Copyright 1990 - Sarah Seton, M.D. 
Sarah Seton, M.D. 

       "In the animal world, the rule is eat or be eaten; in
            the human world, define or be defined."
                        T. Szasz, M.D.1
     "Nothing is more inflexible than what has never been
         defined but has been taken for granted.  With
        definitions one can argue, with assumptions one
      cannot.  No one knows that better -- or has learned
         this more painfully -- than the transsexual."
                       J. Hoenig. M.D.2
          "I have been a tragic figure ... a clown."
                     Renee Richards, M.D.3
      "When you can keep your head when all about you are
      losing theirs, you obviously have no conception of
                         the problem."
                   Paul Ehrlich, Ph.D., 1990

PROLOGUE   Dr. Ira Pauly was once quoted as saying "the suffering
of  transsexuals is beyond belief."4 Truer words are seldom spoken.
Few minority groups are subjected to more discrimination and 
persecution than the transsexual. The inability of our culture
to  overcome the fear of human sexuality and gender-related differences 
has resulted in a societal wide hatred for the transsexual person 
that manifests itself in a variety of socio-politico-economic 

Beginning in early childhood and extending throughout their  lifetime,
the transsexual's gender identity is invalidated by a  culture
that insists they grow up as the opposite sex. When they  assert
themselves and live as Nature meant them to live, they are  shunned
by their families, friends, churches, employers, physicians,  and
the government -- oftentimes forced to endure acts of violence,
employment discrimination, exploitation, and public humiliation
by  the media that would stagger the imagination of most informed 

Transsexuals are not the only ones who suffer as a result of 
this societal fear, or "transphobia", if you will. Parents of 
transsexuals often anguish over feeling like failures as parents.
Many of these parents live in fear of their child failing to
live up  to their expectations and of their own rejection by family,
friends,  and business associates for producing a gender dysphoric
child.  Those parents unable to cope with their feelings of guilt
or fear of  societal rejection, deny their children's birthrights.
The message  is clear -- conform or be disowned.  

Mainstream Christian churches have responded with a virtual  conspiracy
of silence, ignoring the spiritual needs of the  transsexual and
the social injustice that surrounds them. The idea  of accepting
transsexuals as equal members of the church is simply  beyond the
comprehension of most main-stream religious leaders and  lay persons.
Fundamentalist churches have tended to be very vocal,  however,
using the Bible to inflict unnecessary guilt upon the  transsexual,
adding to the severity of their uninvited dilemma. In  the past
year, the inability of transsexuals to gain acceptance by  their
churches has resulted in two suicides. Studies indicate that  long
term adjustment depends on the transsexual obtaining what  others
take for granted: standard medical follow-up care and  acceptance
by their communities.  

Congress added to the transsexual's dilemma this past year by 
further externalizing society's fear of the transsexual through
the  Americans With Disabilities Act of 1990, excluding them from
civil  rights protection under the Act and further grouping them
by name  with dangerous and aberrant behaviors.7 At the same time,
the  Department of Defense has promulgated regulations categorizing 
transsexualism as a perversion, and a disqualifying factor for 
issuance of a security clearance.7.1 Following on the heels of 
their decision to make unlawful an amended birth certificate,
the  European Court of Human Rights has ruled that transsexuals
have no  right to marry.7.2 The Civil Rights Act of 1990 failed
to overturn  the major judicial decisions which have left transsexuals
without  civil rights protections for over 15 years. In a somewhat
similar  vein, the Health Care Financing Administration--a function
of the  Department of Health and Human Services--relying on the
unscientific  writings of Janice Raymond8 and others, has decreed
transsexual  surgery as experimental9, thus denying the transsexual
medical  insurance coverage and access to medical care previously
recognized  as medically necessary by the judicial system.  

Access to quality medical care is further complicated by the 
unwillingness of many physicians to provide even minimal health
care  assistance to the transsexual. This unwillingness to provide 
assistance is, according to J.E. Hoopes and associates, "a  self-
protective one, namely the fear of censure and considerations 
regarding reputation."10 Physicians fear community sanctions such 
as withdrawal of hospital privileges if they treat transsexuals.
This reluctance is further compounded by a growing inability
to  obtain malpractice insurance coverage for medical care of this 
consumer group. Faced with these facts, it is simpler for  physicians
not to treat them.  

