Monthly Archives: July 2012

Diagnosis, disorder, dysphoria? The GID debate

The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is slated for publication in May of 2013. This much-anticipated event has been surrounded by heated controversy since its early planning stages more than a decade ago. One of the more scathing critiques of the DSM revisions comes from Dr. Allen Frances, former chair of the psychiatry department at Duke University School of Medicine – and former chair of the DSM-IV task force. “DSM-V promises to be a disaster,” he recently wrote in a New York Times op-ed piece. And transpeople and trans activist groups are among those who believe that the DSM changes will indeed be disastrous.

For those of you who are unfamiliar with the current and proposed DSM categories, I’ll give a brief overview. Currently, the DSM includes two diagnoses that could potentially apply to transpeople, one of which I’ll talk about in this post. (I’ll address the other one at a later date.)  Gender Identity Disorder (GID) is used to describe people who feel a discontent with the sex they were assigned at birth and the gender roles associated with that sex. In children, this can involve “strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex,” or it can involve an “intense desire to participate in the stereotypical games and pastimes of the other sex.” In other words, a GID diagnosis could be applied to young boys who want to play with dolls and get their toenails painted, and to young girls who want to run around and play with trucks. The most common form of treatment for children diagnosed with GID is gender-reparative therapy – getting them to conform to societally prescribed gendered behaviors.

In adults, GID involves a “preoccupation with getting rid of primary and secondary sex characteristics (e.g., request for hormones, surgery, or other procedures to physically alter sexual characteristics to simulate the other sex) or belief that he or she was born the wrong sex.” Because medical intervention is typically part of the gender transition process, transpeople seeking hormones or surgery have, until recently, needed to get permission from a team of gatekeepers before moving forward. And the first step in one’s gender transition involved being labeled with a psychiatric diagnosis.

Sometimes receiving a diagnosis is comforting, validating, and ultimately helpful. Anyone who’s experienced a mysterious and disturbing collection of symptoms will likely feel a sense of relief once a doctor says, “Oh, you have ________ – and this is what we can do to help you.” When a diagnostic label is applied, it means (1) you’re not the only one that’s experienced this (which can be comforting), and (2) knowing what you have likely gives the doctor an idea about what to do about it (assuming something needs to be done about it).

Unfortunately, being labeled with a psychiatric disorder is, for many people, deeply pathologizing and potentially harmful. For example, a recent wire news article describes the case of a transwoman who was at risk of losing custody of the children she fathered before her transition, because she is diagnosed with a “serious, chronic mental illness.” For many people, receiving a diagnostic label carries an intense level of social stigma. David Rosenhan’s classic article titled, “On Being Sane in Insane Places” documented the results of his study of eight healthy individuals (including himself) who faked a mental illness, got themselves admitted to a psychatric hospital, and behaved normally in an attempt to see whether or not the staff would catch on to the ruse. One of the most powerful findings that emerged from that study was the concept of the “stickiness of the diagnostic label.” If a person receives a diagnosis, it sticks to them forever – and that label clouds the lens through which others perceive them. A person is no longer an individual with dignity – they’re a schizophrenic, or they’re bipolar, or they’re ADHD, and they’re treated like a leper. Being diagnosed with GID, trans activist groups say, strips the individual of dignity and creates yet another target of oppression.

Trans activist groups find themselves between a rock and a hard place. On the one hand, many would like to see the GID diagnosis eliminated altogether, just as homosexuality was depathologized in 1973. Along those lines, last year the World Professional Association for Transgender Health (WPATH), which has developed the Standards of Care for the Health fo Transsexual, Transgender, and Gender Nonconforming People, took a depathologizing stance by eliminating the requirement that a transperson undergo psychotherapy – and receive a psychiatric diagnosis – before undergoing gender transition. However, some are concerned that, because insurance companies require a diagnosis before authorizing reimbursement, eliminating the GID diagnosis altogether will result in people having to pay out of pocket.

