WPATH 2016 poster: “A time of anticipation”

Here’s the poster I presented at this year’s WPATH Symposium:

Anticipation poster.png

You can also download a PDF version here.

The magnet is a metaphor for anticipation, which is both a product of and shapes feelings, emotions and experiences of time. This process is mediated by both trans community discourses and medical systems.

It’s very important to note that the majority of research participants had good things to say about the health professionals who helped with their transition. However, there is also a high prevelance of transphobia and cisgenderism within medical systems and clinical pathways. Anxiety and mistrust of practitioners within the trans patient population is endemic, and this is compounded by long waiting times.

My wider research looks critically at how discourses of trans health are differently understood within and between community/support spaces, activist groups and the professional sphere; however, the purpose of this particular poster was communicate some of the difficult experiences that current patients have with waiting. It sparked some productive conversations and I hope that further work will follow from this.

Sources:

Transitional Demands (Jess Bradley and Francis Myerscough)

Experiences of people from , and working with, transgender communities within the NHS – summary of findings, 2013/14 (NHS England)

Current Waiting Times & Patient Population for Gender Identity Services in the UK (UK Trans Info)

 

Some tips on opposing Kenneth Zucker’s new article on trans children

This morning it came to my attention that notorious child psychologist Kenneth Zucker has co-written a chapter on trans issues for the new (6th) edition of Rutter’s Child and Adolescent Psychiatry. The chapter, entitled “Gender dysphoria and paraphilic sexual disorders” effectively draws upon flawed and outdated research to promote reparative therapy for trans children. You can read most of it via Google Books here.

Cover of Rutter's Child and Adolescent Psychiatry

Abusing children – for science!

This is a big deal because Zucker draws upon harmful theories (including Ray Blanchard’s deeply reductive typology of transsexualism) to promote the idea that issues faced by gender variant children are due to a problem with the child, rather than societal gender norms. He therefore promotes a form of treatment that (to quote his new article) encourages parents to “set limits with regard to cross-gender behaviour, and encourage same-sex peer relations and gender-typical activities” in an attempt to cure them of difference. This is the kind of treatment that leads children to internalise the idea that non-normative gendered expression is shameful or wrong.

Rutter’s Child and Adolescent Psychiatry, meanwhile, is a widely-used textbook and can be found in university libraries and on reading lists in many countries.

I’m not sure what the best way is to stop this article from influencing practice. However, some ideas could include:

  • Write to professional organisations and ask them to explicitly oppose reparative therapy for trans youth
  • Write to University libraries and courses, asking them to consider sticking with the 5th edition of Rutter’s
  • Write to University departments and ask them to teach critical texts alongside the 6th edition of Rutter’s, and/or avoid putting the new edition on reading lists
  • Borrow the book from a local library if it becomes available, and write critical comments in the margins
  • Write to the book’s editors and/or publisher and question why Zucker has been given a platform for his outdated ideas
  • Comment on this post and/or join this new Facebook page to discuss possible ways forward.

The new edition isn’t yet widely available in libraries, so now is a good time to act.

If you’re writing letters or raising awareness of this as an issue, here is some useful information on opposing the article:

  • Zucker’s approach to treatment can seriously harm children
  • Zucker’s Gender Identity Service at the Toronto-based Centre for Addiction and Mental Health was recently suspended pending investigation in the wake of a large number of complaints – his approach to treatment is now also arguably illegal in the province of Ontario
  • Zucker’s new article represents poor academic practice. He cites himself 17 times, relies upon papers at least 20 years out-of-date to make many of his arguments, and also draws strong inferences from statistically insignificant quantitative findings
  • Zucker’s considerable academic position is based in part upon a small “invisible college” of academics who regularly peer-review and cite one another, thereby gaining many publications with a high profile whilst avoiding external criticism
  • There is a considerable evidence-based case to be made against Blanchard’s work. See for instance “The Case Against Autogynephilia“, a peer reviewed article by Julia Serano.

Thanks and respect to Peter Le C for raising awareness of this issue, and to oatc for suggested edits.

Statement of trans-inclusive feminism and womanism

Several individuals have been working hard over the past couple of weeks to put together an international statement supporting trans inclusion in the struggle for women’s rights. The publication of this statement comes as the inclusion of trans people within feminist and womanist groups is once again under question, and as trans concerns gain an increasingly public profile.

I was honoured to be asked to sign this statement. I feel it provides a timely response to the aforementioned issues, as well as a recent radical feminist statement on trans exclusion, and the forthcoming publication of Sheila Jeffreys’ new book.

I stand fully behind the statement, and am also heartened by its international scope. As I write this post, the statement has been signed by 150 individuals and 8 organizations — from 13 countries.

However, I feel it is worth noting the anglo-centric nature of the statement. That is somewhat inevitable given that this is a debate happening largely within the English-speaking world. Still, it would have been good to see signatories from the United States and United Kingdom note their country of origin; at present, I feel that signatories from outside these countries are singled out as unusual through the highlighting of their national location. I hope that this disparity and US/UK-centrism might be addressed in future efforts.

I have reproduced the statement below, and encourage others to disseminate it further.

 

A Statement of Trans-Inclusive Feminism and Womanism

We, the undersigned trans* and cis scholars, writers, artists, and educators, want to publicly and openly affirm our commitment to a trans*-inclusive feminism and womanism.

There has been a noticeable increase in transphobic feminist activity this summer: the forthcoming book by Sheila Jeffreys from Routledge; the hostile and threatening anonymous letter sent to Dallas Denny after she and Dr. Jamison Green wrote to Routledge regarding their concerns about that book; and the recent widely circulated statement entitled “Forbidden Discourse: The Silencing of Feminist Critique of ‘Gender,’” signed by a number of prominent, and we regret to say, misguided, feminists have been particularly noticeable.  And all this is taking place in the climate of virulent mainstream transphobia that has emerged following the coverage of Chelsea Manning’s trial and subsequent statement regarding her gender identity, and the recent murders of young trans women of color, including Islan Nettles and Domonique Newburn, the latest targets in a long history of violence against trans women of color.  Given these events, it is important that we speak out in support of feminism and womanism that support trans* people.

