According to the DSM IV, a person with GID is a male or female that feels a strong identification with the opposite sex and experiences considerable stress because of their actual sex (Task Force on DSM-IV and American Psychiatric Association, 2000). The way GID is characterized by health professionals, patients, and lay people belies certain assumptions about gender that are strongly held, yet nevertheless questionable. The phenomena of transsexuality and sex-reassignment surgery puts into stark relief the following question: “What (...) does it mean to be male or female?” But while the answer to that question may be informed by contemplation of GID, we should also be aware that the answer to the question “what does it mean to have GID?” is shaped by our concepts of male and female. First, I consider the concept of transsexuality, and explain how it forces us to clarify our concepts of sex and gender, and leads to the development of what I will call the “standard view.” I then explain GID from a mental-health standpoint, question the concept of gender identity, and try to uncover some fundamental assumptions of the standard view. I argue that these assumptions are at odds with the plausible view that gender supervenes on physical, psychological, and/or social properties. I go on to argue, contra the standard view, that gender has no essence. I suggest an anti-essentialist account of gender according to which “man” and “woman” are cluster concepts. This undermines the dualistic conception of gender that grounds the standard view. An anti-essentialist view of gender cannot make sense of the concept of “gender identity” and hence sees so-called “GID” as primarily conflict between the individual and her society, and only derivatively a conflict between the individual and her body. (shrink)

Gender Identity Disorder is classified as a mental illness and included in the DSM-IV and ICD-10. It will also be included in the DSM-V. The psychiatric diagnosis, in spite of some apparent advantages, has significant psychological and social adverse implications. This paper discusses some of the main epistemological reasons to consider gender variance as a mental disorder. It will also evaluate whether reasons of other kinds may justify the inclusion of gender variance amongst mental (...) illnesses. (shrink)

Gender Identity Disorder (GID) is regarded as a mental illness and included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). It will also appear in the DSM-V, due to be published in 2013. The classification of GID as a mental illness is contentious. But what would happen to sufferers if it were removed from the diagnostic manuals? Would people lose their entitlement to funded medical care, or to reimbursement under insurance schemes? On what basis should (...) medical treatment for GID be provided? What are the moral arguments for and against funded or reimbursed medical care for GID? This paper starts out with a fiction: GID is removed from the diagnostic manuals. Then the paper splits in two, as in happened in the Howitt’s 1998 film Sliding Doors . The two scenarios run parallel. In one, it is argued that GID is on a par with other body modifications, such as cosmetic and racial surgery, and that, for ethical reasons, treatment for GID should be privately negotiated by applicants and professionals and privately paid for. In the other scenario, it is argued that the comparison between GID and other body modifications is misleading. Whether or not medical treatment should be funded or reimbursed is independent of whether GID is on a par with other forms of body dissatisfaction. (shrink)

Transgender children who are not treated for their condition are at high risk of violence and suicide. As a matter of survival, many are willing to take whatever help is available, even if this is offered by illegal sources, and this often traps them into the juvenile criminal system and exposes them to various threats. Endocrinology offers a revolutionary instrument to help children /adolescents with gender identity disorder: suspension of puberty. Suspension of puberty raises many ethical issues, (...) and experts dissent as to when treatment should be commenced and how children should be followed up. This paper argues that suspension of puberty is not only not unethical: if it is likely to improve the child’s quality of life and even save his or her life, then it is indeed unethical to defer treatment. (shrink)

Häftets samlingstitel: Unveiling the feminism of Islam. AnA society for Feminist Analyses.

In this article, I argue that persons suffering from Body Integrity Identity Disorder (BIID) can give informed consent to surgical measures designed to treat this disorder. This is true even if the surgery seems radical or irrational to most people. The decision to have surgery made by a BIID patient is not necessarily coerced, incompetent or uninformed. If surgery for BIID is offered, there should certainly be a screening process in place to insure informed consent. It is (...) beyond the scope of this work, however, to define all the conditions that should be placed on the availability of surgery. However, I argue, given the similarities between BIID and gender dysphoria and the success of such gatekeeping measures for the surgical treatment of gender dysphoria, it is reasonable that similar conditions be in place for BIID. Once other treatment options are tried and gatekeeping measures satisfied, A BIID patient can give informed consent to radical surgery. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Ethics of Surgical Interventions for Body Integrity Identity Disorder and Gender DysphoriaNicanor Pier Giorgio Austriaco, O.P.IntroductionOn May 20, 2009, Fox News featured a report that described the life of a man named "John" who had spent his life struggling with Body Integrity Identity Disorder (BIID).1 In a phone interview, John admitted that he remembers wanting to amputate his leg when he was between (...) seven and eleven years of age, by sticking his leg under the rear wheel of a bus. He never went through with it but continued to experience an intense desire to amputate his healthy limb for the following fifty-plus years. Described for the first time in 1977 as apotemnophilia, BIID was originally thought to be a psychological disorder characterized by sexual arousal associated with the desire to be an amputee. However, it was renamed when Dr. Michael First, a professor of clinical psychiatry at Columbia University, proposed that the primary motivation behind the condition was an issue of identity rather than of sexual desire.2 This proposal is controversial.3 Despite much [End Page 1003] debate, BIID was not included in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which was published on May 18, 2013.In this essay, we will consider the ethics of surgical interventions for BIID and Gender Dysphoria (GD).4 We begin with a discussion of the principle of totality that distinguishes ethical from unethical modifications of the body. We will refer specifically to the latter category of surgical interventions as "mutilations," though the Catholic moral tradition's use of the term is itself ambiguous.5 This is followed by an extensive moral discussion of (1) amputations of healthy limbs for patients struggling with BIID and (2) sex reassignment surgeries for those who identify themselves as transgender persons. I will propose that an ethical argument can be made to justify the former but not the latter.The Principle of TotalityBecause of the goodness of the human body, its integrity is a good that has to be protected and preserved. The ethical principle that is used to judge the morality of bodily interventions that impinge upon this bodily integrity is the principle of totality.6 It was articulated by St. Thomas Aquinas in his Summa theologiae as follows:Since a member is part of the whole human body, it is for the sake of the whole, as the imperfect for the perfect. Hence a member of the human body is to be disposed of according as it is expedient for the body.... If, however, the member be decayed and therefore a source of corruption to the whole body, then it is lawful with the consent [End Page 1004] of the owner of the member, to cut away the member for the welfare of the whole body.7Over the centuries, Catholic moral theologians appealed to the principle of totality to justify three different scenarios that involved the sacrifice of a bodily organ for the sake of the whole human organism. The first case involves a diseased organ that has to be removed to save the life of the soldier wounded on the battlefield—say a gangrenous, decaying limb as in the example of Aquinas. The second case involves the healthy foot of a man who is trapped on a railroad track that has to be amputated to save his life from a collision with a train, and the third case involves the healthy limb of an individual that has to be amputated in response to a tyrant who orders him to cut off his own hand or lose his head to the executioners instead. In these cases, the sacrifice of the part would be morally permitted as a necessary means of preserving the life of the individual. As Fr. Gerald Kelly, S.J., points out, this final case is particularly significant because it involves a healthy limb whose very presence—and not its diseased or trapped condition—becomes a source of vital harm for the organism.8How does one justify the principle of totality? In 1944, Pope Pius XII explained it this way: "Man's power over his... (shrink)

