Good order and discipline

If you were around during the 1970s and ’80s, you undoubtedly remember the hit television show “M*A*S*H.” And, I’m sure, you remember the cross-dressing Klinger, who clearly was willing to go to any lengths to get a Section 8 psychiatric discharge from the army. Back in the 1950s, when the Korean War was fought, Section 8 discharges were commonly given if you were guilty of “sexual perversion,” which included, but was not limited to, cross-dressing and transsexualism. Of course, Klinger’s efforts were completely unsuccessful, and he remained at the 4077th for the duration of the show.

Today, Section 8 no longer exists in military parlance. And the repeal of “Don’t Ask, Don’t Tell” allows lesbian, gay, and bisexual servicepeople to serve openly in the military. But even today, a person who violates the gender binary in any way faces steep military consequences – because the repeal of “Don’t Ask, Don’t Tell” (a law which focused specifically on sexual orientation, and which never applied to trans* and gender-nonconforming people in the first place) does nothing to protect them.

Although repealing “Don’t Ask, Don’t Tell” was a challenge, allowing lesbian, gay, and bisexual people to serve in the military doesn’t fundamentally challenge the gender binary. However, dismantling the policy firewalls that prevent trans* and intersex people from serving would involve shattering the entire institutional structure of the military – a structure that, for centuries, has rested on the foundation of masculine power. Preserving that foundation involves policing any transgressions of the gender binary – and people whose gender identity transgresses the boundary between “male” and “female” are considered to be a medical and/or a psychological aberration of nature (a particularly effective form of social policing).

Consider the following military policies:

• Medical restrictions. According to Army Recruiting Regulation 601-210, people who are intersex are banned from enlisting. The Marine Corps Military Personnel Procurement Manual contains a similar ban against intersex individuals. And researchers at the Michael D. Palm Center at the University of California, Santa Barbara were told by Navy and Air Force recruiters that “being a hermaphrodite was a medical disqualification.” Interestingly, they didn’t use the word intersex – instead, they specifically chose to use the word that many people in the intersex community consider to be highly pathologizing. Furthermore, according to Army Regulation 40-501, transpeople who have undergone sex reassignment surgery, as well as intersex people who have been subjected to gender-normalizing surgery, are banned from the military:  “Major abnormalities and defects of the genitalia such as a change of sex….” constitutes a disqualifying medical defect. And Air Force Regulation 160-43 states that “major abnormalities and defects of the genitalia such as change of sex, a history thereof, or complications . . . residual to surgical corrections of these conditions” prohibit a person from serving in that branch.
• Psychiatric restrictions.  Army Regulation 40-501 states that “current or history of psychosexual conditions, including but not limited to transsexualism, exhibitionism, transvestism, voyeurism, and other paraphilias, do not” meet the standards for psychological fitness. Even more powerful than that is Article 134 of the Uniform Code of Military Justice, which serves as the foundation of military law. Article 134 prohibits all gender-nonconforming behaviors such as cross-dressing – and it gives the military broad power to discharge service members for any behavior seen as “prejudicial to good order and discipline.”
• Veteran status. The VA doesn’t recognize the World Professional Association of Transgender Health (WPATH) Standards of Care, nor does it offer sex reassignment surgery. According to a 2007 report commissioned by the Palm Center, which was based on 827 surveys completed by U.S. military veterans and active-service personnel, 97% were unable to transition until after leaving the military; about 1/3 who had used the VA hospital had broached the subject of medical gender transition with the VA staff – and almost all requests were denied; and fully 10% had been denied services completely at the VA because they were transgender.

In a nutshell, what all branches of the military are saying is this:

• If your genitalia is non-normative, you are medically unfit to serve.
• If your gender presentation is non-normative, you are psychologically unfit to serve.
• If, after your active duty is over, you exhibit gender-nonconforming behavior (particularly if it involves a gender transition), don’t expect to be entitled to the full range of military benefits typically afforded to veterans.