This broaches upon the problem of stigma. Transsexuals are a 
stigmatized group and as Irving Goffman10.1 writes in his book
by  the same name, stigma is infectious. It is the single most 
effective obstacle to professionals who want to work with a  minority.
To the public, attorneys who defended Blacks in the South  during
the 60's had their skin color questioned. The mentally ill  are
stigmatized and mental health workers -- especially  psychiatrists
-- are satirized as "crazy" themselves, just as those  who ministered
to lepers were thought to have Hansen's disease. So  it is with
any professional that tries to help transsexuals.  

It has not yet become fashionable to champion the cause of this 
sexual minority. For those who pioneer, effective patient advocacy 
depends on a critical re-examination of the subject. Yet, deeply 
ingrained taboos do not disappear overnight and many a career
has  suffered on behalf of the oppressed.  

The transsexual's existence today is clearly precarious within 
our society, and it is growing more socially insecure by the  moment.
The foregoing constitutes much of the transsexual's  personal
reality -- the consequences of which entails the tremendous  waste
of literally hundreds of thousands of talented, intelligent,  and
beautiful lives squandered in avoidable life-long suffering, not 
to mention how our society may be losing the benefits of a potential 
Da Vinci or Einstein.  


M. Scott Peck, eminent psychiatrist and author, writes that "In 
and through community lies the salvation of the world."10 While 
the human race, standing on the brink of self-annihilation,  struggles
to build a world community; few transsexuals have  developed a
vision of community. They are for the present a  politically powerless
and socially unpopular minority group, which  can be likened to
an iceberg.  

The tip of the iceberg is comprised of two small but vocal  groups.
The first group is made up of transsexuals who have found  the
courage to risk being overt and speak out against the ignorance 
and injustice that comprises our society. These individuals suffer 
for all other transsexuals by being placed through their openness 
permanently in a sort of transsexual ghetto. Their high profile 
usually has been initiated through no fault of their own but has 
brought them both long-term unemployment or under-employment,
and an  inability to obtain medical insurance or medical care deemed
a right  by society as a whole. Additionally, they often are hounded 
relentlessly through the years by tabloids, news media, or anyone 
wanting to make a carnival side show of them.  

The second group making up the tip of this iceberg is the  narcissistic
notoriety seekers that perpetuate the socially  unpopular stereotypes
ascribed to transsexuals, thereby undermining  the work of the
first group.  

The remaining transsexuals can be likened to that part of the 
iceberg which is submerged and accounts for its mass. They are
the  covert transsexuals, remaining as much out-of-sight as humanly 
possibly. They live in denial of who they are, often isolated
and  intensely lonely. They are like Dr. Pangloss (satirizing the 
philosopher Liebnitz) in Voltaire's play "Candide," who proclaims 
with every abuse and injustice dealt Candide that "All's for the 
Best in the Best of all Possible Worlds." Candide's (and  Voltaire's)
answer to Dr. Pangloss at the end of the play is that  "Yes, all's
for the Best in the Best of all possible Worlds, but  that does
not mean it is Good!"  

Life is not rosy for the pre-operative or post-operative  transsexual
and professionals don't want to hear the stories their  patients
have memorized from books and articles about transsexualism  (the
so called "book-transsexual"). The problem of independent  verification
confronts the professional when evaluating a patient  for referral
to a surgeon for sex-reassignment. Very often the  decision has
been made on the self-report of the patient who claims  to be a
primary transsexual; patients sometimes in fact know more  about
the syndrome than the physician and can give a credible  account
based on this knowledge. Although psychological testing can  help
rule out psychopathology, it has been necessary to create  further
requirements including having the patient cross-live in the  gender
of choice for at least one year. Unfortunately, this  so-called
"real life test" is not specific (although sensitive) to  primary
transsexuals; many effeminate homosexuals, transgenderists,  and
self-stigmatized transvestites have deceived themselves into  believing
they are ■women■ for secondary gains and can negotiate the  trial
period successfully due to being gifted with a body habitus  close
enough to sex-stereotypes. This represents another form of  self-
selection based on external criteria rather than internal  criteria
as in the case of self-report. As a result of this  diagnostic
confusion, these non-transsexual patients get the surgery  only
to find post-operatively that they really did have a libidinal 
investment in their former genitals; they complain that they made
a  mistake and request sex-reversal surgery or even commit suicide.