We are committed to recognizing and respecting the complex construction of sexual/gender identity; to recognizing trans* women as women and including them in all women’s spaces; to recognizing trans* men as men and rejecting accounts of manhood that exclude them; to recognizing the existence of genderqueer, non-binary identifying people and accepting their humanity; to rigorous, thoughtful, nuanced research and analysis of gender, sex, and sexuality that accept trans* people as authorities on their own experiences and understands that the legitimacy of their lives is not up for debate; and to fighting the twin ideologies of transphobia and patriarchy in all their guises.

Transphobic feminism ignores the identification of many trans* and genderqueer people as feminists or womanists and many cis feminists/womanists with their trans* sisters, brothers, friends, and lovers; it is feminism that has too often rejected them, and not the reverse. It ignores the historical pressures placed by the medical profession on trans* people to conform to rigid gender stereotypes in order to be “gifted” the medical aid to which they as human beings are entitled.  By positing “woman” as a coherent, stable identity whose boundaries they are authorized to police, transphobic feminists reject the insights of intersectional analysis, subordinating all other identities to womanhood and all other oppressions to patriarchy.  They are refusing to acknowledge their own power and privilege.

We recognize that transphobic feminists have used violence and threats of violence against trans* people and their partners and we condemn such behavior.  We recognize that transphobic rhetoric has deeply harmful effects on trans* people’s real lives; witness CeCe MacDonald’s imprisonment in a facility for men.  We further recognize the particular harm transphobia causes to trans* people of color when it combines with racism, and the violence it encourages.

When feminists exclude trans* women from women’s shelters, trans* women are left vulnerable to the worst kinds of violent, abusive misogyny, whether in men’s shelters, on the streets, or in abusive homes.  When feminists demand that trans* women be excluded from women’s bathrooms and that genderqueer people choose a binary-marked bathroom, they make participation in the public sphere near-impossible, collaborate with a rigidity of gender identities that feminism has historically fought against, and erect yet another barrier to employment.  When feminists teach transphobia, they drive trans* students away from education and the opportunities it provides.

We also reject the notion that trans* activists’ critiques of transphobic bigotry “silence” anybody.  Criticism is not the same as silencing. We recognize that the recent emphasis on the so-called violent rhetoric and threats that transphobic feminists claim are coming from trans* women online ignores the 40+ – year history of violent and eliminationist rhetoric directed by prominent feminists against trans* women, trans* men, and genderqueer people.  It ignores the deliberate strategy of certain well-known anti-trans* feminists of engaging in gleeful and persistent harassment, baiting, and provocation of trans* people, particularly trans* women, in the hope of inciting angry responses, which are then utilized to paint a false portrayal of trans* women as oppressors and cis feminist women as victims. It ignores the public outing of trans* women that certain transphobic feminists have engaged in regardless of the damage it does to women’s lives and the danger in which it puts them.  And it relies upon the pernicious rhetoric of collective guilt, using any example of such violent rhetoric, no matter the source — and, just as much, the justified anger of any one trans* woman — to condemn all trans* women, and to justify their continued exclusion and the continued denial of their civil rights.

Whether we are cis, trans*, binary-identified, or genderqueer, we will not let feminist or womanist discourse regress or stagnate; we will push forward in our understandings of gender, sex, and sexuality across disciplines.  While we respect the great achievements and hard battles fought by activists in the 1960s and 1970s, we know that those activists are not infallible and that progress cannot stop with them if we hope to remain intellectually honest, moral, and politically effective.  Most importantly, we recognize that theories are not more important than real people’s real lives; we reject any theory of gender, sex, or sexuality that calls on us to sacrifice the needs of any subjugated or marginalized group.  People are more important than theory.

We are committed to making our classrooms, our writing, and our research inclusive of trans* people’s lives.

Signed by:

Individuals

Hailey K. Alves (blogger and transfeminist activist, Brazil)

Luma Andrade  (Federal University of Ceará, Brazil)

Leiliane Assunção (Federal University of the Rio Grande do Norte, Brazil)

Talia Bettcher (California State University, Los Angeles)

Lauren Beukes (novelist)

Lindsay Beyerstein (journalist)

Jamie “Skye” Bianco (New York University)

Hanne Blank (writer and historian)

Kate Bornstein (writer and activist)

danah boyd (Microsoft research and New York University)

Helen Boyd (author and activist)

Sarah Brown (LGBT+ Liberal Democrats)

Christine Burns (equalities consultant, blogger and campaigner)

Liliane Anderson Reis Caldeira (Federal University of Minas Gerais, Brazil)

Gloria Careaga (UNAM/National Autonomous University of Mexico)

Avedon Carol (activist and writer; Feminists Against Censorship)

Wendy Chapkis (University of Southern Maine) – “I don’t love the punch line ‘people are more important than theory.’  More to the point, it seems to me, is that feminist theories that fail to recognize the lived experiences and revolutionary potential of gender diversity are willfully inadequate.”

Jan Clausen (writer, MFAW faculty, Goddard College)

Darrah Cloud (playwright and screenwriter; Goddard College)

Alyson Cole (Queens College – CUNY)

Arrianna Marie Coleman (writer and activist)

Suzan Cooke (writer and photographer)

Sonia Onufer Correa  (feminist research associate at ABIA, co-chair of Sexuality Policy Watch)

Molly Crabapple (artist and writer)

Elizabeth Dearnley (University College London)

Jaqueline Gomes de Jesus (University of Brasilia, Brazil)

Sady Doyle (writer and blogger)

L. Timmel Duchamp (publisher, Aqueduct Press)

Flavia Dzodan (writer and media maker)

Reni Eddo-Lodge (writer and activist)

Finn Enke (University of Wisconsin, Madison)

Hugh English (Queens College – CUNY)

Jane Fae (writer and activist)

Roderick Ferguson (University of Minnesota)

Jill Filipovic (writer and blogger)