If you think about it, the military uses medical and psychiatric diagnosis very effectively in order to keep gender nonconformity out of its ranks. There’s something wrong with you, they say. And as a result, you are unfit to serve.

But there’s a gaping hole in that argument – a hole so obvious it’s easy to miss. That hole is in the very foundation of military law –  the Uniform Code of Military Justice. Article 134 gives military officials sweeping powers to discharge service members for any behavior seen as a threat to “good order and discipline.” This code isn’t saying there’s something wrong with you. Rather, what it’s saying is, Keep quiet. Don’t rock the boat. Behave yourself, and keep good order and discipline.

I often think about how reframing the problem allows us to consider issues from an entirely different perspective. Gender nonconformity isn’t the problem. The problem involves people’s reactions to gender nonconformity. Just like homosexuality isn’t a problem – but homophobia is a huge problem. What if, instead of using medical and psychiatric restrictions to ban gender-nonconforming people from service, the military clamped down hard on transphobic, dehumanizing, oppressive behaviors?

In many ways, repealing “Don’t Ask, Don’t Tell” was a good thing. But it wasn’t enough – and frankly, I wish the LGBTQIA community could have stood in strong unifying solidarity, arguing for the repeal of DADT and for the elimination of all gender-oppressive military policies.

This Memorial Day, I reflect on the possibilities that acceptance, unity, and inclusivity offer to us. And I honor those who have served openly, and those who have served (and continue to serve) in silence.

 

It takes a lawsuit

June, 1967. A little boy, whose penis had been mutilated beyond repair as a result of a botched circumcision, lies on an operating table at Johns Hopkins University Hospital. The surgeons will remove his testes, and from that point on, the little boy will no longer be a boy. He will be Brenda (known to the public as “Joan”), a boy raised as a girl, and held up as proof of the malleability of gender.  Years later, the child’s doctor says, “The child’s behavior is so clearly that of an active little girl” – and the case is hailed as an unwavering success.

This story, as many of you probably know, does not end well. The doctor was John Money, and the child was David Reimer. As John Colapinto reported in his bestselling book, As Nature Made Him: The Boy Who Was Raised as a Girl, the case was anything but an unwavering success. He never identified as a girl, and he actively resisted wearing dresses and playing with girls’ toys. By age 14, he was openly identifying as a male, and at age 25, he went through a reverse sex reassignment process. Thirteen years later, at the age of 38, Reimer committed suicide – and since then, even though Reimer wasn’t intersex, his case has been used as a cautionary tale for the intersex community.

April, 2006. A 16-month-old baby, a ward of the state, lies on an operating table at the Medical University of South Carolina. This child, whose phallus is not within the “medically acceptable” range, is not easily labeled as either male or female. As a result, the child will undergo a phallectomy, and from that point forward will be raised as a girl. Sounds eerily familiar, doesn’t it?

The outcome? M.C., who is now eight years old, clearly identifies as a boy. He’s been asking his parents, “When will I grow a penis?” And his parents have to find a way to tell him that he was the victim of an unnecessary surgery that may have caused sterilization and reduction (if not outright elimination) of normal sexual functioning. The doctors chose the wrong sex – and M.C. will have to bear the consequences of that choice for the rest of his life. Thirty-nine years after David Reimer’s ordeal, and here we are again.

But this case has the possibility of a better ending. Last week, a lawsuit was filed on behalf of M.C. and his adoptive parents by Advocates for Informed Choice (AIC), The Southern Poverty Law Center (SPLC), and pro bono counsel for the private law firms of Janet, Jenner & Suggs and Steptoe & Johnson LLP.  The lawsuit alleges that: (1) M.C. was subjected to a medically unnecessary surgery without fully determining whether the procedure was in M.C.’s best interest, and (2) the doctors failed to obtain adequate informed consent before proceeding. Specifically, M.C.’s guardians were not warned about the significant risks of the surgery, they were not presented with the option of not having surgery at all, and they were not told that the surgery itself was cosmetic, but medically unnecessary. “His bodily integrity was endangered,” said M.C.’s father, Mark Crawford, in a BBC World Service interview.