Let us speak candidly: Physicians expect transsexuals to have 
no problems after sex-reassignment surgery (SRS); if they do,
then  SRS was a mistake and often the judgement is made that they
are not  ■true■ transsexuals.11 Yet, it is unrealistic for surgeons
to  expect that a surgical solution is without post-surgical problems; 
this is especially true of SRS where fistulas, urethral strictures,
denervation of the dorsal nerves, clitoridectomy, and other  complications
are common.12 The post-operative transsexuals with  these problems
in some cases are ignored or responded to poorly by  surgeons who
do not wish to deal with them anymore. It is also  unrealistic
to think that any one person has no problems -- the  human condition
is inherently problematical as philosophy attests;  this is especially
true with SRS when the whole valence of the  patient's life changes.
Having post-surgical problems and problems  of human existence
is real; it is not real to deny these problems  exist.  

One study13 of post-operative transsexuals (N=281) on follow-
up  yielded a suicide rate of slightly greater than two-percent;
the  figure may be higher in that so many post-operatives are lost
to  follow-up. And, this study did not assess the number who have
had  suicidal ideations and attempts. The study reported that these 
suicides were due to the inability of the post-operatives to obtain 
follow-up medical support. Satisfaction post-operatively has been 
shown to be related to satisfaction with the surgical outcome.
This  observation implicates the transsexual's personal reality
that in  spite of complete sex-reassignment he/she continues to
be abused by  society post-operatively.14  

Transsexuals need the medical profession's support since  physicians
heretofore have been the only advocates for them in  society; this
is why the DSM-IIIR diagnosis 302.5 ("Transsexualism")  is politically
as well as medically necessary for their credibility.  Moreover,
transsexuals are in constant fear of losing SRS; some  believe
that SRS is magical to begin with in that, like Dr.  Pangloss,
everything in their life is perceived as wonderful and all  they
need is SRS for their lives to be perfect -- at least that is 
how they present themselves to peers and professionals; physicians 
often foster this belief by wishfully thinking that SRS should 
result in no problems.  

Contrary to popular belief, SRS is not really a "sex-change"; 
candidates have always been of their chosen gender from birth,
and  SRS corrects a chronic physical problem that needs medical 
attention. SRS is the period at the end of the developmental  sentence.
Transsexualism is a sex error of the body at the level of  brain
dimorphism; it is not a matter of choice. Evidence is  mounting
that an imbalance of the fetal testosterone-estrogen ratio,  due
to a defect in fetal gonadal development at the molecular level,
is responsible. This ultimately is determined by the absence
or  presence of certain genes in the testicular determining factor 
cascade producing defective enzymes responsible for correct genetic 
transcription of instructions for gonadal hormonal and  neurophysiologic
pathways. Correct understanding of this phenomenon  will come from
the molecular genetic level.  

Transsexuals, in order not to lose SRS for themselves, must  co-
opt into the physician's beliefs which may include, in addition 
to hassle free SRS, stereotyped visions of the perfect SRS candidate 
as a young, nubile nymph -- a Pygmalion or Punchinella.  Transsexuals
must play along and meekly submit to the scalpel,  accepting whatever
result the surgeon happens to create for them,  without appeal
to physician peer review or State Boards of Medical  Quality Assurance
that other patients have as their right to being  treated with
dignity. Because of their guilt, fear, and shame,  transsexuals
themselves often do not believe they are worthy of  medical treatment
equivalent to a non-transsexual patient.  Transsexuals must deny
they have problems, and to do this is to deny  their personal reality.

The hatred society directs toward transsexuals during their  lifetime
is often internalized by acceptance of the labels they are  called;
this becomes self-contempt or shame; yet this is denied by  most
transsexuals. The anguish their parents suffer creates guilt  in
transsexuals for not conforming to familial expectations -- this 
also is denied. Growing up as the opposite sex causes continuous 
pain and the anger of invalidation -- the grief of all those years 
the transsexual could not express him/herself; this violation
and  loss of youth typically is not mourned by transsexuals either.
Then  there is the cognitive dissonance -- the pain -- of gender
dysphoria  itself gnawing away at sanity; this supposedly disappears
with  reassignment and can be forgotten. Then there is the pain
and anger  of being shunned by family and society when a transsexual
finally  has the courage to Name-the-World and become that which
had been  continually suppressed inside.  

They further deny the socio-political realities of the U.S.  Congress,
state legislatures, and the courts taking away their civil  rights.
Contrary to current belief, transsexuals are not tormented  by
their condition: it is their condition which prompts society to 
torment them.  