Rose Fox (editor and activist)

Jaclyn Friedman (author, activist, and executive director of Women, Action, & the Media)

Sasha Garwood (University College, London)

Jen Jack Gieseking (Bowdoin College)

Dominique Grisard (CUNY Graduate Center/Columbia University/University of Basel)

Deborah Gussman (Richard Stockton College of New Jersey)

Dr Sally Hines (University of Leeds)

Claire House (International Day Against Homophobia and Transphobia, Brazil)

Astrid Idlewild (editor, urban historian)

Sarah Hoem Iversen (Bergen University College, Norway)

Sarah Jaffe (columnist)

Roz Kaveney (author and critic)

Zahira Kelly (artist and writer)

Mikki Kendall (writer and occasional feminist)

Natacha Kennedy (Goldsmiths College, University of London)

Alison Kilkenny (journalist and activist)

Matthew Knip (Hunter College – CUNY)

Letícia Lanz (writer and psychoanalyst, Brazil)

April Lidinsky (Indiana University South Bend)

Erika Lin (George Mason University)

Marilee Lindemann (University of Maryland)

Heather Love (University of Pennsylvania)

Jessica W. Luther (writer and activist)

Jen Manion (Connecticut College)

Ruth McClelland-Nugent (Georgia Regents University Augusta)

Melissa McEwan (Editor-in-Chief, Shakesville)

Farah Mendlesohn (Anglia Ruskin University)

Mireille Miller-Young (University of California, Santa Barbara)

Lyndsey Moon (University of Roehampton and University of Warwick)

Surya Monro (University of Huddersfield)

Cheryl Morgan (publisher and blogger)

Kenne Mwikya (writer and activist, Nairobi)

Zenita Nicholson (Secretary on the Board of Trustees, Society Against Sexual Orientation Discrimination, Guyana)

Anne Ogborn (frightening sex change)

Sally Outen (performer and activist)

Ruth Pearce (University of Warwick)

Laurie Penny (journalist and activist)

Rosalind Petchesky (Hunter College and the Graduate Center, CUNY, and Sexuality Policy Watch)

Rachel Pollack (writer, Goddard College)

Claire Bond Potter (The New School for Public Engagement)

Nina Power (University of Roehampton)

Marina Riedel (Federal University of Rio Grande do Sul, Brazil)

Mark Rifkin (University of North Carolina – Greensboro)

Monica Roberts (Transgriot)

Dr. Judy Rohrer (Western Kentucky University)

Diana Salles (independent scholar)

Veronica Schanoes (Queens College – CUNY)

Sarah Schulman, in principle (College of Staten Island – CUNY)

Donald M. Scott (Queens College – CUNY)

Lynne Segal (Birkbeck, University of London)

Julia Serano (author and activist)

Carrie D. Shanafelt (Grinnell College)

Rebekah Sheldon (Indiana University-Purdue University-Indianapolis)

Barbara Simerka (Queens College – CUNY)

Gwendolyn Ann Smith (columnist and Transgender Day of Remembrance founder)

Kari Sperring (K L Maund) (writer and historian)

Zoe Stavri (writer and activist)

Tristan Taormino (Sex Out Loud Radio, New York, NY)

Jemma Tosh (University of Chester)

Viviane V. (Federal University of Bahia, Brazil)

Catherynne M. Valente (author)

Jessica Valenti (author and columnist)

Genevieve Valentine (writer)

Barbra Wangare (S.H.E and Transitioning Africa, Kenya)

Thijs Witty (University of Amsterdam, Netherlands)

Groups:

Bishkek Feminist Collective SQ (Kyrgyzstan, Central Asia)

House of Najafgarh (Najafgarh, India)

House of Kola Bhagan (Kolkatta, India)

Transgender Nation San Francisco

Trans controversy at Warwick Medical School

A mature student* enrolled in Warwick Medical School (WMS) has just lost a formal appeal after being denied the opportunity to resit an exam.

The events that led to this outcome indicate that WMS provides poorly for trans students undergoing a physical transition, and suggest that other students with access needs are likely to face similar problems. The student in question argued that these oversights amount to indirect discrimination: a claim rejected by a committee of senior academics from the wider University.

This message this sends is that discrimination against trans people and others is acceptable at the University of Warwick.

An inappropriate request

The first sign of trouble came in September 2011 (at the start of the WMS course) when the student (who I shall henceforth refer to as “B”) was asked to attend an Occupational Health doctor at the University Hospital of Coventry and Warwickshire.

This is not a standard procedure for all students on the course, and instead related to information B had provided to WMS upon enrolment. She was informed by a secretary in WMS that: “You are not being asked to attend on the grounds of being transgender […] I can only assume that you have ticked one of the health issues boxes and the Occupational Health team are required to assess your fitness to cope with the course.

B sought an explanation, writing: “I’m concerned that I am actually being asked to attended simply because I am TG. Under the strictest definition, transexualism is still classified as a ‘severe mental illness’ and consequently it was necessary for me to tick the corresponding box (9? – mental health).” B had commented on the form that was was trans, believing this action to be private disclosure.

Upon further enquiry, Occupational Health confirmed B’s suspicion, explaining that she was asked to attend the meeting because she had ticked the “mental health” box. The meeting was compulsory, with B being told that: “Failure to attend will result in us not being able to clear you health wise for the course“.

Conflicting messages

Ahead of the meeting, B attempted to clarify the situation in an email to an Occupational Health Nurse based in the hospital: “Just so that I’m completely clear, am I being asked to attend due to declaring that I have dysphoria of gender identity?

The nurse’s response was:  “No – it is connected with the health question you replyed yes to on the form.  It has nothing to do with your gender.  We work in accordance with the equality act 2010.

B describes the eventual meeting as follows:

When the OH appointment occurred the doctor walked in, checked the notes, and then said, “Oh, you’re trans”.

At which point I said, “Oh, you’re breaching the Equality Act then,” and proceeded to lecture them on how they were breaking my rights. At which point they asserted the party like about OH being a positive thing. And I pointed out, “then in that case I could have the right to decline your invitation”.