These are serious medical allegations. Yet these practices, referred to as the “concealment model,” have been going on ever since the days of David Reimer and John Money. In fact, the concealment model (also sometimes referred to as the “optimal gender” model) has been the standard operating procedure (literally and figuratively) for intersex babies and children. It involves choosing a gender at birth, “normalizing” the infant’s genitalia so its body matches its gender assignment, and raising the child as a “normal” girl or “normal” boy, with no reference to the intersex condition whatsoever. Pretend as if the intersex condition never happened, and move forward from there.

In the same BBC World Service segment cited above, the interviewer asked, in a heartfelt tone of voice, “Do you believe this decision [to perform surgery on M.C.] could have been made in good faith?”

No, I don’t believe that this decision could have been made in good faith. If you consider the following time frame, I think you’ll see why:

July 1993:  The Intersex Society of North America (ISNA) is formed, which is the first major group to advocate for the human rights of intersex people.

February 2000: David Reimer’s story is made public in As Nature Made Him: The Boy Who Was Raised as a Girl.

May 2005: The San Francisco Human Rights Commission releases a report titled, “A Human Rights Investigation into the Medical ‘Normalization’ of Intersex People,” which among other things, says this about genital surgeries on intersex infants:

[T]he medical community . . . [tries] to make the problem ‘disappear’ with a scalpel and the withholding of information. . . .'[N]ormalizing’ interventions are inherent human rights abuses and deprive persons of the right to express their own identity.

February 2006:  The National Institute of Health releases their Strategic Plan for Pediatric Urology, which covers, among other things, the clinical and medical management of “congenital anomalies of sex differentiation” (otherwise known as intersex conditions). Prior to listing a set of clinical and research recommendations, the report provides a patient-centered perspective of the damaging effects of the concealment model (which, to me, sounds chillingly similar to M.C.’s experience):

They object to the fact that they were either not informed or were misinformed about their condition and had difficulty obtaining accurate information about their condition and treatment. They feel stigmatized and shamed by the secrecy surrounding their condition and its management. Many also attribute poor adult sexual function to damaging genital surgery and repeated and insensitive genital examinations, both performed without their consent.

April 2006:  M.C. is subjected to medically unnecessary surgery.

August 2006:  The highly-regarded journal Pediatrics publishes an article titled, “Consensus Statement on Management of Intersex Disorders.” Citing 90 references (all of which, by the way, were published before April of 2006, when M.C.’s surgery took place), the report presents a detailed set of best practices for treating people with intersex conditions. These recommendations include, but are not limited to, a much more cautious approach to surgery, emphasizing the functional outcome rather than mere cosmetic appearance. The publication of this article – in the flagship journal of the American Academy of Pediatrics – was seen as a major victory for the intersex community.

May 2013:  Medically unnecessary surgeries continue to be performed on intersex children. Frequently.

If this had happened twenty, thirty, forty years ago, one could argue that the decision to perform surgery was made “in good faith.” But considering that the medical community was engaging in broad-based conversations about intersex conditions right when M.C.’s surgery took place, that argument doesn’t hold much water – and frankly, it exhibits flagrant disregard of the existing medical recommendations. This lawsuit won’t reverse the harm that M.C. was subjected to. But it might do what the NIH Strategic Plan and the AAP’s Consensus Statement have been unable to do – prevent this from ever happening to another child. Anne Tamar-Mattis, who is the executive director for AIC, was quoted as saying: “This case is about ensuring the safety of all children who do not have a voice.”

How sad that it takes a lawsuit in order for that to happen. If only it could have helped David Reimer, and all the other individuals who had surgery when it wasn’t needed.

* * * * * * * * * *

If you would like to learn more about this case, or if you’d like to find out how to get involved and show your support, please visit the Advocates for Informed Choice website at http://aiclegal.org.