As early as recorded time, the Right-to-Name-the-World has been 
the birthright of everyone in our culture. In Eden, Adam in the 
image of God the creator of all these things named the animals
and  plants. Throughout the Old Testament, patriarchs gave special
names  to persons or places of significance. This tradition of
naming the  world continued throughout subsequent history. Poets
named the  sentiments, philosophers named newer world views, theologians
named  the manifold of God's Laws and Plan for humanity, and politicians 
named the codes of secular law. The Bible chronicled the  Right-
to-Name-the-World as a unique gift given to all mankind as a  sign
that we are, in God's image, wordsmiths and creators of our  linguistic
universe as He is of the Natural World. Whereas over  time the
anti-democratic cultures of antiquity subverted this right  and
placed it into the hands of the wealthy and powerful. The  hierarchy
began to name themselves as the definers and all others as  the
defined. Gradually, there developed masters of language and  their
slaves; a new form of oppression emerged: linguistic  imperialism.
Whole philosophic systems were commissioned by the  elite to sequester
the Right-to-Name-the-World unto themselves and  thereby define
a world view which made the hierarchy seem not only  unavoidable
but part of the natural order or ordained by God.  

Today linguistic imperialism is still with us despite  democratic
reforms to world culture. For almost everyone, our  personal reality
is named by those who control the media and the  constituency.
Few people are aware that they have a God given right  to become
a master of language and name their personal experience of  life.
Radical Christian pedagogues like Paolo Fierre, working in  Brazil
with the poor, teach the oppressed to name the squalor of the 
ghetto, name the abridgement of human rights, and name their  oppressors.
Transsexuals are among the few who struggle in  isolation against
those who would define them as the opposite sex.  They assert their
God given right to name their sex against  tremendous odds. They
suffer and fight for this right to be a  creator in God's image
motivated by sheer personal survival. As it  is with many vanguards,
they unknowingly are not only fighting for  themselves but for
all those who are oppressed and slaves of  language. As T. Szasz
once wrote, the rule in the human world is  define or be defined;
in the animal, eat or be eaten.  

To maintain control over discourse, the masters of language  must
themselves adhere to certain rules or meta-beliefs which are  generally
unknown to the slaves of language who are subject to them.  They
are the hidden stabilizers which make common beliefs seem  inevitable
and not open to question. Everyone learns these  meta-beliefs implicitly
as we come of age in society and pass  through the various rites
of passage of our particular tribes. We  learn that some subjects
cannot be spoken of and these very often  are the ones that matter
most. Meta-beliefs are the crucible in  which our belief system
is forged; our beliefs form the out-line of  the figure of our
consciousness while the meta-beliefs shape the  background or in-
line of this figure and form what is not open to  consciousness.
Although meta-beliefs are seldom conscious, their  presence is
felt in every day discourse and it is impossible for  discourse
to be free with them -- to be free of them requires a  critical
re-examination or meta-analysis of the belief system. Yet,  a meta-
analysis is dangerous for those who under take it because, by 
exposing the meta-beliefs, one is revealing the Real Relations 
behind why they exist and the purpose they serve in the society
to  maintain the status quo. The Real Relations frequently involve
the  oppression of one group in society by another, the splitting
into  factions, the bigotry and intolerance, the usurpation of
civil  rights, the perpetuation of poverty, and the maintenance
of  illiteracy for the purposes of squelching free discourse.  

Let us take a simple example: Aristotelian Logic. In  Aristotle,
we can find many meta-beliefs which helped his culture  justify
the inevitability of slavery, war, and a ruling class of  anti-
democratic elite. One meta-belief is the Law of  Non-contradiction
that states "an attribute can be ascribe to an  object or it cannot
but an attribute cannot be both ascribed and not  ascribed to an
object at the same moment." In application, either  an object is
A or it is Non-A but it cannot be both A and Non-A at  the same
time. In meta-analysis, this is called splitting and is  caused
by a cognitive deficit having to do with a lack of  object-permanence
in the first year of childhood; the infant cannot  keep the presence
of the loved object permanently in consciousness  in the absence
of the loved object because the loved object is never  there. A
child without object constancy grows up looking at the  world as
A or Non-A, Good-cop or Bad-cop, Black or White, Male or  Female,
Good or Evil, Self or Other, Object or Subject, Observer or  Observed,
Saved or Damned, In-Group or Out-Group, Lumpers or  Splitters.
...Masters or Slaves. In short, the universe of discourse  is fractioned
into mutually exclusive sets with hard edges and this  creates
a mind conditioned to bigotry and intolerance, sometimes  referred
to as the Borderline Personality Disorder. In fact, our  cognitive
universe is interactional and interdependent, made up of  fuzzy
sets whose categories blend into one another forming soft  boundaries;
we have come to this understanding via the meeting of  modern physics
and Eastern philosophy, general system theory,  existential philosophy,
modern logic, and community psychiatry, and  the rise of democracy.