And the appointment ended. Nothing else was discussed.

There was no good reason for Occupational Health to know that B was trans. Through the arrangement of this meeting, she was unnecessarily outed to considerable number of people, and it was implied that her trans status might upon her ability to eventually graduate as a “Warwick doctor”.

However, worse was to follow.

 

A limited window of opportunity

Medical degrees are typically very intense. Students on B’s course are expected to take no more than three week’s sick leave per year during their four year course and subsequent two years as a foundation doctor. The maximum holiday period available is four weeks. The only exception to this is the summer holiday period between students’ first and second years.

As of autumn 2011, B was undergoing a physical transition, funded by the NHS and overseen by Charing Cross gender identity clinic. She intended to take a brief break in order to undergo genital surgery during her time as a medical student. However, the long recovery time (patients are typically recommended to take off at least eight weeks post-op; B was recommended to take off twelve weeks because of the physical nature of her course) and short breaks permitted during the six years of medical training meant that it would be difficult for her to find time to do so.

B was informed by the Senior Tutor at WMS that the only time she could realistically take off for surgery was her first summer holiday period. As a consequence of this, she was likely to forgo any chance to resit exams failed during her first year.

Private surgery

B then approached Charing Cross about the possibility of scheduling genital surgery for the summer of 2012. At this point, she would have completed the year of “real life experience” required by the current World Professional Association of Transgender Health Standards of Care. However, her request was rejected by Charing Cross on the grounds that she would have been attending the gender clinic for less than two years at the time of surgery.

B then faced a difficult dilemma: to wait six years for surgery, or pay for a private operation in order to complete her physical transition within the timeframe effectively demanded by WMS. She eventually took the decision to spend her savings on private treatment in order to minimise disruption to her study.

The possibility of failure

Whilst considering her options, B approached a couple of tutors for advice. She was particularly concerned about the possibility of failing her exam and then missing the resit during her time in hospital. This was a valid concern: not because B is a poor student, but because resits are not exactly uncommon within medical schools. As one academic within WMS commented in email correspondence to B:

As I am sure that you are becoming aware, medical exams can be a bit of a lottery and do not necessary relate to the candidate’s ability.

B was, however, informed that she was unlikely to fail any of her modules, and decided to go ahead with the surgery.

The exam

As it turned out, B failed her exam – along with 35% of her cohort.

An investigation by WMS formally dismissed any possibility of responsibility for this on the part of course conveners and school policy. However, B’s failure is arguably down in part to the complexities of the system as much as her own work. The manner in which the exam was marked meant that B got a higher percentage of marks than some students who passed, but failed the exam after doing poorly on a couple of very particular sections.

The exam results were announced the day that B regained consciousness in hospital following her operation. She spent the next few days in email contact with WMS from her hospital bed in an attempt to safeguard her second year of university.

The response

B requested that she be allowed (like the rest of her cohort) the opportunity to resit her exam. Unfortunately, the resit was to take place whilst she was still in hospital. WMS refused to provide any means for B to take her exam remotely, and insisted that it would not be possible for her to re-take her exam individually.

It later emerged that WMS were not prepared for any student to resit an exam individually under exceptional circumstances. Their argument is that it takes 60 working hours over the course of six months to prepare an individual exam, and that it is therefore too much work to prepare more than one paper.

B was reminded that she had been made aware that she would have to re-take the year in the event of failing any exam. WMS was not prepared to make any accommodation for her exceptional circumstances.

This would seem to imply that any student at WMS who is forced to miss an exam because of transition, disability or emergency surgery would be placed in a similar position to B.

The appeal

After pursuing the case within WMS for several weeks, B eventually decided to make a formal appeal within the wider University. The appeal entailed the preparation of a case, to be scrutinised by a committee of senior academics (including several faculty heads) before a recommendation was made to the Vice-Chancellor.

B argued that the approach of WMS amounted to indirect discrimination. The Equality Act and Disability Discrimination Act (which is applicable to individuals recovering from major surgery) both insist that suitable provisions are made for individuals with a legitimate need. The inability of WMS to provide a resit for students who have a legitimate medical reason for missing the standard resit effectively makes it difficult for anyone requiring surgery to undertake particular courses.

She therefore requested the opportunity to resit her exam, or (failing that) financial support for her re-take of the first year.

After a lengthy process of assessment (including an hour-and-a-half meeting with B in which she was able to direct present her case and answer questions) the committee rejected B’s appeal.

Some particularly telling extracts from the appeal documents follow (emphasis mine).

From the minutes of the committee’s meeting with B:

(i)  It was noted that [B] believed she required surgery as a matter of medical need;

(ii)  [B] was aware that she intended to undergo surgery at the time she applied for, and subsequently enrolled on, her degree and would also have been aware of the structure of the academic year (through the School’s Code of Practice 2011) and the fact that this would limit her opportunities to undergo elective surgery

From a letter outlining the panel’s decision:

(ii) [B’s] decision to undergo private, rather than NHS, surgery was a result of her own rational choice and was not forced by the Medical School;

(iii) The Committee accepted that the structure of the academic year for the MB ChB, in which resit exams are scheduled during the long vacation, did not allow sufficient time for students requiring long-term elective medical treatment, including transgender students requiringtransition surgery;

(iv) The Committee considered that the imposition of a structured academic year applicable to students generally is proportionate to the legitimate aim of providing education and therefore does not constitute indirect discrimination against students requiring gender re-assignment under s.19 Equality Act 2010;

(v) It was noted that the University has a duty to make reasonable adjustments under s.92(6) Equality Act 2010 where a rule or practice impacts adversely on a student with a protected characteristic;

(vi) As such, the Committee deemed temporary withdrawal for an academic year a reasonable adjustment, as it is always available for students requiring long-term treatment, including students undergoing gender re-assignment;

(vii) In relation to the question whether the Medical School should prepare a special resit paper to be taken at a time convenient to [B], it was noted that it is not uncommon in other Faculties for special arrangements to be made to enable students with disabilities to take scheduled resit examinations;

(viii) Nevertheless, it was noted that in this instance, the process of setting, marking and moderating a special exam would take the equivalent of 60 staff hours and if it were required that special resit papers for individual students with particular characteristics (i.e. transgender students) should be set, to be taken outside the calendared exam periods, it would be necessary as a matter of fairness to offer this service to other students with disabilities, protected characteristics or general illness who were unable to take scheduled resits

[…]

In relation to the supplementary ground of complaint:

(i) That there would be no reason for any member of Warwick Medical School staff to anticipate this level of failure;

(ii) That advice given to [B] by the Senior Tutor made clear that early scheduling of treatment would incur a risk and that [B] should consider her degree of confidence in passing the exams, before scheduling her elective treatment;

(iii) The Committee was therefore satisfied that the advice given by the Senior Tutor was appropriate.