Hanging by a pink ribbon

I hate the mall. The only time I ever go is with my mom – and last week, since my mom was visiting from New Jersey, guess where we went? The mall. It occurs to me that you can take the girl outta Jersey, but you can’t take the Jersey outta the girl – especially when her mother’s in town.

So off to the mall we went. And when we got there, the first thing I noticed were all the pink ribbons. Pink ribbon signs, pink ribbon banners, even pink ribbon balloon sculptures. As it turns out, our local Race for the Cure was to be held that following Saturday, the day before Mother’s Day, and the Susan G. Komen Foundation was holding a race sign-up event and fundraising drive. Interestingly, there were quite a few stores that were holding Mother’s Day sales, several of which brandished the familiar pink ribbon logo on their Mother’s Day sale signs. It used to be that on Mother’s Day, you got carnations and breakfast in bed, I thought to myself as we walked through the mall. Now, you get a pink ribbon and a friendly reminder to get your mammogram.

And it isn’t just the mall. Many cities, including Philadelphia, Chicago, Minneapolis-St.Paul, and Pittsburgh, are holding Mother’s Day breast cancer walks and/or runs. The American Cancer Society is holding their “A Mammogram for Mother’s Day” campaign. And pink-stitched balls will be used at major league baseball fields throughout the country. Obviously, the link between Mother’s Day and breast cancer awareness has been firmly cemented – which, to me, seems a little odd.

Why? Because, compared to other groups, mothers aren’t the highest-risk group for breast cancer. Having a full-term pregnancy before age 30 significantly reduces cancer risk. Breastfeeding has also been shown to reduce breast cancer risk. If breast cancer awareness groups are looking to target women who are at a higher risk for breast cancer, they’re barking up the wrong tree by choosing Mother’s Day as their focus. Motherhood is actually a protective factor, not a risk factor.

So which groups are at higher risk?

Lesbian and bisexual women. According to a 2010 study published in the Journal of Women’s Health, lesbians are at higher risk for breast cancer, ovarian cancer, and endometrial cancer, compared to heterosexual women. Moreover, a 2012 study showed that women with same-sex partners have a greater risk of dying from breast cancer. Smoking and alcohol consumption, which some studies indicate are more common behaviors among lesbians, account for some of the heightened risk. According to some studies, lesbians tend, on the average, to weigh more than their heterosexual counterparts, and higher body weight is a risk factor for breast cancer. Women who are in relationships with women are less likely than married heterosexual women to have children, which also increases the risk. And numerous studies indicate that non-heterosexual women are less likely to seek health care due to a fear of a chilly health care climate – and studies show that, as a result,  a lower percentage of lesbians receive mammograms compared to other women.

Transgender men and women. To date, no prevalence studies have been conducted that assess the rates of breast cancer for transgender individuals. However, health care providers note that, for transgender women, being on long-term hormone therapy likely increases the risk of breast cancer, and for transgender men, the body converts excessive testosterone into estrogen, which elevates the risk of breast cancer. Moreover, transgender men are less likely to engage in breast self-examination, and they may not realize that top surgery does not remove all breast tissue.

African-American women. Although African-American women have lower rates of breast cancer compared to White women, their risk of dying from the disease is 38 percent higher, according to statistics from the National Cancer Institute. A 2010 study conducted by Cheryl Fields indicated that African-American lesbians and bisexual women may be at even heightened risk, given their multiple minority status and associated barriers to health care. Moreover, African-American women are at a higher risk for triple-negative breast cancer, in which the tumor is estrogen receptor-negative, progesterone receptor negative, and HER-2 (human epidermal growth factor 2) negative. Triple-negative breast cancer tends to be a very aggressive disease, with high mortality rates.

Latina women. Like African-American women, Latina women are at heightened risk for triple-negative breast cancer. In addition, although Latina women have a lower risk of breast cancer compared to White women, they tend to get diagnosed at the later stages of the disease.