It can be seen now that meta-beliefs are the taboos and myths 
of a tribe; one can see these easily in other cultures through
the  meta-analysis of the anthropologist. In our culture, Alan
Watts  identified the taboo against knowing who you are. "One must
not  question those who are in authority■ is another taboo. One
must not  "tell the emperor he has on no clothes." Aristotle's
Logic might be  called the Taboo of the Excluded Middle. For the
transsexual, the  operative meta-beliefs are "Society's opinion
of me is true" and  "Transsexualism is a psychopathia sexualis.
" Taboos like these  create ■permissible talk■ and "no talk." The
No-Talk-Rule is the  taboo against naming the world -- the disenfranchisement
of the  Right-to-Name-the-World discussed above.  

How is the No-Talk-Rule applied to transsexuals? In this  society,
transsexuals are punished for breaking this Rule. Suppose  the
society defines a person a certain way: the obstetrician, based 
upon at best a superficial inspection of one's genitals at birth,
defines one as male or female (the Taboo of the Excluded Middle)
.  This sets in motion a pervasive and barely conscious cultural
force  that affects how society will treat the child from that
point  onward. The infant's perceived or assigned sex from birth
will  constitute the person. Pink or blue clothing, choice of name,
pronouns used, legal status, social conventions and a myriad
of  other distinctions relentlessly remind and reinforce in the
child's  mind that he is a boy or she is a girl. The way the society
defines  a person is the way that person is expected to become.
If the self  is radically opposed to society's definition, as
in the conviction  that one is opposite to the sex of rearing,
a struggle is set up by  this tension. The self is victimized internally
by the imposition  of the sex-determination from without. With
the No-Talk-Rule in  force, the self is powerless and helpless
to live with themselves;  this is shame. A psyche, steeped in the
untreated shame of the  ingrained societal opinion of them, colludes
and aligns itself with  a internalized self-loathing; they take
on an identification with  the oppressor as a psychological defence
against facing their shame.  A reaction formation develops in some
transsexuals which has been  called the ■flight into hyper-masculinity■
or, less so femininity,  as a way of denying their identification
with the oppressor.  

If any transsexual speaks up and breaks the No-Talk-Rule, they 
mark themselves as a victim and by implication others are marked
as  the persecutors (Taboo of the Excluded Middle). Defiance such
as  this exposes briefly the Real Relations at work in the situation 
between the persecutor and victim -- that both are subjected equally 
by the meta-beliefs that maintain this society in the clutches
of  consciouslessness and set off one powerless group against another
in  factions which serve to divert attention from those who really 
control the power and discourse.  

The No-Talk-Rule is enforced by another Taboo: the Myth of the 
Self-Fulfilling Prophesy. The simple act of complaining elicits 
persecutory behaviors in others which cause the identified victim
to  act as if he were a victim, by becoming defensive, and thereby 
seeming to have brought the situation on himself. The ones who
break  the No-Talk-Rule are sacrificed by Self-Fulfilling-Prophesy
so that  society can remain in its dogmatic slumber. The dynamic
of singling  one group out by defining them a certain way, not
permitting them to  speak out and making them victims of a self-
fulfilling prophesy if  they do speak out is called "stigma." It
explains how a person  defined by society can become that person
to avoid stigma; even  though the defined person is self-loathed,
this is still preferable  to becoming a martyr but in untold cases
transsexuals have opted for  suicide. The No-Talk-Rule took Hitler
and other tyrants in history  to the pinnacle of their powers by
exterminating those who broke the  Rule.  

The transsexual's uninvited dilemma resolves down to whether 
each can break the No-Talk-Rule about their being defined as the 
opposite sex. Most transsexuals have done this by objectifying
the  struggle. They quietly change their dress, behavior, identification 
papers, and their bodies in a kind of guerilla warfare with social 
taboos. They are caught up in the momentum of placing themselves
at  odds with the definers without breaking the No-Talk-Rule outright.
By not speaking out, they unawares collude and align themselves
with  their internal self-loathing and shame.  