This is a response to an article published inSociety & Animals in 2008 that argued for the existence of a “species identity disorder” in some furries. Species identity disorder is modeled on gender identity disorder, itself a highly controversial diagnosis that has been criticized for pathologizing homosexuality and transgendered people. This response examines the claims of the article and suggests that the typology it constructs is based on unexamined assumptions about what constitutes “human” (...) identity and regulatory fictions of gender identity. (shrink)

In Kise and Ngyuen’s “Adult Baby Syndrome and Gender Identity Disorder” (2011), the authors refer to their male subject as “Ms B” because he prefers to identify with being a female. But they do not refer to her as being a baby, even though the subject also prefers to identify with being a baby. This shows that although they respect the subject’s gender identity preferences, they do not respect the subject’s age identity preferences. One (...) reason for this might be that some people feel the term “adult baby syndrome” sounds a bit silly and therefore that the wishes of someone having this syndrome are not worthy of being taken seriously, not as seriously, at least, as someone who shows the more scientifically respectable gender identity disorder. A solution here might be to replace the term “adult baby syndrome” with the term “age identity disorder”, perhaps involving “age dysphoria”. This would also be more accurate because not all of those who are discussed under the heading of “adult baby syndrome” wish to be identified as babies, but rather as toddlers or older children. The problem then is that numerous people prefer to identify with being a different age. Such people do not believe they are older or younger than they really are, but neither do those with adult baby syndrome. (shrink)

Body integrity identity disorder (BIID), formerly also known as apotemnophilia, is characterized by a desire for amputation of a healthy limb and is claimed to straddle or to even blur the boundary between psychiatry and neurology. The neurological line of approach, however, is a recent one, and is accompanied or preceded by psychodynamical, behavioural, philosophical, and psychiatric approaches and hypotheses. Next to its confusing history in which the disorder itself has no fixed identity and could not (...) be classified under a specific discipline, its sexual component has been an issue of unclarity and controversy, and its assessment a criterion for distinguishing BIID from apotemnophilia, a paraphilia. Scholars referring to the lived body—a phenomenon primarily discussed in the phenomenological tradition in philosophy—seem willing to exclude the sexual component as inessential, whereas other authors notice important similarities with gender identity disorder or transsexualism, and thus precisely focus attention on the sexual component. This contribution outlines the history of BIID highlighting the vicissitudes of its sexual component, and questions the justification for distinguishing BIID from apotemnophilia and thus for omitting the sexual component as essential. Second, we explain a hardly discussed concept from Maurice Merleau-Ponty’s Phenomenology of Perception (1945a), the sexual schema, and investigate how the sexual schema could function in interaction with the body image in an interpretation of BIID which starts from the lived body while giving the sexual component its due. (shrink)

The aim of this study is to investigate Iranian psychotherapists’ behaviors and beliefs toward sexual orientation and gender identity. The sample consisted of 358 Iranian psychotherapists, of whom 29.3% were male and 67% were female. Results from the chi-square analyses showed that more male participants reported accepting homosexual clients and treating them as having a pathological disorder than their female counterparts; and licensed respondents reported engaging more in accepting only male or female clients, accepting more homosexual and (...) transgender clients for treatment, and treating them as having a pathological disorder when compared with their unlicensed counterparts. Furthermore supervised respondents reported accepting more homosexual clients than their unsupervised counterparts. However results from the multivariate analysis of variance has indicated that the female participants reported “accepting homosexuals or transgender clients for treatment” more often than the male participants; unsupervised participants reported “accepting homosexual or transgender clients for treatment” and “treating homosexuality per se as a pathological disorder” more often than their supervised counterparts. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.2 (2003) 161-167 [Access article in PDF] Social, Cognitive, and Neural Constraints on Subjectivity and Agency:Implications for Dissociative Identity Disorder Peter Q. Deeley In this commentary, I consider Matthew's argument after making some general observations about dissociative identity disorder (DID). In contrast to Matthew's statement that "cases of DID, although not science fiction, are extraordinary" (p. 148), I believe that there (...) are natural analogs of the disorder that, when considered, make it seem less puzzling and exotic. After discussing these examples, I examine the relations between social, cognitive, and neural processes supporting subjectivity and agency, to identify sources of personal identity in cases of DID that can be used as a basis for assessing Matthew's points against Behnke and Sinnott-Armstrong. I am not proposing a comprehensive theory, but rather identifying what I believe are components of such a theory. I then outline an approach to determining criminal responsibility in DID, drawing on analogies with other psychiatric disorders. Dissociative Identity Disorder DID is a disorder described in DSM-IV, which "is characterised by the presence of two or more distinct identities or personality states that recurrently take control of the individual's behaviour accompanied by an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness" (American Psychiatric Association, p. 519). Recognizing Personal Identity How is personal identity recognized in normal cognition? If we take personhood to involve recognition of continuity of social, psychological, and physical identity for a given individual, then such judgments are routinely made rapidly and automatically as an aspect of what has come to be termed social cognition (Adolphs 2003). There is likely to be considerable redundancy in [End Page 161] the types of information used to make judgments about whether a person is the same as one who was previously encountered, or perhaps heard about—for example, facial features, movement patterns, speech prosody, dress, speech content, gender, ethnicity, social role, among other features, all provide information about individual identity, and hence personhood. When uncertainty exists, it is likely to reflect a loss or alteration of cues that would ordinarily be used in a rapid, automatic, unexamined way (Adolphs 2003). In such extreme cases (for example, severe mental illness or disfigurement), the problem of identification becomes the subject of explicit reasoning (and hence of potential disagreement, because we then engage in post hoc rationalizations to establish criteria for determining personhood, whereas normally we rely on essentially automatic, implicit abilities that work in most circumstances, some of which make little use of linguistic representations and formal reasoning—for example, individual facial identity recognition, which may occur as quickly as 170 ms after stimulus onset [Adolphs 2003]). Nevertheless, examining our judgments and intuitions in cases that force us to explicitly consider whether personal identity is preserved may provide analogies and clues for how we should proceed with DID. Let us consider, then, some natural analogs of DID. Natural Analogs of DID Method Acting I suggest that method acting is an analog of DID (Manderino 1985). Method acting refers to an approach to acting training and performance in which emphasis is placed on intensely imagining and identifying with the mental life of the character being portrayed. Training courses and manuals list many techniques and practices that can be used to facilitate absorption in a role, drawing on different kinds of memory—for example, experiential memories, memories of others, general knowledge (semantic memory), and memories of sensations and feelings, to creative a vivid sense of the subjective experience and actions of the character. Manderino, a method acting teacher, comments: "it is important to investigate the way in which your own mental makeup can improperly influence a character. Insecurities, self-consciousness, shyness or self-doubts can maintain a strong hold, and permitting any of these feelings to enter a performance is to remain the actor and not enter into the mental life of the character. For some, acting allows personal problems to be left behind, and they are thankful for the complete escape that... (shrink)