Asian-American women. Oddly enough, for Asian American women, acculturation seems to be a risk factor: immigrants to the United States have a lower risk of breast cancer than Asian-American women who have lived in this country for many years. Women who are native Hawaiian and Samoan have even higher rates of breast cancer than White women.

Native American/Indigenous women. Compared to other ethnic groups, Native women have very low rates of breast cancer – but their mortality rates rank among the highest. Women who live in Alaska have the highest rates, whereas rates of breast cancer among Native women in the Southwest are much lower.

Ashkenazi Jewish women. Women of Ashkenazi Jewish descent seem to be at a higher risk for breast cancers that result from BRCA gene mutations. Genetic testing can determine whether a woman has a mutated form of the BRCA1 or BRCA2 gene.

Poor women. This almost goes without saying – obviously, if a woman lacks health insurance, doesn’t have access to preventative care, or faces other socioeconomic barriers, she will be at a higher risk for a range of illnesses and diseases, including but not limited to breast cancer. However, the Susan G. Komen Foundation and other cancer awareness groups don’t typically isolate this group as being high-risk – so I thought I would.

If you scan the list, I think it’s fair to say that being a member of a historically marginalized group is a significant risk factor. Note that many of these groups are not necessarily at a high risk for a breast cancer diagnosis – but they are at a high risk for breast cancer mortality. And note, too, that women in most of these groups, due their marginalized (or multiply marginalized) status, are more likely to be economically disadvantaged, which increases the breast cancer mortality risk dramatically. Given those realities, is a Mother’s Day breast cancer awareness event the most effective intervention?

I think not.

Instead, the Susan G. Komen Foundation ought to head over to LGBT Pride events and community centers, to transgender-specific events, to ethnic and cultural celebrations, to religious and spiritual centers, to food banks, to WIC offices, to community health centers that serve ethnically-specific populations. And merely spreading awareness isn’t enough – we need to address the numerous barriers to health care that these historically marginalized groups experience. Instead of pinkwashing our malls, streets, and ballfields with the familiar ribbon logo, let’s refocus our efforts and think about how we can truly reach all women.

 

 

Finding my tribe

“It was 1989. My thoughts were short, my hair was long. Caught somewhere between a boy and man.”

-Kid Rock, “All Summer Long”

Sixteen days and counting. I can smell summer getting closer and closer. When I hear that song, I can imagine myself down the shore in New Jersey, in the summer of ’89, right after I graduated high school. And I’m thinking, I am SO glad to be the hell out of there.

High school wasn’t horrible, but it wasn’t great. It was particularly not great if you were different in any way from the mainstream. Being queer wasn’t really on my radar screen at that time, but I was definitely “different.” Recently, one of the people I interviewed used the term “intellectually variant” to describe herself, and I thought, That’s how I was different! I enjoyed reading classic literature. I was really good at math – and liked it enough that I joined the Math Club (and, later, the Math Team). I went to art museums and listened to classical music (and contemplated the relationship between music and math). I cared more about all that stuff than I did about partying, or going to football games, or any of the stuff that normal high school kids do. And a lot of kids thought I was weird for it.

But I had places to plug in, uncool as they may have been. At least there was a Math Club, and a humanities class, and a Science Club, and other spaces for intellectual variants like me. However, if I’d been grappling with my sexual identity, there wouldn’t have been any obvious places for me to go for support. I could hang out with the theater crowd, or the artsy crowd, or the chorus people. I could look for the people who listened to Depeche Mode and Erasure, the people who had Andy Warhol and Keith Haring images in their lockers. I would have been left to my own devices to find the subterranean queer spaces that existed. If they even existed at all.

Fast-forward 24 years to 2013, and we’re looking at a totally different landscape. There are over 3,500 Gay-Straight Alliances in high schools throughout the United States, and more than 130 of them are in New Jersey, where I grew up. Of course, not every school (including mine) has a GSA – in many states, the landscape is pretty stark. The queer kids who live in California, New York, Massachusetts, Pennsylvania, Illinois, and yes, New Jersey, are very lucky, comparatively speaking.