Within the gender "community," transsexuals usually deny their 
insecurity and project it onto other transsexuals by identifying 
with the oppressor15, becoming like them, and shunning one another.
By being dealt with cruelly whenever they have come to trust 
someone, they distrust everyone's intentions and motives including 
their peers and providers of care. Transsexuals by nature are 
extremely competitive with their peers at being men or women and,
when given the chance for self-actualization, are the most earnestly 
motivated. Understandably, transsexuals have been deprived all
their  lives of what everyone takes for granted, and when they
are finally  set free, they want it all -- right now. Every transsexual
wants to  be recognized as an individual; some deal with this by
drawing  attention to themselves in public and in the case of some 
narcissists this is taken to an extreme thereby putting  transsexuals,
in general, in an unfortunate light.  

In this way, transsexuals persecute themselves. "We have met 
the enemy," as Pogo once said, "and he is us." Rather than the 
personal becoming political, the political is turned inside out
and  becomes interpersonal. Usually, transsexuals hate other  transsexuals
who are more beautiful than they are, who ■pass■ in  society with
less trouble, who are more masculine or feminine. The  accidents
of birth endowing one with a body habitus more in common  with
the prevailing sex-stereotypes do indeed translate into a  better
survival advantage than those who are less fortunate. The  ones
gifted enough to pass without problems disappear ■into the  woodwork■
-- become covert -- and seldom participate in medical or  psychosocial
follow-up contributing to research which would aid  other transsexuals
left behind. They are the ■successful■  transsexuals -- yet are
they really?  

By identification with their oppressors, they have lost their 
constituency and solidarity; they have lost the ability to defend 
themselves politically: "...And then they came for me, and by
that  time, there was no-one left to speak up"16. The covert  transsexuals,
in fact, live in constant fear of being discovered,  and some
are alone with no-one to share their most intimate  accomplishments;
no-one is there to accept and understand with the  exception of
other transsexuals. This is the dubious goal of  anonymity for
which all transsexuals strive.  

Why is this? There is a No-Talk-Rule amongst transsexuals  against
telling anyone who they really are -- suffering, courageous,  and
talented people. When they break the No-Talk-Rule, they lose  their
jobs, careers, friends, social status -- everything -- and  downwardly
drift into the transsexual ghetto, or worse, the  sociological
sewer where prostitutes of San Francisco's Tenderloin  District
or the "entertainers" of Hollywood's demi-monde dwell.  Those that
are "successful" learn to keep silent and mind their own  business.

Hence, transsexuals, in striving to deny problems, project  security,
and identify with the oppressor, are not being real --  they are
being caricatures of people -- something pointed out by  early
gender researchers when transsexuals appeared to them as  ■caricatures■
of men and women. Instead today, it could be said  that they are
good at being men and women, but not people. This is  Transsexual


What are the alternatives? On the one hand, transsexuals can 
continue to behave like Dr. Pangloss with one another, dancing 
through the gender programs, conventions, newsletters and magazines 
with their meat-markets declaring to each other ■Isn't life  wonderful?
I'm fine. I'm peachy. I'm glad I don't have your  problems!■ Thereby,
transsexuals can continue to be their own worst  enemies. Or,
on the other hand, transsexuals can break the  No-Talk-Rule with
themselves and be real with one another. They can  admit squarely
and without denial that the manifold of their  personal reality
exists. They can explore and deal with the ideas  and issues outlined
here in order to gain acceptance of themselves.  They can be mutually
open to one another and see that the other's  personal reality
is his/her own too. They can realize that this is  the best of
all possible worlds yet that does not make it good.  They can express
the pain, the self-contempt, the shame, the grief,  the distrust,
and the guilt to one another and let go of it. With  self-acceptance
comes a more tolerant acceptance of societal  intolerance; in the
same way, many people will have less trouble  with transsexuals
if others are accepting of themselves. It is a  myth to believe
that if you have no trouble with yourself then  others will not
have trouble with you -- this is simply an  application of the
No-Talk-Rule. As for the public who will never  accept, the trade-
off is between what the transsexual needs from  others in comparison
with what he/she is willing to give up to them  -- the old zero-
sum game.  

These points are vital to the pre-op transsexuals. They should 
use the trial period in group and private therapy working on issues 
and feelings instead of just marking time with the professionals
who  monitor the referrals to SRS. Pre-ops will save themselves
a big  mistake17 post-operatively -- even suicide -- if they openly
deal  with the unpleasant realities of their life situation.  

What I have been writing about in this article advocates the 
setting of priorities. It is healthy to have "feel good" gatherings 
across the country; it builds networks and has a salutary effect
on  people's morale. But such activities should be done in the
context  of a political consciousness. Transsexuals absolutely
must make the  personal political, because surely if transsexuals
don't hang  together, they will all hang separately.  