Instead of eliminating the GID diagnosis, the DSM-V working groups are proposing a name change and a distinction between children and adults. The two newly proposed categories are “Gender Dysphoria in Children” and “Gender Dysphoria in Adolescents or Adults.” The criteria for these diagnoses remain similar to the verbiage in DSM-IV. What’s interesting is that, in both diagnostic categories, two subtypes are being proposed: “with a disorder of sex development” and “without a disorder of sex development.” A disorder of sex development (DSD), essentially, is an intersex condition – a term used for a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn’t seem to fit the typical definitions of female or male. So now intersex people are at risk for being labeled with a psychiatric diagnosis, whereas DSM-IV excludes people with intersex conditions from consideration for the diagnosis. Essentially, we’ve ended up with more diagnostic categories, instead of fewer. From my vantage point, that looks like a step backward, rather than a progressive move forward.

So much has been written about ethics, empowerment, and psychiatric diagnosis – particularly from the feminist community – and I wish the DSM-V Task Force would pay attention to it. Laura Brown’s book Subversive Dialogues: Theories in Feminist Therapy contains a chapter titled, “Diagnosis and Distress,” which I think should be required reading for anyone involved in the enterprise of psychiatric diagnosis. From her perspective, diagnoses in and of themselves aren’t inherently bad – but the motivations behind them and the ways they are used can be incredibly harmful. There’s a vast difference between using diagnoses as a tool of conformity and a form of control, and using diagnoses to empower people and improve their quality of life.


Filed under gender nonconformity, human rights, intersex, mental health, psychological research, reparative therapy, transgender, transphobia, Uncategorized

The myth of gay affluence

Gays are affluent.

Because gays aren’t usually saddled with children, they have lots of disposable income.

The “gay dollar” is a powerful market that businesses and political organizations need to tap into.

If your exposure to LGBTQ people is limited to the news and entertainment media, then it would be very easy to fall into the trap of believing these statements. A frequently-cited statistic is that this year, in 2012, the lesbian and gay market is worth $790 billion dollars. Since the 1990s, newspapers and magazines have run scores of articles about the increasing market presence of the LGBTQ community. Business journals have published articles and run advertisements courting the gay dollar. And there is some statistical data out there that supports the power of the gay dollar. Numerous books, including Steven Kates’ Twenty Million New Customers! Understanding Gay Men’s Consumer Behavior and Bob Witeck’s Business Inside Out: Capturing Millions of Brand Loyal Gay Consumers, have been marketed to the business community. (As an aside, Bob Witeck heads up Witeck Communications, a think tank that conducted the market analysis that yielded the $790 billion statistic.)

Businesses – and politicos – are paying attention. Earlier this month, Billie Jean King and Jane Lynch launched LPAC, the first lesbian super PAC to be established that raises money for pro-lesbian political candidates. Leveraging the “lesbian dollar,” they successfully raised $200,000 in the first day. American Airlines, a company known for its support for the LGBTQ community, saw almost a tenfold profit increase after the company formed a team devoted to gay and lesbian marketing. And just this past week, when Chick-fil-A president Dan Cathy stated the company’s opposition to same-sex marriage and reiterated their Bible-based values, the ensuing boycott of the fast-food chain led company officials to soften their stance – probably because they feared the hit their profits would take. Based on these examples, it’s hard not to have reverence and respect for the power of pink money.  

But, sad to say, the idea of the all-powerful gay money is really just a half-truth. If we focus our microscope solely on urban, well-educated, affluent gay men who don’t have kids, then of course we’re talking about people who are likely to have a lot of money. But that’s only a narrow sliver of our incredibly diverse community. When we widen the scope, a different reality emerges.

Here’s a slice of that different reality. In Money, Myths, and Change: The Economic Lives of Lesbians and Gay Men, M.K. Lee Badgett, an economist at the University of Massachusetts, Amherst, uses numerous scientific studies to debunk the myth of gay affluence. Among other things, Badgett cites bans on same-sex marriage, wage discrimination, the intersection of discrimination against women and homophobia (the wage gap between women and men is still alive and well), and lack of access to workplace benefits such as health benefits and retirement plans as barriers to achieving financial stability and success. Over the months I’ve been writing this blog, I’ve made clear again and again the impact of oppression and marginalization against LGBTQ people. When we experience discrimination and oppression because of our sexual orientation or gender identity and expression, we take a serious financial hit.  