In 2018 the World Heath Organization decided to re-examine the classification of gender identity disorder and exclude it from being defined as a mental illness. This re-examination means that sex a...

Transgender issues and transgender rights have become increasingly a matter of media attention and public policy debates. Reflecting changes in psychiatric perspectives, the diagnosis of “trans‐sexualism” first appeared in the International Statistical Classification of Diseases and Related Health Problems in 1975 and shortly thereafter, in 1980, in the Diagnostic and Statistical Manual of Mental Disorders. Since that time, international standards of care have been developed, and today those standards are followed by clinicians across diverse cultures. In many instances, treatment of (...) older adolescents and adults is covered by national health care systems and, in some cases, by private health insurance. Most recently, the Medicare ban on coverage for gender reassignment surgery was lifted in 2014.In contrast to the relative lack of controversy about treating adolescents and adults, there is no expert clinical consensus regarding the treatment of prepubescent children who meet diagnostic criteria for what was referred to in both DSM‐IV‐TR and ICD‐10 as gender identity disorder in children and now in DSM‐5 as gender dysphoria. One reason for the differing attitudes has to do with the pervasive nature of gender dysphoria in older adolescents and adults: it rarely desists, and so the treatment of choice is gender or sex reassignment. On the subject of treating children, however, as the World Professional Association for Transgender Health notes in their latest Standards of Care, gender dysphoria in childhood does not inevitably continue into adulthood, and only 6 to 23 percent of boys and 12 to 27 percent of girls treated in gender clinics showed persistence of their gender dysphoria into adulthood. Further, most of the boys’ gender dysphoria desisted, and in adulthood, they identified as gay rather than as transgender.In an effort to clarify best treatment practices for transgender individuals, a recent American Psychiatric Association Task Force on the Treatment of Gender Identity outlined three differing approaches to treating prepubescent gender dysphoric children. (shrink)

In recent years the Australian parliament has been considering the rights to protection from discrimination of intersex and gender identity disorder people. In 2013 such protections were made law in the amendment to the Sex Discrimination Act 1984, which in turn has influenced Senate inquiries into the medical treatment of intersex people. This year’s Australian report describes the purview and the potential ramifications of the inquiry of the Senate Standing Committees on Community Affairs, published in October 2013, (...) into the involuntary or coerced sterilization of intersex people in Australia. (shrink)

The Diagnostic and Statistical Manual of Mental Disorders is the guidebook for psychiatric practice in medicine. In the fifth edition, published in 2013, the American Psychiatric Association significantly revised the section on gender identity disorder, which it renamed gender dysphoria. In previous editions, the conviction that one’s sex did not match one’s gender was treated as a mental disorder in need of psychiatric treatment. In DSM-5, the remedy for that same conviction was changed to (...) hormonal and surgical procedures to give the patient the appearance of the opposite sex. A complete reversal of this sort is surprising, as it implies that all previous guidance on this question was in error. The change is even more perplexing given that little evidence shows that hormonal or surgical interventions actually improve the psychological health of the sufferer. (shrink)

Atypical gender identity organisation (AGIO) is a serious medical condition in which the phenotypical appearance is experienced as alien by the person affected. AGIO is source of great distressDistress, and obtaining medical treatment is for many a life-or-death matter. Many of those who cannot receive treatment are at high risk of suicide. AGIO is not only a problem of personal health, but also a public problem, because sufferers are often exposed to discrimination, abuse and violence, and each act (...) of discrimination, abuse and violence is a public issue. Thinking about AGIO represents a great challenge for us all. It involves rethinking about gender identity in a more comprehensive way, inclusive of phenomena that go beyond the classic gender divide ‘male–female’, and thinking of ways of ensuring all citizens, whatever their gender identityInternational guidelines for treatment of gender identity disorder, a secure and peaceful place in society. I explain what AGIO is, how it manifests itself, and provide a brief history of AGIO. I offer an overview of risks and benefits of available treatments. I analyse the ethico-legal issues that surround AGIO. In particular, ethics of interfering with natural development, competenceMinors, competencein minorsCompetence in minors, validity of informed consentConsent, role of the family, moral and legal responsibilityResponsibility of professionals for omission of treatment and ageismAgeism. I conclude that medical treatment should be offered, even to minors just after the onset of puberty, if the child has a profound and persisting AGIO, if she/he is competent to make a judgement on the matter, and if treatment is likely to enhance his/her quality of life. Deferring treatment till adulthood is not a morally neutral option, and it is indeed unethical, if the child is likely to be harmed by pubertal development. (shrink)