Here are some suggestions for what the gender-community can do 
for itself right now:  

1) Establish a national twelve-step recovery program called  "Transsexuals
Anonymous" for the purposes of providing support for  recovering
transsexuals based on principles and not personalities.  This will
assure that the locus of control for therapy is within the  gender-
community but not in the hands of personality cults created  by
certain transsexuals in domineering positions. Presently some 
leaders are unqualified to give advice or therapy.  

2) Create a national ad-hoc medical committee on gender  identity
consisting of physicians and surgeons who are  gender-conflicted.
This committee would meet regularly in confidence  to protect
the professional identity of its members. Its tasks would  include:
a) physician peer review of unethical or unprofessional  treatment
of transsexuals by other physicians, b) liaison with state  boards
of medical quality assurance to enforce sanctions, c)  publishing
anonymously under the committee name of scientific papers  related
to gender and position papers regarding treatment of  gender-conflicted
professionals as ■consumers■ by other  professionals and other
professional issues.  

3) Create a national legal defense committee on gender identity 
consisting of attorneys who are gender-conflicted. This committee's 
task would be to take under advisement cases of abridgement of
the  civil rights of the gender-conflicted, prepare anonymous defense 
briefs, and hire pro se litigants to represent the committee in 
court on behalf of the defendants.  

4) Create a national ad-hoc committee on gender and the media 
consisting of gender-conflicted entertainers, writers, producers,
and publicists, to prepare public service announcements on national 
prime-time television and radio to educate the public about gender 
dysphoria syndrome and the people who suffer with it.  

5) A regional and national political action committee for the 
purpose of advising and lobbying legislators on legislation of 
interest to the gender-community.  

6) Revision of the HBIGDA Standards of Care to extend to the 
pre- and post-operative period in order to guarantee continuity
of  medical care.  

There is a vast pool of talent amongst transsexuals.  Psychological
assessments indicate that as a group transsexuals have  superior
intelligence. The trend with SRS is toward older, mature  candidates
who have already established themselves as physicians,  surgeons,
lawyers, judges, political leaders, media professionals,  scientists,
engineers, educators and business executives. The power  is there
to harness, the question is: does the transsexual have the  courage
to do what it takes to survive? They must use that talent  now
before there is no-one left to speak up.  


1. Szasz, T., Law, Liberty and Psychiatry, Beacon Press, 1970.

2. Hoenig, J.L., ■The Legal Position of the Transsexual: Mostly 
Unsatisfactory Outside Sweden,■ Can. Med. A.J., Feb. 5, 1977,
at 319.  

3. Woodman, S., ■Renee Richards takes Stock,■ New York Woman,
Dec/Jan, 1990, 118-121.  

4. Pauly, I., ■Outcome of Sex Reassignment Surgery for  Transsexuals,
■ 15(1), Aust. NZ. Jn. of Psychiatry, 45-51 (1981).  

5. Leff, G., ■Genes, Gender and Genital Reversal,■ Medical  World
News, April 18, 1977, at p.56.  

6. (■. . . [t]hese people are often hurt by other people . .
. .  ■) Hynie, J. ■Treatment of Transsexualism,■ Vol. 44, DIALOG
Abstract  16739; (■. . . [a]re in my view contemptuous of transsexuals,
with  an intolerance and prejudice that is palpable.■) Ulane v.
Eastern  Airlines, 581 F. Supp. 821, 832 (N.Il. 1983).  

7. The Senate version of the ■Americans With Disabilities Act 
of 1990■, Senate Bill 933, and the House version, H.R. 2273, were 
both amended to exclude pedophiles, kleptomaniacs, pyromaniacs,
voyeurs, exhibitionists, drug addicts, transsexuals, and a host
of  other sexual disorders from protection under the Act.  

7.1. 52:67 Federal Register, 11222-11254.  

7.2. Cable News Network, October 1, 1990.  

8. Raymond, the author of The Transsexual Empire: The Making
of  the She-Male, (Beacon Press, 1979), ■has criss-crossed America,
ensuring through non-medical testimony that insurance companies 
provide no medical coverage to transsexuals.■ Fisher, Lia, ■What
Sex  Am I,■ The Philadelphia Inquirer, (5/9/85).  