What also strikes me about the “gay affluence” stereotype is that, at least in my mind, the image of a gay person with disposable income is often a White male. Lesbian women are more likely than gay men to be raising children, and that has a significant impact on economic status. Moreover, wage gap data collected over the past 60 years indicates a shrinking – but still distinct – difference in the earnings between women and men. When we consider race and ethnicity, the “gay affluence” image gets even more sketchy. In a 2006 study titled “Nuestras Voces/Our Voices: The National Study of Latino Gay Men,” researchers Rafael Diaz, Edward Bein, and George Ayala found that, over a one-year period, 61% of the 397 participants ran out of money for basic necessities, 54% had to borrow money at some point in order to get by, and 45% had to look for work sometime over the course of that year. Not surprisingly, experiences of financial hardship put people at higher risk for social isolation, low self-esteem, and psychological distress. And just this past Friday, the Queer Southeast Asian (QSEA) Network released a study titled A Census of Our Own: The State of QSEA America. While the results of this study focused predominantly on experiences of racism and homophobia, the study revealed that, of the 364 LGBTQ Southeast Asian Americans who participated in the study, 74% had been on public assistance at some time in their lives. If that doesn’t debunk the myth, I don’t know what does.

To me, the conflicting economic narrative we’re seeing here is all about where we choose to focus our lens. If we decide to study whether or not gay men shop at Whole Foods, and we get participants by standing outside of Whole Foods, then right off the bat we’re getting a skewed version of reality. Of course, most researchers would never commit such a novice sampling error. However, studies have shown repeatedly that, when we don’t include a diversified sample, or if they rely solely on a volunteer or convenience sample, what we’re going to get is largely a White, well-educated, affluent demographic in our participant base. That clearly paints an inaccurate picture of the realities of our community.

What if there wasn’t so much focus on how to get a piece of the gay money pie, but instead efforts were channeled – with equal fervor and drive – towards creating an economically equitable community? What if we leveraged our financial power to eradicate homelessness, poverty, and economic distress among our LGBTQ brothers and sisters?   




Filed under homophobia, human rights, LGBTQ, media, mental health, psychological research, racism, same-sex marriage, sexism, stereotypes

A tale of two coming-out stories

“Anderson Cooper caught everyone by surprise when he revealed he was gay on July 2 in an email to Andrew Sullivan that was shared with the public.” The Huffington Post, July 13, 2012

Caught everyone by surprise? Were people really surprised by this disclosure? Frankly, Joan Rivers’ comment seemed to be much more on target:

I am thrilled that Anderson Cooper finally came out” (emphasis added). 

Some of you may remember my blog post titled, “Setting off my gay-dar,” a piece that was inspired by Kristy McNichol’s public coming-out (which, for many people, was also not particularly surprising). In that post, I named a lengthy list of celebrities who had set the public’s gay-dar off for years before they actually came out. Anderson Cooper fits that profile – he was out to people in his personal life, but he very carefully chose when to come out publicly, probably because, as quoted by one insider, he didn’t want to “commit career suicide” by openly identifying as gay.

I don’t want to downplay the strength and courage it took for Cooper to come out of the closet. Coming out and choosing to live openly and authentically, while accepting the consequences of that decision, is a milestone moment for every LGBTQ person. What helps Cooper is that others in the news/media industry have begun to pave the way for him – Rachel Maddow, Steve Kornacki, and Thomas Roberts, all anchors at MSNBC; ABC News’ Dan Kloeffler; and CNN’s Don Lemon, to name a few. If I had a crystal ball, I’d predict that career suicide is not in the future of Anderson Cooper – in fact, I bet his coming out will actually elevate his status, like it has for Ellen DeGeneres.

But let’s switch to another coming out story – a story which has created a different kind of celebrity buzz. On July 4, Frank Ocean, an African-American hip-hop and R&B artist, posted a lengthy statement on his Tumblr site that revealed his love for another man, beginning at age 19. Ocean went on to say this:

“I don’t know what happens now, and that’s alrite [sic]. I don’t have any secrets I need kept anymore.