Despite a “spatial imaginary” which constructs Europe as a location of sexual and gender freedom (Rao, 2014), presently, twenty countries in Europe require sterilisation in order to legally recognise transgender people’s gender identities, including four of the seven countries in the INFERCIT study: Greece, Italy, Turkey, and Cyprus (but not Spain, which since 2007 does not require sterilisation for gender identity recognition [see Platero, 2008]. In Bulgaria and Lebanon no gender identity recognition for trans (...) people is provided by law; the latter lies outside the “European” region) (TGEU, 2014). Compulsory sterilisation—classified as a crime against humanity in the Rome Statute of the International Criminal Court (UN General Assembly, 1998: art. 7.1)—is widely in force against transgender people, who constitute “the only known group in Europe subject to legally prescribed, state-enforced sterilisation” (Hammarberg, 2009: 19). However, forced sterilisation of trans people is not generally conceptualised as a eugenicist or genocidal policy, in part because sterilisation is conflated with gender reassignment surgical interventions which, widely considered as that which brings transgender bodies into being, are in turn conflated with embodied transgender subjectivities. On this view, transgender individuals could not exist except through a medicalised process that, by design, precludes their “natural” reproductive capacities and is generally not accompanied by fertility preservation or the provision of assisted reproduction technologies (Plemons, 2014: 38; De Sutter et al., 2002; De Sutter, 2001). Sterilisation laws are justified through a pathologising discourse on transgender lives which constructs gender reassignment interventions as medical “treatment” of gender identity disorder (Suess, Espineira & Crego Walters, 2014: 73-76). Adopting a depathologising perspective enables us to contextualise compulsory sterilisation (which naturalises the sexually dimorphic, cisgender, heterosexual body) as a form of “gendercide” which has historically been instrumental in the imposition of a Euro-colonial binary gender system (Miranda, 2010; Lugones, 2007). The state-imposition of medical interventions on trans people not only has deleterious effects on their reproductive rights, “effectively undermin[ing] their right to found a family” (Hammarberg, 2009: 21; see OHCHR et al., 2014)—as “family” is hegemonically defined by a heteronormative and bio/ logical kinship order (Butler, 2002; van Anders, 2014). I argue that state regulation of transgender reproduction constitutes a form of institutionalised gendered violence inasmuch as it impedes transgender people’s ability to exercise inherent first-person authority over the materiality and meanings of their gendered embodiments (Bettcher, 2009; Spade, 2013). Efforts to renaturalise gender and kinship inextricably intersect (Kantsa, 2006) in the biopolitical attempt to regulate transgender embodiments and reproduction, which conditions the emerging legal recognition of transgender subjects as a rights-bearing minority (Stryker, 2014). (shrink)

This paper reviews the characteristics of anorexia nervosa described in the DSM-III-R , relates them to normative gender roles and adolescent development, and critiques those roles on feminist grounds. Two apparently contradictory explanations for the irrational pursuit of thinness are considered: a) the anorexic thus attempts to conform to a socially defined feminine ideal; b) the anorexic thus attempts to avoid the appearance and consequences of mature womanhood. I propose that both explanations are applicable, together emplifying the ambiguity that (...) Simone de Beauvoir considers characteristic of female experience. Because both explanations suggest a gender identity disorder, I question the fact that the DSM-III-R fails to indicate this linkage. I argue further that therapeutic considerations require efforts to alter the socialization factors that are implicative in anorexia nervosa. Keywords: anorexia nervosa, diagnoses, feminism, philosophy of biology, psychiatry CiteULike Connotea Del.icio.us What's this? (shrink)

In the past few years, the introduction and rapid acceptance of puberty suppression has transformed the clinical treatment of children diagnosed with Gender Identity Disorder. This essay analyzes the narratives used by some advocates of this treatment, particularly the elements of saving children from the looming disaster of puberty and from future abject lives of violence and suicide as transgender adults. It briefly addresses the potential implications of this account for the well being of the children brought (...) under clinical purview. (shrink)

ABSTRACT This article focuses on issues of gender identity and bodily integrity in the context of profound desires to modify the body. It contends that, while hormonal and surgical interventions in treating gender dysphoria must continue to be considered medically necessary for many people, we do not yet fully understand why it is justified as medically necessary for this condition and not for others with similar features. The article discusses the difference between the medical classification of “ (...) class='Hi'>gender dysphoria” and “body dysmorphic disorder” and the notion of mental distress in embodiment. It discusses the role that gender essentialism may have played in the medical sanction of hormonal interventions and gender reassignment surgeries. Finally, it proffers the alternative justificatory criterion, following Eve Kosofsky Sedgwick, of “propriodescriptive authority” and explains why this justification, though highly subjective, provides better rational grounds for adjudicating which types of body modification can be considered medically necessary, grounds that can include, but also go well beyond, cases of gender dysphoria. (shrink)

Disorders of sexual development are a heterogeneous group of disorders in which chromosomal, gonadal or anatomical sex development is atypical. The majority of these children are recognized at birth by ambiguous genitalia. Legal and societal pressures require the physician and parents to assign sex rapidly. Though sex assignment is undebated in several disorders of sexual development, many others need an individualized approach to gender-related concerns. Gender dysphoria is prevalent in disorders of sexual development, and early gender-defining surgeries (...) have potentially lifelong consequences. We use two cases, one of partial androgen insensitivity and another of simple virilizing congenital adrenal hyperplasia to illustrate that in disorders of sexual development, the ethical management principles remain the same at their core despite the vast differences in phenotypes. Sex assignment should maximize functional, psychological and sexual needs. Sex assigned should coincide with gender identity. We propose that we manage such children with the mutual participation of the physician, parents and the child. Though the parents and the physician have the child's best interests when making a decision, the child's developing autonomy should be protected. The communication of the health provider to the parent must be honest if early sex assignment is difficult. (shrink)