9. HCFA Transmittal 883, dated October, 1981; HCFA Publ. 14-3,
Sec. 35-61.  

10. Hoopes, J. E., Knorr, N. J. and Wolf, S. R.,  ■Transsexualism:
Considerations Regarding Sexual Reassignment,■  147(5) Jn. of
Nerv. & Mental Disease, 510, 512 (1968); (■. . . could  not the
time and effort of such talented researchers be put to  better
use, to more legitimate challenges? If a glamorous challenge  is
insisted upon, we suggest that brain transplanting be preferred 
to castrating and altering `sick' males.■). Letter from Nicole
J.  Michaud and Elliot Bold, G. F. Strong Laboratory for Medical 
Research, to the Editor, Am. Journal Obstet. & Gynecol., 135(1)
, 163  (9/1/79).  

10.1. Goffman, Irving, Stigma,  

11. ■It has frequently been said here that the term  'transsexualism'
has come to encompass a variety of conditions that  under other
circumstances might be labeled extremely effeminate  homosexuality,
transvestism (particularly, conscience-ridden  transvestism),
schizoid or borderline personality disorder,  polymorphous perverse
psychopathology, as well as individuals who  apparently have manifested
cross-gender drives -- the classical  'transsexual.' Other patients
occasionally found among applicants  for sex reassignment are obsessional
neurotics with profound  masochistic trends, notoriety seekers,
vocationally motivated  homosexual prostitutes, borderline patients,
and the overtly  psychotic.■ Meyer,J.K. ■Some Thoughts on Nosology
and Motivation  Among 'Transsexuals',■ Proceedings of the Second
Interdisciplinary  Symposium on Gender Dysphoria, 32 (1972).  

12. SRS surgeons in many cases do not provide an enervated  clitoris
during the reconstructive part of the surgery. As a result,  the
post-operative transsexual is unable to satisfy herself sexually 
and must depend upon intercourse with males in order to experience 
orgasm. This is very reminiscent of certain male chauvinistic 
Third-World countries such as in Africa which practice  clitorectomies
on young girls so that as grown women they will be  bound to men
for sexual satisfaction.  

13. Pauly,I., ■Current Status of the Change of Sex Operation,
■  147, Jn. of Nervous and Mental Disease, 460, 1968.  

14. Transsexuals have suffered under the deliberate negligence 
of medical personnel who hold grudges against what they are. In
one  case, a transsexual was allowed to suffer a cholelithiasis
to the  point of emergent cholecystectomy without proper diagnosis
and  treatment. The examining physician wrote in big red letters
in her  medical chart ■sex change■ and from there onward the chart
was  passed around and read by other physicians, nurses and staff 
members. The result was ■unethical, illegal, immoral, and totally 
unprofessional hospital care.■ (Sister Mary Elizabeth SSE, Legal 
Aspects of Transsexualism, IFGE Press, 1990). In another case,
a  surgeon completing an operation unrelated to gender remarked
to his  anesthesiologist off-handedly that the patient on the table
was a  transsexual; when the surgeon turned away the anesthesiologist
cut  off the oxygen to the patient. (Brown, G., Unpublished Manuscript)

15. By the oppressor, I suggest a culture based upon the  patriarchal
supremacy of a male-dominant ideology which through  agents such
as Madison Avenue or Hollywood defines what a man or a  woman is
supposed to be. Woman's image in the media for example is  male-
defined not woman-defined. Michelle Pfeiffer or Kim Bassinger 
are not typical women, as they represent perhaps a tenth of a 
percent of the women in this country; their prominence is  attributable
to their being male-imagos projected for the  sexual-fantasies
of other males. The common man has been flooded  with these images
and has come to expect women to look and act like  these fantasies.
So do SRS surgeons expect this of the MTF  transsexual; the ■pretty
boys■ that were operated on using body  habitus criteria later
committed suicide when their male homosexual  lovers rejected them
as women. Fat women, ugly women, lesbian women  are ridiculed in
comparison and so is the burly transsexual who  can't ■pass■. The
medium is the message: the anorexic starving to  achieve the ultimate
feminine body.  

16. The Rev. Martin Niemoller (1982 - 1984).  

17. It has been reported unofficially by gender clinics over 
the years that as many as nine post-op transsexuals have requested 
surgery to change them back to their original sex . In the Gender 
Dysphoria Program of Orange County, 96% of the candidates decided 
before surgery that SRS was not for them. However, it is not certain 
how many of these clients went elsewhere. (Personal Communication,
Sr. Mary Elizabeth, Coordinator, Gender Dysphoria Program of
Orange  County.)  

SOURCE: J2CP Information Services 

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