University of Santo Tomas (UST), one of the oldest universities in the Philippines, to give a Transgender 101 talk to a freshman Nursing class (see pic above). A group of students in the class sent me an invitation saying that they wanted to work on a paper on transgender issues in the Philippines.

I began the session by reminding the class that in the past, during Spanish times, UST was an all-male school. As years went by, UST underwent a “sex change” of sorts when it started taking in female-bodied students. I patterned this short introduction from a personal story by Atty. Kim Coco Iwamoto, a prominent trans activist in the US, who during her time in law school at the University of New Mexico (UNM) faced opposition on her use of the women’s toilet.

Talking about gender in a way that resonates with students always gets their attention. I am always happy when I see them have their own Eureka moments in their seat when they realize the injustice that a binary gender system can wreak. For these students, gender is something that they take for granted every day. It is always good to remind them that such is not the case for many transgender people for whom gender may end up being like a daily cross to bear.

The session was only good for one and a half hours and it was not enough to cover everything. I was only able to break down the key terminology and cut the lecture short to allow the students to ask questions. I was glad when someone asked about the issue of transgender health and how things are in that area for trans people in the Philippines. I told them that transgender health care is non-existent in the country. Ten years after the new millennium, medical practitioners from different fields remain unknowledgeable about the health needs of transgender Filipinos.

I told them about my own discriminatory experience a long time ago before I started hormone replacement therapy (HRT). I wanted to be supervised by an endocrinologist and so went to see one at the Makati Medical Center, supposedly a world-class hospital at the heart of the Makati Central Business District where I was working at that time. The endocrinologist I saw was a middle-aged woman who looked sharp around the edges. At the start, she was quite pleasant. She had me seat in front of her and asked me to tell her my story. So I did. I told her that I wanted to begin HRT and I wanted to consult her on the process. I told her that I had many questions about it and would be glad to hear her expert opinion. She listened to me patiently but after 15 minutes proceeded to tell me with a distinct odium in her voice “I’m sorry but I cannot do what you are asking me to do. It is against my religious beliefs.”

I was flabbergasted when I heard her say this. At that time I was young and naïve. I did not know for sure if doctors could actually refuse a person treatment based on their faith. Because I am normally flexible, I did not pay the issue much mind. I just forgot about it and moved on to the next available doctor. I told the class that now I see that it was a clear case of prejudice at work because doctors are not supposed to judge their patients. They are supposed to provide health services to those who need them most. They are there to ensure the well-being of all regardless of who they are.

I told the class that I hope that when they become professional health care workers themselves that they will not let their own personal biases get the better of them. Transgender people who seek help for their health deserve competent medical care as much as the next person. I told them never to forget an idea usually associated with the Hippocratic oath of doctors which can also apply to them: “First, do no harm.” That is their only mandate as health care professionals, to do good and do no one any harm.

Because health care is in itself expensive, and doctors and nurses are ignorant of transgender issues and hospitals become very intimidating environments for trans people, many of them end up self-medicating which can prove hazardous to their health. I told the class that I hope that they will make sure that in the future, the medical profession becomes a kinder and more compassionate profession as it was originally envisioned. Furthermore, I told them that the main reason why I make time to meet young people and talk to them is because I have faith that they will actually change the world for the better.

This is really the reason why we go out there, why we go to Universities and Colleges all over the Philippines and abroad too when possible. We are not only talking to them about our issues, we are also recruiting them into a global project. That is to recreate a world that will uphold the dignity of all and give everyone an equal chance at life. Every single head in that class was nodding in agreement when I told them this and for me that was enough.

I know that advocating for the human rights of transpeople will be a long battle to win hearts and minds. But I am always hopeful and talking to the young is always a good start. When I was looking at every single fresh face in that classroom today, my heart was filled with hope and ardor. I knew that they understood what exactly I was saying. I love these kids. Their desire to learn about, comprehend and empathize with us is truly humbling and touching.

After my talk, we had a jolly time taking pictures. I particularly relish this group picture that they took below. I guess it says it all.

Goodbye J.D.

The first thing I do when I board a plane is grab the day’s paper. I was flying Philippine Air Lines (PAL) again on Saturday morning, the 30th of January, from Hong Kong and when I got on flight PR 301, I went to the newspaper shelf, got the Philippine Daily Inquirer before putting away my laptop and hand carry bag in the storage bin above my seat.

When I was comfortably seated, I scoured the headlines and was shocked to see that one of the American writers whose work I have long admired and loved had died. The news item said that Jerome David or J.D. Salinger died in his home in New Hampshire at the age of 91 (see pic above). As I was reading the news obituary about Salinger, I could not help myself and began to cry.

The plane had not taken off yet at that point and the cabin crew was still helping people into their seat assignments. I was relieved that the flight was not fully booked and found myself last in a row of four seats, three of which were unoccupied. I let the grief wash over me, said a silent goodbye to Salinger in my head and after a few minutes, the tears stopped rolling. I took out a tissue to wipe my face and started to retrace my steps back into the past and how I discovered this great American writer.