Transgender healthcare faces a dilemma. On the one hand, access to certain medical interventions, including hormone treatments or surgeries, where desired, may be beneficial or even vital for some gender dysphoric trans people. But on the other hand, access to medical interventions typically requires a diagnosis, which, in turn, seems to imply the existence of a pathological state—something that many transgender people reject as a false and stigmatizing characterization of their experience or identity. In this paper we argue (...) that developments from the human enhancement debate can help clarify or resolve some of the conceptual and ethical entanglements arising from the apparent conflict between seeking medicine while not necessarily suffering from a pathology or disorder. Specifically, we focus on the welfarist account of human enhancement and argue it can provide a useful conceptual framework for thinking about some of the more contentious disagreements about access to transgender healthcare services. (shrink)

This article responds to Neil Levy's recent suggestion that: (1) the use of pharmaceutical enhancers can be understood as promoting our authenticity, no matter which of the two main contemporary conceptions of authenticity we adopt; and that (2) we do not need to decide between these two rival models (the ‘self-discovery’ and the ‘self-creation’ conception) in order to assess the common worry that enhancements will undermine our authenticity. Levy's core argument is based on a comparison between cases of people with (...) ‘Gender Identity Disorder’ (GID) seeking sex reassignment surgery, and cases of enhancement via pharmaceuticals. While conceding the plausibility of Levy's claim (1), I offer reasons to resist (2), by pointing out structural differences between GID cases and some paradigmatic cases of pharmacological enhancement. I argue that these differences prevent the latter sort of cases from counting as authenticity-promoting on the self-discovery view. I conclude that Levy's proposed way of ‘breaking the stalemate’ in this debate is unsuccessful: we cannot avoid settling the dispute between the two models if we are to adequately address the authenticity worry about pharmacological enhancement. (shrink)

This is a rebuttal to Fiona Probyn-Rapsey’s criticisms of the original furry research conducted in 2006 and published in 2008. Her focus on gender identity disorder misses the main point of the study, which was that it was the first empirical study to collect data scientifically and report findings on the furry fandom, an often misrepresented subculture.

"I have the worst birth defect a woman can have: I was born with a penis and a pair of testicles." Thus we meet Hera, who shares her reason for starting psychoanalysis and whose statement embodies the debate over transgenderism, rigorously dissected in _Please Select Your Gender_. Is it a mental disorder, as some would claim, or a matter of sexual identity? An orientation or a life choice? Despite differing opinions, transgenderism has lost much of its stigma over (...) the past decade or so – though perhaps none of its shock value. Nevertheless, the door is open for a reformulation of the hysterical question, "Am I a man or a woman?" Utilizing rich clinical vignettes and elements of Lacanian theory, Patricia Gherovici demonstrates how the transgender discourse has both reoriented psychoanalytic practice and reframed debates about gender in American society at large. She traverses historical, theoretical, and clinical grounds to explore what has been termed the "democratizing of gender" – for what could be more democratic than the choice of one’s own gender, now able to be changed on demand? Arguing for the depathologization of transgenderism, _Please Select Your Gender_ aims to revise current notions of human sexuality in general. In doing so, it challenges the theory and practice of psychoanalysis with questions typically addressed only indirectly, but which are themselves transforming how analysis is done, advancing new ideas for the clinic that can be extrapolated to social and intellectual contexts in an effort to engage the broader dialogues of gender and sexuality. (shrink)

This study explored the furry identity. Furries are humans interested in anthropomorphic art and cartoons. Some furries have zoomorphic tendencies. Furries often identify with, and/or assume, characteristics of a special/totem species of nonhuman animal. This research surveyed both furries and non-furry individuals attending a furry convention and a comparison group of college students . Furries commonly indicated dragons and various canine and feline species as their alternate-species identity; none reported a nonhuman-primate identity. Dichotomous responses to two key (...) furry-identity questions produced a two-by-two furry typology. These two independent dimensions are self-perception and species identity . One-quarter of the furry sample answered “yes” to both questions, placing them in the “Distorted Unattained” quadrant. This type of furry has certain characteristics paralleling gender-identity disorder. To explore this parallel, the furry typology, and the proposed construct of “Species Identity Disorder” needs further research. (shrink)

This article works across multiple disciplinary boundaries, especially queer theory, to examine critically the controversial, and often socially controlling, role of biomedical knowledge and interventions in the realm of human sexuality. It will attempt to situate scientific/medical discourses on sexuality historically, socially, and culturally in order to expose the ways in which “proper” sexual health in medical research and clinical practice has been conflated with prevailing social norms at particular historical junctures in the 20th and 21st centuries. How might the (...) relationship between clinical and cultural spheres be better engaged in biomedical knowledge and clinical practice in understanding sexual health, given the impact of homophobic and transphobic assumptions in the diagnostic histories of homosexuality and Gender Identity Disorder in Childhood, a new diagnostic category introduced into the DSM following the removal of homosexuality from the DSM-III? The article will argue further that biomedical knowledge is always already mediated through culture by analyzing normative racial, gender, class, and sexual ideologies that regulated early understandings of the epidemiology of the HIV/AIDS pandemic in the West and in the postcolonial world while informing global health policy on HIV/AIDS. The article concludes by examining the implications of medical education for both LGBTQI patients and medical professionals, for understanding gender and sexual rights as human rights, and for thinking about new kinds of interventions, contestations, and struggles to resist continued homophobic and transphobic assumptions in biomedical practice today and their ongoing effects in the everyday world. (shrink)