Particularly unimpressive is the assumption that students such as B can afford (in financial as well as emotional terms) an entire year out from study, and the implication that a decision in her favour would set an awful precedent in which the University would have to appropriately support disabled students.

Concluding thoughts

I find the handling of this whole affair by WMS and the wider University of Warwick to be quite disturbing.

Of course medical courses should be difficult, and of course exams should be stringent. But everyone should have an equal chance to pass (and fail!) them.

Of course University departments have limited time, resources and money, particularly at this time of financial crisis. But they’ve had to spend a whole lot of time and money on this appeal, and they’re going to have to spend more on dealing with the fallout from this case.

I’ve tried to keep this post relatively succinct. It’s inevitably ended up being pretty long, but there’s so much background to this, and so much I haven’t been able to cover. The general impression I get is that WMS (and the University of Warwick) were keen to bury this case underneath a mountain of bureaucracy. The fact that it even reached the appeal stage is a minor miracle.

My concern now is not just for B, but for future students at WMS. I’ve seen a lot of evidence that suggests they don’t take discrimination seriously enough. Let’s hope that in the wake of this we might see policy change to ensure otherwise.

If you wish to contact WMS about this affair, please do. But please do not send any hate mail or threats!

* The student in question wishes to remain anonymous at the time of writing.

Edit: for a more personal take on this story, see No More Lost. There is also now a discussion up at Trans Medic.

Trans Grrrl Riot, part 1: Was riot grrrl transphobic?

Bikini Kill

I love Bikini Kill. I love the uncompromising power of their music, the feminist rage in their lyrics, their wider political approach. Bikini Kill who inspired me to finally pick up the bass guitar that had sat forlorn in a corner of my room for several years, and Bikini Kill helped me believe that I could make music.

I realise it’s a bit of a cliché, but they’re the band responsible for getting me into riot grrrl, and from there  began to explore feminist punk music (including that from contemporary UK bands) more widely.

I wanted to be a riot grrrl too, and was sad that the original movement faded away back in in the mid-1990s, well before I was ever aware of its existence.

Trans invisibility

However, riot grrrl doesn’t necessarily have the best reputation amongst trans people familiar with its history. I haven’t come across an account of (or by) a single trans woman who was involved in riot grrrl during its early 90s heyday. We weren’t the only ones to be marginalised either. The original riot grrrls may not have all been as middle-class as the mainstream media would like to make out, but the scene appears to have been predominantly white.

I haven’t come across anything particularly transphobic  within those 1990s riot grrrl recordings and writings that remain in circulation on the Internet today. Still, various high-profile individuals made their views entirely clear through their involvement with the famously trans-exclusive Michigan Womyn’s Music Festival (also known as “Michfest”).

Trans exclusion

In 1999, controversy erupted after queer punks The Butchies played Michfest. Butchies frontwoman Kaia Wilson had previously been a member of riot grrrl band Team Dresch, and at the time was also running Mr Lady Records jointly with Tammy Rae Carland (a zine editor, spoken word performer, and subject of the Bikini Kill song For Tammy Rae).

A number of trans activists approached Mr Lady Records, asking the label – and its bands – to boycott Michfest. Wilson released a statement claiming to support trans rights, but also backing Michfest’s “womyn-born-womyn” policy. A 2010 interview suggests that she has not changed her views on the matter.

In 2001 and 2005, feminist electro-pop act Le Tigre were similarly criticised for playing Michfest. The group were fronted by Kathleen Hanna, former lead singer in Bikini Kill. Like The Butchies, Le Tigre were a sort of post-riot grrrl act: they came into being after the original movement faded away, but have become associated with riot grrrl in the minds of many both because of their politics and because of the involvement of particular musicians. Le Tigre were at one point signed to Mr Lady Records, although the record label dissolved in 2004.

Le Tigre don’t seem to have been in the slightest bit apologetic about playing Michfest. The argument was once again that womyn have a right to organise autonomously, with the unspoken proviso that trans women are (obviously) not womyn. Of course, this perspective couldn’t possibly be transphobic, what with all the gender-bending the band indulged in.

There’s also lot of talk on the Internet about Hanna also supposedly writing transphobic essays during the 1990s, but I’ve yet to see any evidence of these (and it seems I’m not the only one).

It’s interesting that Le Tigre (and, through Hanna, Bikini Kill) remain implicated in all of this, whilst The Butchies, Mr Lady Records, Tammy Rae and Team Dresch do not. As of 2012, trans activists and allies are still quick to condemn Bikini Kill as “problematic” in Tumblr posts and blog comments. This is no doubt down to the wider media profile experienced (although not necessarily enjoyed!) by Hanna and the various bands she’s been involved in. Wider criticisms of transphobia and cissexism within riot grrrl seem confined largely confined to blogs written by somewhat disallusioned veterans of the original movement.

Meanwhile, whilst Hanna doesn’t seem particularly keen to explicitly distance herself from her past actions and/or comments, she does seem to have quietly moved on, at least somewhat. In more recent interviews she can be seen praising “trans activism”, and earlier this year one fan reported receiving an interesting letter about the matter.

…So?