My first Salinger encounter was not through his defining and most famous work, The Catcher in the Rye. That would come much later in fact. The first work of his that I read was his short story collection entitled unpretentiously, Nine Stories. I was in high school and was going through our clan’s, the Magistrado-Estanislaos’ book collection. These were books that were owned formerly by the various adults in our household including aunts who were by then already long gone from our home town and were working abroad. I found Nine Stories in an old cigarette box full of musky-smelling books and when I opened it, I was unable to put it down. From the first story, A Perfect Day for Bananafish to the last Teddy, Salinger made me laugh, cry and gasp in awe. Salinger’s prose is very accessible you see. There is an easiness to the tone of his writing that belies the depth of what he talks about: suicide, sadness over an unrequited love, family and more. Discovering Salinger at a young age made me see how a great writer could inspire affinity and affection from readers. I must have reread Nine Stories a hundred times over before entering University. I went to it when I was happy and when I was blue, when I was inspired or needed to be inspired. I found Salinger's voice both brilliant and comforting. When I went to college I made sure not to forget my old, dilapidated copy of Nine Stories (see pic below).



The Catcher in the Rye, I first heard about from the writer Jessica Zafra. The first time she mentioned Holden Caulfield, I thought, “Of course Salinger has other works!” and I could not wait to get a copy of this generation-defining book. When I was in college at the University of the Philippines, Zafra had a column in the broadsheet Manila Today called Twisted, which I followed loyally. I first discovered Zafra in high school via her old column called Womenagerie in the now defunct magazine Woman Today, to which my mother used to subscribe. Woman Today was like the Cosmo of the Philippines in the 80s and 90s. When the magazine died and Zafra moved to the broadsheet, I followed suit.

I used to photocopy Jessica Zafra’s column at the basement of the UP Main Library which housed the periodicals section. Back in the dorm, I would cut them out neatly and file them in a folder. I was glad to do it because I was a fan. Later when she decided to publish her old column in collected, book form, I realized that I had read all of their contents and so did not have the urge to buy any of them. I always found Zafra’s humor sinister but intelligent and ultimately heartfelt, a trait which I feel she shares with Salinger. The best thing about Zafra was that she was an English major and her columns were peppered with literary allusions. She told people what to read and she made regular references to Salinger’s work. Before the end of my freshman year in UP in 1994, I found a second hand copy of Catcher in the Rye at the old second-hand book store at the Shopping Center.

That night I refused to sleep just to finish the book. As I went through page after page, I found myself being pulled into the irreverent thoughts of Holden Caulfield and his quest for authenticity. When he called someone or something a phony, I agreed. I was hooked and exhilarated. I found the book witty, fast-paced and cheeky. As with Nine Stories, I would reread The Catcher in the Rye over and over again and would never tire of it. In my third year in college, someone borrowed my Salinger collection including The Catcher in Rye, Nine Stories,, Franny and Zooey, and Raise High The Roofbeam, Carpenters and never gave it back.

Since then, I would always make sure to look for Salinger’s books in thrift book shops. Now I have in my possession all of the books mentioned above save for The Catcher in the Rye. The first thing I did when I got home from Hong Kong was to take out my Salinger collection out of its storage place and reread my favorite short story Uncle Wiggily in Connecticut.It never fails to undo me with its heartrending ending. I reacted to it the same way I did the first time I read it, with a combination of pain and distress. This story always makes me cry. I am now going through Raise High the Roofbeam, Carpenters and so far I feel like I am taking a trip down memory lane, remembering the times in the past when I would go back to my old copies of Salinger's books and the state of my emotions at those times. I am glad I do not have a copy of The Catcher in the Rye. I don’t think I can handle reading it right now. One of these days though when I have fully recovered from Salinger’s death, I know that I will get hold of this book, hopefully a brand new one, and link hands once more with Holden Caulfield.

The good thing about reading Salinger’s work one after the other is that they speak to each other. Franny and Zooey in fact belong to the Glass family, the same family that is written about in Raise High the Roofbeam, Carpenters and referred to in stories in Nine Stories. Salinger became a recluse in the 60s and hauled himself to New Hampshire to retire from the literary world. He refused to grant interviews and was rarely heard from except when he was suing people who tried to use his writing in ways that he did not approve of (e.g., an authorized sequel to The Catcher in the Rye, attempts to turn his work into film, etc.). He also instructed publishers to print and reprint his work between plain covers that only showed the text of his book titles, no art and no blurbs. For me, this is testament to his devotion to his work. There is nothing more important than the fine print. Everything else does not matter. And if I had entitled this piece melodramatically, after one of his work’s titles for example, I know that he would have turned in his grave. So once more, very simply but with much gratitude and love, goodbye J.D..