In this article, I attempt to bring some colour to a discussion of fraught topics in education. Though the scenes and stories (from education and elsewhere) that feature here deal with racism, the discussion aims to say something to such topics more generally. The philosophers whose work I draw on here are Stanley Cavell and Judith Butler. Both Butler and Cavell develop (or depart from) J.L. Austin's theory of the performative utterance. Butler, following Derrida, argues that in concentrating on the (...) illocutionary force of utterances (their capacity to do things), Austin fails to account for the force of words themselves. The iterability of language means that words are never at one with themselves. They carry their old contexts with them as they enter into new ones. This has important consequences for ethical issues that pertain to what Butler calls the ?performativity? of gender and race. Though we are performed by language, this performance has a dynamic quality that leads to the reshaping of identity. In contrast, for Cavell, the disappointing aspect of Austin's thought relates to the latter's neglect of the perlocutionary effect of language ? what is done ?by words?. By taking on this project, Cavell embraces the unconventional aspects of language characterised by ?passionate? expression and exchange. Butler and Cavell approach the performative utterance from different directions. In the last part of this article, the significance of this difference is discussed in relation to the provision of a moral education with regard to tackling issues surrounding racism. (shrink)

Is it ethical to perform a surgery whose purpose is to make a male look like a female or a female to appear male? Is it medically appropriate? Sexual reassignment surgery (SRS) violates basic medical and ethical principles and is therefore not ethically or medically appropriate. (1) SRS mutilates a healthy, non-diseased body. To perform surgery on a healthy body involves unnecessary risks; therefore, SRS violates the principle primum non nocere, “first, do no harm.” (2) Candidates for SRS may believe (...) that they are trapped in the bodies of the wrong sex and therefore desire or, more accurately, demand SRS; however, this belief is generated by a disordered perception of self. Such a fixed, irrational belief is appropriately described as a delusion. SRS, therefore, is a “category mistake”—it offers a surgical solution for psychological problems such as a failure to accept the goodness of one’s masculinity or femininity, lack of secure attachment relationships in childhood with same-sex peers or a parent, self-rejection, untreated gender identity disorder, addiction to masturbation and fantasy, poor body image, excessive anger, and severe psychopathology in a parent. (3) SRS does not accomplish what it claims to accomplish. It does not change a person’s sex; therefore, it provides no true benefit. (4) SRS is a “permanent,” effectively unchangeable, and often unsatisfying surgical attempt to change what may be only a temporary (i.e., psychotherapeutically changeable) psychological/psychiatric condition. National Catholic Bioethics Quarterly 9.1 (Spring2009): 97–125. (shrink)

This study explored the furry identity. Furries are humans interested in anthropomorphic art and cartoons. Some furries have zoomorphic tendencies. Furries often identify with, and/or assume, characteristics of a special/totem species of nonhuman animal. This research surveyed both furries and non-furry individuals attending a furry convention and a comparison group of college students. Furries commonly indicated dragons and various canine and feline species as their alternate-species identity; none reported a nonhuman-primate identity. Dichotomous responses to two key furry- (...) class='Hi'>identity questions produced a two-by-two furry typology. These two independent dimensions are self-perception and species identity. One-quarter of the furry sample answered “yes” to both questions, placing them in the “Distorted Unattained” quadrant. This type of furry has certain characteristics paralleling gender-identity disorder. To explore this parallel, the furry typology, and the proposed construct of “Species Identity Disorder” needs further research. (shrink)

The author was consulted by two Catholic schools in separate cases of a student and a teacher preparing to undergo sex reassignment. Such cases give rise to special ethical and pastoral concerns. This article discusses the disorders that may lead to sex reassignment, distinguishing between con­genital disorders of sex development (intersex conditions) and gender identity disorder (gender dysphoria). It also notes the ethical differences between the correction of congenital anomalies and interventions to relieve dysphoria: in the (...) former, treatment is meant to restore as much normal function as possible; in the latter, mutilating intervention destroys what were otherwise healthy bodily functions. In Catholic schools, concern for the well-being of an affected student or teacher is required, as is a clear understanding of the condition being treated, the ethical implications of treatment, the privacy issues, the effects on other students and staff, and the effects on a teacher’s ability to give faithful witness to Catholic teaching. National Catholic Bioethics Quarterly 12.1 (Spring 2012): 85–97. (shrink)

Once described as hermaphrodites and later as intersex people, individuals born with intersex variations are routinely subject to so-called “normalizing” medical interventions, often in childhood. Opposition to such practices has been met by attempts to discredit critics and reasserted clinical authority over the bodies of women and men with “disorders of sex development.” However, claims of clinical consensus have been selectively constructed and applied and lack evidence. Limited transparency and lack of access to justice have helped to perpetuate forced interventions. (...) At the same time, associated with the diffusion of distinct concepts of sex and gender, intersex has been constructed as a third legal sex classification, accompanied by pious hopes and unwarranted expectations of consequences. The existence of intersex has also been instrumentalized for the benefit of other, intersecting, populations. The creation of gender categories associated with intersex bodies has created profound risks: a paradoxically narrowed and normative gender binary, maintenance of medical authority over the bodies of “disordered” females and males, and claims that transgressions of social roles ascribed to a third gender are deceptive. Claims that medicalization saves intersex people from “othering,” or that legal othering saves intersex people from medicalization, are contradictory and empty rhetoric. In practice, intersex bodies remain “normalized” or eliminated by medicine, while society and the law “others” intersex identities. That is, medicine constructs intersex bodies as either female or male, while law and society construct intersex identities as neither female nor male. Australian attempts at reforms to recognize the rights of intersex people have either failed to adequately comprehend the population affected or lacked implementation. An emerging human rights consensus demands an end to social prejudice, stigma, and forced medical interventions, focusing on the right to bodily integrity and principles of self-determination. (shrink)

The paper proposes a theoretical analysis of A Pale View of Hills, using a psycho-literary approach to the themes of Japaneseness-Englishness, displacement, and the hybrid individual as they emerge from Kazuo Ishiguro’s novel. Etsuko’s pidgin identity results from the main character’s existential migration, which, in turn, stems from her experiencing and witnessing gender inequality, domestic abuse, and war trauma along with the gaping rift between generations. In line with Freud and Jung’s oneiric theories, the paper investigates Etsuko’s post-traumatic (...) stress disorder in order to explain why the protagonist fails to face the suicide of her elder daughter, Keiko, whose avoidant-insecure behaviour might have worsened after her forced uprooting and immigration to England. Although the middle-aged expatriate Etsuko is willing to find new motivation for living, based on the unusual habit of the subconscious to get used to repetitive traumas, her pidgin identity, impossible to recalibrate, may affect her ability to heal. (shrink)

