Andre Charles, more commonly as RuPaul, likes to say that “we are all born naked, and the rest is drag.” RuPaul swears by this quote, implicating that when we are born, we are not boys or girls, we are human beings. Then, eventually, we dress, act, and portray ourselves according to how we feel on the inside – we all practice drag. As a society, this has been a difficult concept to grasp, some parents go as far as to throw a big so-called gender reveal party for an unborn child, one who has not yet had the chance to explore their gender. Throughout history, people whose sexual identity does not match their gender identity have been misunderstood, discriminated against, and shamed by society. However, as time went on, people became less ignorant of what it means to be transgender, and progress has been made in working toward a more accepting world.
The medical field has played a large role in the history of sexuality and gender, defining how to categorize and care for transgender patients. As the medical view evolved, the terms used to define such patients have been altered and tweaked, never quite hitting the mark but always missing it less than the term before. Although transgender history is far from over, and the current understandings still need to be widened, it seems that the medical approach to “curing” transgender patients started as an attempt to change the mind to be aligned with the body, and has transitioned to an attempt to change the body to be aligned with the mind.
When someone digresses from the “norm,” their differences are often misunderstood and misdiagnosed. Doctors and psychologists originally considered transgender people as mentally ill. Dr. Sigmund Freud’s psychoanalytic theory played a large role in the treatment of transgender people and the way the world viewed mental illness as a whole. Freud and his contemporaries misguidedly used psychoanalysis to help “fix” transgender people, which entailed therapeutic sessions to try to investigate their unconscious minds. On the other hand, other psychiatrists committed transgender people to asylums and institutions because they felt their nature was depraved and perverted, claiming that there was no help or “cure” for being transgender.
In Germany, a forward-thinking doctor began the process of surgical gender reassignment in 1910. Dr. Magnus Hirschfeld, an advocate for LGBTQ+ and founder of the German Institute for Sexual Science, coined the term transvestite. Dr. Hirschfeld performed the first documented gender-reassignment surgeries. Most famously, Dr. Hirschfeld provided medical care for Lilli Elbe, the protagonist in the film The Danish Girl. “Hirschfeld was the linchpin, and his institute the hub, of the international network of transgender people and progressive medical experts who set the stage for the post-World War II transgender movement” (Stryker, A Hundred-Plus Years of Transgender History). Lilli Elbe Underwent four operations to attempt to transition to fully female, one of which attempted to give her transplantation of an ovary. Unfortunately, this procedure was too ahead of its time, and complications led to Lilli’s death in 1931. Her story inspired the modification and success of countless gender-reassignment surgeries to come. As for Dr. Hirschfeld, the Natzi regime in WW II put an end to his studies and destroyed many documentations of the progress Dr. Hirschfeld had made. It is disheartening to imagine if, maybe, in a world without WW II the studies and understandings of sexuality and transgender people would have advanced much earlier in time.
As time went on post-WW II, psychiatrists developed a system for categorizing transgender as a mental illness. The Diagnostic and Statistical Manual of Mental Disorders (DSM) classified this system and the terms associated with it, and has been altered as new knowledge of the topic has been uncovered. The first term included in DSM and DSM-II to describe transgender patients was “sexual deviations.” This term came with a negative connotation, and it did not mention gender identity at all. It was not until the DSM-III, published in 1980, that gender identity becomes associated with transgender patients, giving them the label of “transsexualism.”
Dr. Harry Benjamin, endocrinologist and sexologist, explains that “true transsexuals feel that they belong to the other sex, they want to be and function as members of the opposite sex, not only to appear as such. For them, their sex organs, the primary (testes) as well as the secondary (penis and others) are disgusting deformities that must be changed by the surgeon’s knife” (Benjamin, 11). The publication of Benjamin’s book The Transexual Phenomenon in 1969 was the turning point for both the medical world’s and society’s views on transgender people. It was made clear that you can not change a transgender person’s mind about their gender identity, but you can change their body. In the next ten years after the publication of the book, twenty medical centers provided gender reassignment surgeries, and over a thousand patients had made use of these services (Reay, The Transsexual Phenomenon: A Counter-History). This unfolded at a key time in history, for the 1960s were a time of pushing back against societal norms and aiming at equal rights. As a society, people were fighting for acceptance and equality, and beside the Civil Rights Movement and the second wave of feminism, transgender people were finding their voice as well.
In 1994, as an effort to further normalize being transgender and veer away from the negative stigma attached, the DSM-4 altered the diagnosis to “sexual and gender identity disorders.” Finally, in 2013, DSM-5 again changed the label to “gender dysphoria,” directly targeting the distress transgender individuals face as the medical condition, rather than their gender identity being the condition. “The DSM–5 articulates explicitly that ‘gender non-conformity is not in itself a mental disorder.’” (American Psychiatric Association, Gender Dysphoria Diagnosis). This diagnostic code switched the emphasis of the issue to the dissatisfaction provoked by one’s mind and body not being aligned.
Throughout the 21st century, progress has been made that has positively shaped how transgender individuals are able to live their everyday lives. Modern doctors have the resources and tools to assist transgender patients to help them look and feel like the gender they identify with. The diagnosis is still not perfect, but it is necessary in order for transgender people to receive the health care they need. Without it being classified as a “disorder,” insurance companies will not pay for the surgery or medications needed. However, psychiatrists no longer consider it a disorder of the mind and this has done wonders for the acceptance of transgender people today.
Over time, the way people view sexuality and gender has changed drastically, morphing from a mental disorder that needs to be therapeutically altered, to a self-identification that can be surgically made possible. The history of transgender diagnoses shines a light on the power of words – exposing that how a character trait is viewed by the medical world can influence a society’s views and actions. The evolution of the medical terms and their implications is parallel to the evolution of transgender people in society – over time both became more normalized and more understood.
References:
American Psychiatric Association: https://www.psychiatry.org/psychiatrists/cultural-competency/education/transgender-and-gender-nonconforming-patients/gender-dysphoria-diagnosis
BARRY REAY’s The Transsexual Phenomenon: A Counter-History: file:///Users/Rebecca/Downloads/JournalofSocialHistory-2014-Reay-1042-70.pdf
Caughie, Pamela L., Emily Datskou, Sabine Meyer, Rebecca J. Parker, and Nikolaus Wasmoen, eds. Lili Elbe Digital Archive. Web. Date of Access. <http://www.lilielbe.org>.
Susan Stryker. Transgender History, Second Edition : The Roots of Today’s Revolution. Vol. Second edition, Seal Press, 2017. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&AuthType=ip,uid&db=nlebk&AN=1525380&site=eds-live.
The TRANSSEXUAL PHENOMENON Harry Benjamin, M.D.: http://www.mut23.de/texte/Harry%20Benjamin%20-%20The%20Transsexual%20Phenomenon.pdf
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