What does this mean for Bikini Kill? Not a great deal, in my opinion. Kathleen Hanna – a woman whose relationship with the media has always been complex – is not a perfect human being, and has said and done some fairly awful things. Her implicit support of Michfest in particular was never acceptable. She appears to be increasingly aware of this, and has clearly made some moves to educate herself. Still, an explicit acknowledgement of her past cissexism would certainly be welcome.

However, Hanna is in no way the totality of  “Bikini Kill”, let alone “riot grrrl”. As her bandmate Tobi Vail pointed out:

We are not in anyway ‘leaders of’ or authorities on the ‘Riot Girl’ movement. In fact, as individuals we have each had different experiences with, feelings on, opinions of and varying degrees of involvement with ‘Riot Girl’ […] As individuals we respect and utilize and subscribe to a variety of different aesthetics, strategies, and beliefs, both political and punk-wise, some of which are probably considered ‘riot girl.’

The very rifts that fractured riot grrrl also gave it strength, for there was no one dogmatic, overriding ideology to bind it. Kaia Wilson, Tammy Rae Carland and Kathleen Hanna were not the movement. As a young woman looking back at a feminist movement I never had the opportunity to be involved with, I’m left with the impression that riot grrrl did not wholly welcome trans people, but did not intentionally reject us either (in spite of the backwards attitude of certain participating individuals). And of course, this situation wasn’t really good enough, but it’s nowhere near as bad as it could have been.

The future

Fast-forward to 2012, and the idea of riot grrrl is once again gaining a certain cultural currency. The mainstream media are arguably rediscovering riot grrrl in the light of Pussy Riot’s magnificently brave actions of personal resistance, but new bands and collectives have been springing up around the world at an impressive rate for the last two or three years.

Doll Fight

Riot grrrl never really went away: whilst former members of the original movement founded started new bands, new record labels, and new approaches to opening up underground music to girls and women (such as Ladyfest and Girls Rock Camp), there were always individuals and bands who clung to the label. Recently, the idea of a “riot grrrl revival” has blossomed into something more vital on a local, national and international level.

In the UK alone there are now local groups such as Riot Grrrl Birmingham emerging; frequent local events such as Riot Grrill in Leeds, Pussy Whipped in Edinburgh and Riots Not Diets in Brighton; and a whole host of new bands, many of whom communicate with one another through means such as the Riot Grrrl UK group on Facebook.

And one of the many wonderful things about all of these groups is that they’re all explicitly trans-inclusive. They’re not only drawing upon trans language and symbolism: they also see trans struggle as feminist struggle. These are groups that seek to understand cissexism and binarism, groups that talk about supporting CeCe McDonald in the same way that they talk about Pussy Riot.

Similarly, the international music compilations released regularly by the Riot Grrrl Berlin collective explicitly welcome trans artists, and ban transphobic language. There are even (shock, horror) riot grrrl bands with trans members emerging.

We should learn from the past, but not be bound by it. Trans-inclusive riot grrrl is finally here. Let’s make the most of it!

(Guest Post) Draft Protocol Review

A review of England’s draft protocol for gender dysphoria services by CL. You can read a copy of the draft protocol here, respond to the survey here, and read my own analysis here.

Following the lead of an information note published by the department of health, the draft protocol confirms and compounds the problems of treating gender dysphoria on the NHS. It would at least mostly standardise treatment protocols across England, burdening everyone with the same problems: We’re all in this together, right?

The Gender Services Clinical Reference Group is aiming to implement standardised service provision by April 2013 and has given interested groups until September 30 to respond. GIRES has responded, as has Terrence Higgins Trust’s Trans* Women’s Sexual Health and Wellbeing Group, whose submission I contributed to. Our issues with the Department of Health’s Information Note are seen again here, and I’d like to focus on those in particular: the framing, tailoring and requirements of treatment.

Framing Gender Services Treatment

A problem in the protocol that has carried over from the information note and current practice, is the framing of gender dysphoria treatment as the property of psychiatric specialists. Even in updating the condition being treated to ‘gender dysphoria’ from Gender Identity Disorder, which explicitly frames the problem as one with our gender identities rather than our physical characteristics and the dysphoria resulting from them, the protocol places gender dysphoric people under the care of “a mental health professional (eg. psychiatrist or psychologist) who specialises in transsexualism/gender dysphoria and has general clinical competence in diagnosis and treatment of mental or emotional disorders.”

The logic behind this in the current protocol is not forthcoming. Perhaps it is because there’s a likelihood of additional mental health issues due to the stress of dysphoria. Realistically, it’s because dysphoric people have always been treated as mentally ill, and tradition has kept us under the exclusive care of psychiatrists.

Assessment is a large part of the GICs role: confirming that we have Gender Dysphoria and are not merely deluded about our gender identities. Gender Dysphoria strong enough to necessitate transition is rare, certainly, and doctors are warned to be warey of ‘Zebra diagnoses’ (as House of God, the inspiration for ‘Scrubs’ described them). That is, when you hear hooves, think horse, not zebra. That’s sensible advice, but if you’re in southern African plains, thinking Zebra first might not be so unreasonable. In this case, if someone is distressed by their assigned gender and sexed body, identifies strongly as another gender and feels relief when living as that gender, a diagnosis of ‘trans*’ is the most likely answer. Trusting this principle would rob the GICs of hours of questions about your childhood hobbies and masturbatory habits, but it would free up a lot of unnecessary appointments.

Scotland has already moved away from the complete ownership of Gender Services by mental health teams, allowing patients to self refer to a GIC. This saves an appointment with a GP, one with a community mental health team and allows direct access. For those who need a diagnosis, removing these two stages of waiting, where ignorance or prejudice can delay or waylay a patient, can get them that diagnosis quicker. Given the burden on admin staff and funding, a time, appointment and money saving move like that is far better than the protocol’s recommendations.