What if I’d been born 24 years later – and what if I had been one of the lucky ones? Quite honestly, I’m not sure that I would have joined. In some ways that might sound strange – why wouldn’t you want to join a GSA, if there’s one available? As it turns out, there are other kids out there who, like me, choose not to join either, for various reasons.

Nicholas Heck, a clinical psychology graduate student at the University of Montana, asked that same question – how come some queer kids choose not to join the GSA if one exists at their school? He recently published a study in the Journal of Gay & Lesbian Social Services titled, “To Join or Not to Join: Gay-Straight Student Alliances and the High School Experiences of Lesbian, Gay, Bisexual, and Transgender Youths,” in which he surveyed 79 GSA members and 66 non-members, whose identities ranged across the LGBTQ spectrum. To the non-members, he asked: “Why weren’t you a member of this group?” Their responses fell into five different categories:

1. I’m not interested.

In some cases, kids chose not to join because their school’s GSA was more of a social group, and they wanted to be more politically involved:

[The GSA group at my school is] too touchy-feely and lazy for me. I wanted to do social justice work, but nobody seemed to have enough drive (Heck et al., 2013, p. 93).

2. I’m not out, and I’m not interested in coming out.

One student said:

I attended this school during ninth and tenth grade, and at this point, I was very unaware of my sexuality. Also, all of my friends were straight and I’m sure I would have gotten harassed had I chosen to attend these meetings (Heck et al, 2013, p. 91).

3. I’m afraid.

This theme elicited some of the most poignant responses. Some of the kids were afraid of their parents finding out they were queer:

I did not want to associate with things that were blatantly gay. Although (I think) it was quite obvious that I was gay throughout high school, I did not want people to know that I was gay because I was afraid it would somehow get back to my parents (Heck et al., 2013, pp. 90-91).

4. I’m too busy.

Sometimes students didn’t attend because they were involved in other clubs and organizations. Others didn’t participate because of responsibilities outside of school:

I had a lot of responsibilities at home, my mom was a single parent, so I helped her raise my little brothers (Heck et al., 2013, p. 89).

5. Our GSA is too disorganized/inactive/not welcoming.

This theme elicited a range of responses, such as this one below:

It was nice that we had a GSA, but I didn’t attend regularly because sometimes I felt uncomfortable there. Many of the people were nice, and I made a few friends there, but the regular attendees were rude to me sometimes. Some of the events were fun, but there were not enough events organized (Heck et al., 2013, pp. 92-93).

Some chose not to participate in their school’s GSA. But others felt shut out. And for them, it’s like being in high school in 1989, with a twist – because there’s nothing worse than feeling excluded from the group that was set up to support them in the first place. For poor and working-class students in a middle-class school environment, outside responsibilities might interfere with GSA participation. If a female student wants to participate in a largely-male GSA, (or if a student of color wants to join a largely-White GSA), the reception might be a bit chilly. And an intellectual variant (and budding social activist) like me? Well, if the GSA’s activities involved reading LGBTQ subtexts in Shakespeare’s plays, or setting up a Queer Math Team, or convincing our biology teachers to include sexual variation in the animal kingdom in our curriculum, I’d sign up in a heartbeat.

We place such high hopes on GSAs. They help to create more welcoming school environments. They are associated with higher GPAs, lower suicide rates, less drug and alcohol use, and a higher sense of belonging. But we can’t place the state of LGBTQ youth solely on the backs of GSAs. We don’t always find our reflection in the same place – that’s why we need a diverse range of queer spaces, so that all of us can find our reflection.  And, more importantly, we need an infrastructure that will support a range of queer spaces – including, but not limited to, GSAs.

“All Summer Long,” a mashup between two classic rock songs, ends with a sampling from Lynyrd Skynyrd:

“Singing Sweet Home Alabama all summer long.”

If only Alabama, and other places, were so sweet for us queers.