The discursive production of the ‘self in the context of mental health care has potential implications for how the subjects of intervention come to understand and experience themselves. Eating disorders provide an illustrative example of the ways in which conceptualizations of the self that structure mental health practices can be gendered, because they are mainly diagnosed in women and dominant explanations of their origins are feminized. This discourse analytic study examines the gendered nature of mental health workers’ constructions of the (...) eating-disordered self through the psychological construct of ‘identity’, examining the dominant discourses implicated in the feminization of deficient identity, and addressing the implications of this construction for mental health practice. (shrink)

Argues that from a feminist perspective the history of clinical psychology reveals a troubled relationship with women. Diagnoses and treatments have at times controlled and victimized women. Over the past 25 yrs, feminist scholarship, activism, and practice have contributed to knowledge. Yet, these accomplishments may go unnoticed in the field of abnormal psychology. Besides sexism, there may be other sources of resistance. Textbooks present disorders as abstracted, medicalized entities. Within this frame of reference, everyday identities, social categories , and cultural (...) politics are rendered irrelevant. Textbooks present an idealized image of psychology as a scientific, objective discipline that is humane and beneficent. That image could not be sustained if an accurate account of its history and social relations were given as well. 2012 APA, all rights reserved). (shrink)

A theory of gender ought to be compatible with trans-inclusive definitions of gender identity terms, such as ‘woman’ and ‘man’. Appealing to this principle of trans-inclusion, Katharine Jenkins argues that we ought to endorse a dual social position and identity theory of gender. Here, I argue that Jenkins’s dual theory of gender fails to be trans-inclusive for the following reasons: it cannot generate a definition of ‘woman’ that extends to include all trans women, and (...) it understands transgender gender identity through a cisgender frame. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Removing the Mask: Hopeless Isolation to Intersex AdvocacyAlexandra von KlanStrangers undoubtedly perceive me as female, but I identify as an intersex woman. My karyotype is 46,XY, a typically defined marker of male biological sex, and I was born with undeveloped, non–functioning gonads. As an intersex person, I know firsthand the negative consequences of pathologizing intersex people’s lived experience by categorizing otherwise healthy, functioning organs and bodies as abnormal. The (...) following narrative recounts conversations and interactions with medical providers during my diagnosis and subsequent treatment of pure XY gonadal dys-genesis, sometimes referred to as Swyer Syndrome. I hope to elaborate upon emotionally significant actions and inactions of medical care providers to expose consequential effects on my emotional processing, physical health, and self–actualization.In December 1988, I was born with “typical” female genitalia. No one knew I was an intersex woman with 46,XY karyotype. Thus, there was no hesitation in the announcement of the birth of a girl in the delivery room or later, on my birth certificate. My parents raised me as a girl and dressed their firstborn in culturally normative feminine garments and accessories: lace frilly frocks, oversized bows, white stockings, and black patent leather Mary Jane’s. I embraced femininity and expressed this gender identity throughout my childhood and adolescence. I’m the eldest of six children split between two households.In January 2005, a month after my sixteenth birthday, delayed puberty and absent menstruation prompted an appointment to a local women’s health center. Nurses collected blood samples and administered an MRI scan on my pelvic region. A week later, my father received a perplexing phone call. An inexperienced doctor told him “there must be something wrong” with me, because lab results revealed I was “chromosomally male.” My father recalls the information presented like, based on the evidence, “your daughter may not be completely female,” and that is that. His impression was that she knew little about the subject and was a bit clueless. She did not mention Swyer Syndrome, or any diagnosis for that matter.Up to this point, I was unaware that a member of my extended family also had Swyer Syndrome. Born in the 1950s, secrecy engulfed her medical treatment and doctors warned her parents against revealing her true chromosomal sex in order to prevent the hysterical panic and depression they [End Page E14] thought the truth would bring. Years later, she sought her medical records and unearthed the truth. Shortly after my father received that dubious phone call, my relative’s endocrinologist provided a referral to his mentor, “Doctor A,” a clinical reproductive endocrinologist.Under Doctor A’s care, I experienced the first of many pelvic exams. Much to my discomfort, Doctor A inspected my semi–clothed body with a male resident in the room. As a people–pleasing teen, I granted permission for his presence; I didn’t voice my preference for a female alternative. Doctor A’s cold hands pressed around each undeveloped breast, pulled a gown away from my hips to inspect a sparse patch of pubic hair, and conducted an examination of my vaginal canal.Shortly after the examination, Doctor A charted Swyer Syndrome as the official diagnosis. Speaking to my father and me, he described my condition as an extremely rare genetic mutation. He told us that Swyer Syndrome was an intersex condition, a group of congenital disorders impacting a person’s internal or external reproductive systems, including endocrine function and genitalia. He explained I had atypical streak gonads instead of ovaries and that, despite having typical male sex chromosomes, I was still very much a girl. He disclosed that my vaginal canal was moderate in length, perhaps further evidence—or consolation—that my body possessed normative female reproductive attributes after all.Next, Doctor A identified a pressing medical concern—golf–ball–sized benign tumors had developed on each streak gonad; if allowed to remain, they would pose an increasing risk of malignancy. We scheduled an appointment for laparoscopic gonadectomy six months later. I left his office with a 3–month prescription for estrogen and progesterone oral tablets. On the way home, we drove to an electronics store where my father... (shrink)