Tailoring Service

The introduction to the protocol claims that it is ‘informed by the 7th edition of the WPATH Standards of Care’ – sadly, it isn’t based on them. Some key recommendations from the 7th SOC were: HRT could be prescribed without RLE and one assessment, Lower Surgery required only one year of RLE (rather, one year of HRT). None of those recommendations are followed here, so the role of the 7th SOC’s ‘informing’ is not apparent. As Ruth points out, this is essentially just the existing Charing Cross treatment.

The protocol makes references to giving patients time to consider other options, other approaches, time to reflect and, of course, the RLE’s time to consolidate. There can be great value in this and many people seek the GIC to explore and understand their gender identity. Chances to really assess their history, feelings and situation can be very valuable. A friend in this situation said that her diagnosis brought her great relief and confirmation of her feelings.

For others though, this is unnecessary. Many others will have thought, reflected and considered extensively, almost exclusively at times, before seeking a GIC: they know who they are and what they need. For them, the numerous stages to access a GIC, double assessments and arbitrary RLE periods merely delay them, take up clinic time and appointments and cause additonal frustration as they wait for their treatment.

Clinics shouldn’t be forcing surgery on everyone at the first appointment, but the slowest common denominator approach is hardly ideal either, and unnecessary, arbitrary waiting is positively detrimental in many cases.

Requirements

Despite the 7th SOC’s ‘informing’ of the protocol (perhaps they were low on coasters?), RLE remains a key feature of the proposed gender services. The protocol is unclear about RLE requirements for HRT, but indicates that full HRT can be prescribed ‘Dependent on whether an individual has socially transitioned in the sense of living full time’ or is likely to ‘do so immanently’. Top surgery needs a year of RLE, lower surgery needs 2 years.

The problems with this are numerous:

  • It’s arbitrary. There are medical reasons for a year of HRT for lower surgery, but not for living full time in role.
  • Requirements of being employed have nothing to do with a stable, well founded gender identity.
  • Whilst individuals vary greatly, some people have considerably more difficulty being read as their gender prior to HRT, and AMAB people are more likely to recieve certain forms of harassment if people read them incorrectly. Forcing people into public facing roles to get the treatment they need puts them at direct risk of violence, harassment and discrimination.
  • What ‘real life’ is being experienced? From my own and others’ experience, I know that living full time as a woman pre HRT is vastly different to being full-time after a year on HRT. The near daily abuse and marginalisation, with incumbent stress, is not the real life I’m  experiencing now, but was a feature of living as a woman who was visibly trans*. The RLE required is entirely unrepresentative.
  • For all the regional variation and obfustication, the 2 years of RLE for surgery is well known, and patients work to it. The lengthy requirement can prompt patients to ‘start the clock’ running on RLE long before they are ready. Who knows how much suffering has come from that, or from knowing that no help will come before an arbitrary deadline?
  • Patients remain on the GIC’s book during this period: the aforementioned zebras get called in for appointments to needlessly check that they’re still serious, then sent away to wait another 5 months. This takes up appointments that could help patients who are less certain of their needs.

Overall, this protocol standardises existing Charing Cross treatment, which is already behind the times in not adjusting to WPATH’s SOC 7, and seems particularly inadequate when compared to the updated Scottish protocol. Most worryingly, its requirements standardise the appointments that add to the waiting times, administrative burden (which currently means Charing Cross are taking 2-3 months to send appointment summaries) and sense of disempowerment that service users experience. With multiple screenings, assessment and ‘time for reflection’, it is particularly unsuited to those who have a clear understanding of their identity and wish to proceed, and who have thought over their option extensively prior to seeking a referral. If this protocol is to last for any significant time, it will hold service users to standards that are already inadequate – If the next update will last, we need to fight for a protocol that truly moves treatment forward, so make sure to give your views in the protocol’s survey.

Business as usual? A look at the draft English protocol for gender dysphoria

The main achievement of England’s new draft protocol for transition-related services is not to offer progress, but to codify certain elements of existing practice.

In this sense, it somewhat resembles Scotland’s new protocol, which was published a couple of weeks ago.

The Scottish protocol appears to have been based largely upon the services offered by Sandyford, the nation’s largest gender identity clinic. The English protocol seems rooted in current practice at Charing Cross, which plays a similar role within England and Wales. The differences between the documents hinge largely on the differences between the progressive policies instituted at Sandyford, and the more conservative attitude of Charing Cross.

In this article I’m going to examine some aspects of the draft English protocol that have really struck me, before discussing political elements of difference between the English and Scottish protocols. I also briefly talk about the survey that is being distributed alongside the draft guidance.

The Good

LanguageThe language used within the draft English protocol largely acknowledges the complexity and diversity of trans experience. It encourages a respect for patient identities in terms of correct name, pronoun usage etc. (regardless of legal status). There’s even an explicit acknowledgement of non-binary identities, although this is somewhat undermined by binary assumptions elsewhere in the document, and a focus upon transitions that follow the typical “female to male” or “male to female” routes.

Referrals – The document provides some important clarifications for referral to a gender clinic: that individuals do not have to have lived in their preferred gender role prior to referral, that neuro-diversity and mental/physical health issues should not be a barrier to referral, and that psychotherapy is not a necessary precursor to referral. However, these points are not made as strongly as they could be, leaving some room for (mis)interpretation.

Treatment process The document states that two appointments should be sufficient for a diagnosis of gender dysphoria (to be diagnosed according to the ICD-10 criteria, as opposed to DSM-IV). The prescription of hormones should (if appropriate and desired) follow this diagnosis, and surgery should follow within approximately two years. This might all sound very familiar to Charing Cross patients, but may work to reign in some of the more eccentric practices of smaller gender clinics such as Nottingham.

Overall – It will be beneficial to have this protocol at hand to bring local referral practices and the actions of smaller GICs in line with national standards.

The Bad

Referrals – Referrals must come from a GP or specialist (psychiatrist or psychologist), with clinics able to insist upon referral from a specialist. This means that long-winded battles for referral look set to continue as normal. In contrast, the new Scottish system appears allows individuals or GPs to refer to any clinic.

Treatment process – The protocol states that it is informed by the most recent edition of the WPATH Standards of Care. However, it seems (again, contrary to the Scottish protocol) to ignore large parts of the Standards of Care in favour of current Charing Cross practice.