I feel like a free man.”

A free man. What a beautiful statement to make on Independence Day.

The African-American hip-hop world, however, is a very different landscape from the cable news environment – and, in my opinion, the stakes are higher for Frank Ocean. While there is scant psychological literature exploring homophobia within hip-hop culture, many psychologists, including Beverly Greene at St. John’s University, have documented extensively the challenges of homophobia in the Black community, particularly among African-American males. If we look beyond psychology and explore other disciplines, such as anthropology, linguistics, communications, sociology, and cultural studies, we find quite a bit of scholarship on homophobia in hip-hop culture. For example, in his article “No Homo,” published in the Journal of Homosexuality, linguist Joshua Brown of Penn State University explores the ways in which that phrase entered the hip-hop nomenclature, and how “no homo” effectively prevents any type of sexual or gender transgressions, particularly any violations of masculinity. Joel Penney, professor of communications at the University of Pennsylvania, explores in a recent article published in Popular Music and Culture how the use of the phrase “We don’t wear tight clothes,” originally coined by rap artist  Thug Slaughter Force, fueled a “gay panic” in the hip-hop community. In his article, Penney talks about how phrases like this are used to police the boundaries of black masculinity – and that they connect with a long history of homophobia within African-American culture.

So what does all of this mean for Frank Ocean? Artists like Beyoncé and Jay-Z have publicly expressed support for Ocean. Ocean’s new album is currently ranked #1 on iTunes. And, in a post titled, “The Courage of Frank Ocean Just Changed the Game,” Russell Simmons wrote this (which I have included in its entirety):

Today is a big day for hip-hop. It is a day that will define who we really  are.  How compassionate will we be? How loving can we be? How inclusive are  we?

I am profoundly moved by the courage and honesty of Frank Ocean.  Your  decision to go public about your sexual orientation gives hope and light to so many young people still living in  fear. These types of secrets should not matter anymore, but we know they do, and  because of that I decided to write this short statement of support for one of  the greatest new artists we have. 

His gifts are undeniable.  His talent, enormous.  His bravery,  incredible.  His actions this morning will uplift our consciousness and  allow us to become better people.  Every single one of us is born with  peace and tranquility in our heart.  Frank just found his.

Frank, we thank you.  We support you.  We love you. 

And yet, just a few days ago, Target announced its decision not to stock Ocean’s new album on the shelves of its stores. Of course, it’s not clear as to whether this is just a business decision or an ugly example of covert homophobia (and that’s not a completely unfair assumption, given Target’s checkered history with the LGBTQ community). However, it’s these kinds of reactions that, compounded over time, could in fact lead to career suicide for Ocean.

Whether he realizes it or not, Frank Ocean is a traiblazer and a pioneer, giving young African-American LGBTQs license to live openly and honestly. But he has also taken a significant risk, and time will tell regarding whether Ocean’s career will skyrocket, crash and burn, or slowly smolder. The hip-hop community stands at the turning point, and we’ll have to wait and see what unfolds from here.


Filed under coming out, covert homophobia, gay-dar, homophobia, LGBTQ, LGBTQ youth, media, psychological research, racism, Uncategorized

Left out in the cold

Walking past a newsstand this past Thursday, I glanced at the headlines of the San Francisco Chronicle and saw this:


Whoa!!!  Did I read that correctly???


Yes, I read that correctly.

California’s largest college, serving 90,000 students, may close as early as this October. Citing “serious, longstanding problems of leadership and fiscal planning,” the Accrediting Commission for Community and Junior Colleges (ACCJC) has given the institution eight months to prove why it should retain its accreditation, but at the same time to “make preparations for closure.”

This story has hit the national news radar, and various opinions about the verdict have been offered – the overly stringent accreditation standards, the impact of the state’s ongoing divestment from higher education, the inflexibility of leadership in the face of rapid-fire budget cuts. Obviously, if CCSF shuttered its operations, and 90,000 students are left out in the cold, that is a serious blow to the city and county of San Francisco, and to the state of public higher education in California. But, in my opinion, this is also a VERY serious blow to the LGBTQ community, both locally and nationally.