In mid-2018, following a survey of lesbian, gay, bisexual and transgender groups, the UK government issued a consultation on the proposed reform of the Gender Recognition Act for England and Wales.1 When it was first introduced in 2004, the GRA was considered innovative, even world-leading legislation.2 The act enables any adult to seek to change their legal gender provided several criteria are met. These include: If the applicant is successful, he or she is issued with a ‘gender (...) recognition certificate’, their birth certificate is changed and ‘for all purposes’ they become, legally, their acquired or affirmed gender. Since 2004, cultural change in relation to gender identity has been rapid. During the government’s preliminary survey, several concerns were raised about the GRA, particularly among those who have changed, or who may be seeking to change, their gender. These included: The government has stated that being trans is not a mental illness—more a fact of human diversity. It points to the World Health Organisation’s revision of the International Classification of Diseases, in which ‘gender incongruence’, another term for gender dysphoria, is no longer classed under ‘mental and behavioural disorders’.3 ### Draft proposals for change The government considers the reform of the GRA …. (shrink)

The purpose of this article is to develop and illustrate an approach for making the commonplace visible in a natural, as opposed to manipulated, social setting. The key research task was to find a way of capturing the ongoing production or enactment of the self that provides some insight into the way in which it is produced in a routine, matter of fact way. The article takes a number of steps to develop a research approach to the task. First, (...) class='Hi'>gender-identity was selected as a more specific aspect of self-production. Second, the concept of "flashpoints" was used to refer to a particular moment in the routine which achieves some significance or salience as a result of the participants seizing upon some otherwise unremarkable action or statement and twisting it to their purpose. In this study, the purpose was gender-identity creation. Primary school children in the classroom and their teachers were the participants of the study. Through the use of flashpoints, the article demonstrates how gender-identity production of these children can be caught in flight. The article concludes that this approach can be added to the researcher's toolkit. (shrink)

Our gender identity is our sense of ourselves as a woman, a man, as genderqueer, or as another gender. Our gender is the property we have of being a woman, being a man, being non-binary, or being another gender. What is the relationship between our gender identity and our gender? Recently, much work has been done on ameliorative accounts of the gender concepts that we should accept and on the metaphysics of (...) gender properties. From this work 4 views of the relationship between having gender identity G (e.g. having a female gender identity) and being a gender G (e.g. being a woman) have emerged. A first, the no connection view, says that gender identity and gender are entirely distinct; Sally Haslanger’s ameliorative account of gender, as well as Theodore Bach’s account of gender properties, are instances of this view. A second, the gender-identity-first view, says that all there is to our gender is our gender identity; this view is at least similar to views that Talia Bettcher and R.A. Briggs and B.R. George have argued for. A third, contextualist view, says that in some contexts and relative to certain standards, our gender identity determines our gender, and that in others it does not; Ásta and Robin Dembroff have proposed and defended views along these lines. A fourth view, the two gender properties view, says that there are two properties that can make it the case that one is gender G (in any context), one’s having gender identity G and one’s being socially classed as a G; Katharine Jenkins and Elizabeth Barnes have proposed views along these lines. This article explains these 4 different views and spells out their prospects, and the problems they face, as both ameliorative and as metaphysical views. (shrink)

Feminist approaches within the social sciences have expanded enormously since the 1960s. In addition, in recent years, geographic perspectives have become increasingly significant as feminist recognition of the differences between women, their diverse experiences in different parts of the world and the importance of location in the social construction of knowledge has placed varied geographies at the centre of contemporary feminist and postmodern debates. Gender, Identity and Place is an accessible and clearly written introduction to the wide field (...) of issues that have been addressed by geographers and feminist scholars. It combines the careful definition and discussion of key concepts and theoretical approaches with a wealth of empirical detail from a wide-ranging selection of case studies and other empirical research. It is organized on the basis of spatial scale, examining the relationships between gender and place from the body to the nation, although the links between different spatial scales are also emphasized. The conceptual division and spatial separation between the public and private spheres and their association with men and women respectively has been a crucial part of the social construction of gendered differences and its establishment, maintenance and reshaping from industrial urbanization to the end of the millennium is a central linking theme in the eight substantive chapters. The book concludes with an assessment of the possibilities of doing feminist research. It will be essential reading for students in geography, feminist theory, women's studies, anthropology and sociology. (shrink)

A Letter to the Editor about the origin of "gender identity" and deficiencies in its current definition.

‘Gender identity’ was clearly defined sixty years ago, but the dominant conceptions of gender identity today are deeply obscure. Florence Ashley’s 2023 theory of gender identity is one of the latest attempts at demystification. Although Ashley’s paper is not fully coherent, a coherent theory of gender identity can be extracted from it. That theory, we argue, is clearly false. It is psychologically very implausible, and does not support ‘first­person authority over gender’, (...) as Ashley claims. We also discuss other errors and confusions in Ashley’s paper. (shrink)

Talk of gender identity is at the core of heated current philosophical and political debates. Yet, it is unclear what it means to have one. I examine several ways of understanding this concept in light of core aims of trans writers and activists. Most importantly, the concept should make good trans people’s understanding of their own gender identities and help understand why misgendering is a serious harm and why it is permissible to require information about people’s (...) class='Hi'>gender identities in public life. I conclude that none of the available accounts meets these essential criteria, on the assumption that the gender norms of femininity and masculinity are unjustified. But we can, and should, pursue the feminist project without “gender identity”. Such feminism can include trans people because it is possible to account for the specific harm of misgendering without assuming a claim to the recognition of our gender identities. I conclude that we should eliminate the concept of “gender identity.” To understand the phenomena that are putatively captured by “gender identity,” we are better off employing other concepts, such as “sexual dysphoria,” (assigned or aspirational) “gender roles,” and (internalised or endorsed) “gender norms”. These concepts can usefully replace “gender identity” in an individual evaluation of each of the trans people’s claims to inclusion into particular spaces. (shrink)

Although the concept of gender identity plays a prominent role in campaigns for trans rights, it is not well understood, and common definitions suffer from a problematic circularity. This paper undertakes an ameliorative inquiry into the concept of gender identity, taking as a starting point the ways in which trans rights movements seek to use the concept. First, I set out six desiderata that a target concept of gender identity should meet. I then consider (...) three analytic accounts of gender identity: the dispositional account, the self-identification account, and the norm-relevancy account. I argue that only the norm-relevancy account can meet all six desiderata. Finally, I defend the norm-relevancy account from three objections: that it is cis-normative, that it has problematic implications regarding trans women, and that it entails that some people do not have the gender identity they take themselves to have. (shrink)