For instance, FtM spectrum individuals must have been on hormones for at least six months and full-time for at least a year before top surgery is considered, and patients must wait at least two years before being offered genital surgery (although a referral appointment for surgery may take place after 18 months under some circumstances). This last point in particular is justified with reference to ICD-10. Interesting here that guidance for diagnosis from 1992 is given precedence over guidance for care from 2011.

Trans youth– There is an acknowledgement of the benefits of hormone blockers for under-18s, but (unlike the Scottish protocol) no real engagement with the possibility of hormones and surgery for trans people aged between 16 and 18. The protocol continues to relegate all young people to specialised – and limited! – youth services.

Overall – The document pays lip service to the WPATH Standards of Care but does not really live up to the spirit of those guidelines. This is particularly evident when the draft document is compared to the Scottish protocol. Patients are expected to put up with a long-winded, complex system in which treatment is spread out over many years.

The Ugly

Get a job – Patients are still expected to be in education or employment in order to gain a referral for genital surgery. If you don’t have a job or you’re not on a course, you’re expected to be involved in some volunteering role. It’s all about demonstrating your ability to move through the world in your “new” gender prior to irreversible surgery.

This requirement is patronising, stupid, and fetishises trans genitals. What other surgery requires that those who undergo it are in work? Why is it that genital reconstruction is seen such a massive step, but the permanent changes that come with long-term hormone therapy is not? Yes, surgery is a big deal, but it’s clear that clinicians regard this surgery as something else entirely.

I can’t understand how this can possibly be acceptable at the best of times, but at a time of recession and mass unemployment it strikes me as particularly cruel and unreasonable. How to account for individuals who cannot find a volunteering role in their local area? Individuals with anxiety issues? Individuals who are told by the Job Centre not to volunteer, with the threat of benefit withdrawal hanging over this order? And how can this possibly be acceptable when trans people face considerable inequalities in the job market (with trans unemployment estimated at 50% in some European countries).

Physical examination – GPs are apparently “expected” to perform a physical examination of trans patients. Why? No reason is given. The document simply states that: “The GP will be required to carry out a basic physical examination and investigations, as a precursor to those physical treatments which may later be recommended.

I simply cannot comprehend where this idea comes from. For many trans people – particularly those contemplating physical transition – the very idea of a physical examination is extremely unpleasant and can cause severe distress. There are times when pre-operative trans people might require a physical examination: such as immediately prior to surgery, or during a sexual health check-up. These experiences can be deeply unpleasant, but at least they’re necessary.

GPs are not trained to understand the complexities of trans people’s relationships with their bodies. In fact, most GPs don’t receive any training on trans issues whatsoever. What are they meant to be looking out for during such an examination, and how are they supposed to know? An invasive examination such as this should only be performed when necessary, by someone who knows exactly what they’re doing.

Discussion: England vs Scotland

The headlines from the Scottish protocol included a number of moves to bring treatment more in line with the most recent edition of the WPATH Standards of Care. These included provisions for self-referral and referral by GP, less waiting time for surgeries, access to a wider range of treatments (e.g. hair removal) and full access to treatment for individuals aged between 16 and 18.

Whilst representatives from groups such as the Scottish Transgender Network played a vital role in putting provisions such as these on the national agenda, it’s important to recognise that many of them had already been implemented by Sandyford GIC.

The message seems to be that the English clinics – who are almost entirely responsible for the development of this draft protocol – are not interested in developing new practice, let alone conforming with the seventh edition of the WPATH Standards of Care. Instead, they seem keen to maintain a tight control over the processing of patients, an approach that renders the draft protocol even more strict than a new national commissioning policy that is being simultaneously developed.

Survey

The survey that accompanies the draft protocol is extremely short. This makes it quick and easy to fill in, but the form also seems to have been designed to shut down unwanted criticism. The Department of Health appears interested only in how current experiences match up to the proposed protocol, and seems keen to avoid any kind of critical feedback on the document.

It is, however, possible to offer you opinion on the nature of the protocol itself. Here are some tips for doing so:

  • Where your experiences differ from the protocol in a positive manner (e.g. you didn’t receive a physical examination from your GP), emphasise how your experience was more positive than would be the case should the protocol be implemented as-is.
  • Where your experiences differ from the protocol in a negative way, emphasise any manner in which you think the protocol could go further to ensure better treatment.
  • If you have sought care outside of the NHS for necessary treatments (e.g. hair removal for trans women) explain why this treatment should be a necessary part of the protocol

Final thoughts

The introductory text to the survey suggests that current political and financial pressures on the NHS prohibit the introduction of any real changes within the draft protocol:

DH wants the final document to outline the current position for transgender people seeking gender reassignment services through the NHS. The document should outline what support and services a transgender person can expect to receive in the tight financial constraints currently placed on the NHS.

This doesn’t really make a huge amount of sense. Yes, if more trans people have access to services (e.g. laser hair removal), this will cost money. But surely there is a lot more money to be saved through progressive reform?

Insisting on longer real-life tests, longer waits for surgery and so on won’t save a lot of money in the long term. A similar amount of trans people will be accessing services: they’ll just have to wait longer as individuals in order to access the a services. The money will still be spent. So why have such long waiting times?

Insisting on referral through a specialist (i.e. psychiatrist or psychologist) won’t save money. How does the NHS possibly benefit financially from insisting that trans people see more specialists rather than having them directly referred to a gender clinic by their GP? This is particularly the case when specialists decide that they need to assess people over multiple appointments before referring them to a gender clinic. The individuals concerned experience a frustrating delay, and it costs more money because the NHS is paying for all these extra appointments.

This isn’t really about the money. It’s about gatekeepers maintaining a certain level of control over patients, and putting certain ideologies into practice. It’s about picking and choosing which parts of ICD-10 and WPATH SOC 7 fit best with their pre-existing ideas, and using those elements to justify existing practice. It’s about conservativism over progression: a wasted opportunity.