City College of San Francisco, you may or may not know, pioneered the concept of “LGBT/queer studies” in the United States. The first gay literature course was taught at CCSF in 1972, and several years later CCSF was the first college in the United States to establish a Gay and Lesbian (now “Lesbian, Gay, Bisexual, and Transgender”) Studies department. Professor Trinity Ordona, a current member of the department, was recognized by Curve Magazine as one of the 20 most powerful lesbian academics (among her other accolades). CCSF has a Queer Resource Center and an Outlist (an online list of people employed by the college who are publicly out), neither of which are typically found at community colleges. Moreover, all CCSF employees are required to attend trainings in order to better understand issues of homophobia, racism, sexism, classism, heterosexism, sexual harassment, transphobia, and ability rights. At many institutions, this type of training is voluntary, but not mandatory. At quite a few community colleges, it is nonexistent.

So although City College of San Francisco received an F on its accreditation report, I think it deserves a five-star LGBTQ campus climate rating. And that’s no small accomplishment.  

As I’ve noted in previous blog posts, numerous studies have been conducted on the campus climate for LGBTQ students and employees, mostly revealing a mixed bag of findings. However, none of these surveys have included community colleges, so we really don’t have a clear picture of what the climate is like for LGBTQ students and staff at these institutions. In fact, almost no one has studied the adjustment, well-being, and educational success of LGBTQ community college students – and community colleges (including the California Community College system) don’t collect data on the sexual orientation, gender identity, or gender presentation of their students. They are, in the psychological and educational literature, a severely neglected population.

The little data that’s available, however, appears to indicate the following:

  • LGBTQ students at community colleges may experience mental health issues stemming from institutional, familial, and internalized homophobia, which can interfere with their academic success.
  • LGBTQ students at community colleges may not have the emotional and financial support from their families to pursue their educational goals.
  • LGBTQ students at community colleges are typically less likely than students at four-year institutions to have visible LGBTQ role models and resources available to them at their schools. 

It doesn’t take a rocket scientist (or a psychological researcher) to come up with the following equation: 

High Stress (from homophobia, transphobia, biphobia, etc.) + Low Levels of Support = Low Student Success.   

We’ll have to wait and see what the fate of City College of San Francisco will be. Undoubtedly, CCSF will be in the higher education spotlight for the next several months. And yet, here’s the irony of the situation: If the ACCJC included an “LGBTQ campus climate rating” as one of its accreditation standards, I bet most community colleges in California would be put on notice – and CCSF might be the only one left standing.

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Filed under biphobia, homophobia, LGBTQ, LGBTQ youth, psychological research, San Francisco, transgender, transphobia

Alphabet City

Lately I’ve seen a lot of discussion in various Internet forums about the “gay alphabet” – the ever-increasing initials used to describe the queer community. While at one time the word “gay” or “homosexual” was the only available terminology, we have now, in the spirit of inclusiveness, dramatically expanded our nomenclature. Just to give you a sense of what I mean, here’s a sampling from’s “gay alphabet” entries:

LGB:  Lesbian, gay, bisexual.

LGBT:  adding “transgender” (probably the most utilized initials). 

LGBTQ:  adding “queer” or “questioning.”

LGBTQI:  adding “intersex.”

LGBTQIA:  adding “allies.”

LGBTQQIA:  adding “queer” and “questioning.”

LGBTQQIAAP:  adding “asexual” and “pansexual” – someone who is attracted to the qualities of a person, regardless of that person’s gender identity and presentation.

LGBTTIQQ2SA:  distinguishing between “transgender” and transsexual”; adding “Two-Spirit” (2S; a term derived from various Native American/Indigenous traditions of gender and sexual fluidity).

Whew! It’s hard to keep track of such a rapidly increasing list of initials. And, not surprisingly, there has been quite a bit of reactivity within the LGBTQ(QIAAP?) community. In fact, UrbanDictionary itself includes “gay alphabet soup” as an entry, with the following definition and commentary:

Going over-board with adding letters to the traditional “GLBT (Gay/Lesbian/Bi-sexual/Trans)” acronym (sic) to attempt to include every non-homophobic possibility. GLBT alphabet soup can become a very long, nonsensical acronym (emphasis added).

Now I’ll take the opportunity to weigh in on this, and to offer a counterpoint. It’s not the changeling, tongue-twister-like qualities of these initials that bother me, although I will admit that they don’t roll off the tongue very easily. I will also admit that it’s humbling to be teaching a class and using one set of initials, only to be outed by a student as not being on top of the latest nomenclature. But this doesn’t upset me so much. Rather, what’s unsettling to me is the venom behind the critiques of the initals. For example, let’s look at an exchange between two commenters responding to a Huffington Post blog about the “gay alphabet”:

 Wouldn’t pansexual be bi? I mean, there are only two genders.

 Actually, there are not two genders. Gender is a spectrum, not an either/or. There are people who identify at just about any point between male and female. Thus, pansexual includes genderqueer individuals, genderfluid individuals and others.

 Oh, WHATEVER (emphasis added). 

So here’s an attempt to educate a commenter about the diversity and complexity of our community, and the response is “oh, whatever.”  That, in my mind, is far more disturbing than any unwieldy set of initials. It’s a dismissive statement, and it reveals an unwillingness to accept the fluidity of our community.

Two issues come to mind for me. One is that visibility is critical to our community. Coming out and being open about who we are, if we consider UC Davis professor Gregory Herek’s research, has been one of the most powerfully effective tools in reducing homophobia, both on a personal level as well as on a cultural level. But, in my opinion, not everyone in our community is given the same opportunity to be open and speak their truth. Intersex people, for example, have been silenced by the medical community’s attempts to assimilate them into one singular gender category. The queer community still wrestles with whether to include the “I” in its nomenclature, largely because, well, they don’t fit easily into our existing paradigm. The queer community also wrestles with the inclusion of the “T,” even though it’s generally been included in the alphabet roll call for quite some time. Some see the “T” as the proverbial ball-and-chain of the queer community – if we use the Employee Non-Discrimination Act (ENDA) as an example, adding gender identity protections ended up being a deal-breaker in the 2007 Congressional vote – and it divided the LGBTQ activist community, some of whom saw the trans community as stalling the path of progress.

I’d like to segue into another idea, and that is that visibility is not enough. If we’re including more initials so we can earn our political correctness card, but we’re unwilling to really listen to and be present for the issues of that community, then we are doing far more harm than good. In Geneva Reynaga-Abiko’s 2011 review of the book Lesbian, Gay, Bisexual, Trans & Queer Psychology by Victoria Clarke, Sonja Ellis, Elizabeth Peel, and Damien Rigg, published in the journal Cultural Diversity and Ethnic Minority Psychology, she correctly notes that the terms “bisexual” and “trans” are included in the title of the book, but each of those identities receives only a few paragraphs’ worth attention in the entire book. Giving lip service isn’t enough. If we’re going to include the “T,” it needs to really be included. Sometimes there may be reasons not to include the “T,” or only to include the “T,” depending on what kinds of issues we’re focusing on. But these decisions need to be made intelligently and respectfully, not just as a way to appease our discomfort.

Several months ago, I wrote a couple of blog posts on the “don’t say gay” policies implemented by several public school districts. These policies have something of a “see no evil” mentality behind them – if we don’t talk about it, we won’t see it, and if we can’t see it, then it’s not an issue. If we make the gays go away, then life will be easier. If we make the ever-increasing list of initials go away, then life will be easier. In a community that is complex, fluid, and ever-changing, sometimes keeping things simple just doesn’t work. Instead, I’d like to see our community use the growing list of initials as an opportunity to connect, to listen, to ask questions, to learn, and to work towards ending invisibility, marginalization, and oppression of sexual and gender minorities.


Filed under bisexuality, intersex, LGBTQ, transgender, Uncategorized