Foreword by Christine Burns...

It seems an age now since J. Michael Bailey's infamous book, "The Man Who
Would Be Queen" burst into the lives of transsexual people the world
over to insult us all. In fact it is just two and a half years since the
book was published in March 2003, and already almost a year since the
FIRST chapter of the story closed, with the author unceremoniously
removed from his position as Chair of the Psychology Department at

Northwestern University in Chicago, following investigations into complaints
about research misconduct.

The anger aroused by Bailey's allegedly "scientific" trashing of our
reputations was great enough at the time to spill over into other areas.
The Lambda Literary Foundation, for instance, was forced into a
humiliating reversal of its initial decision to shortlist the book as a
contender in their annual LGBT awards. Angry trans activists and authors
called on the organisation to "Give us Back Our T". Eventually, in March
2004, the nomination was withdrawn. In June 2005 the Executive Director
of LLF, Jim Marks, resigned from the post he had held since 1995.

Although slow to react at first, some academic and clinical commentators
stood up to be counted during the first crucial months of the
controversy.

In July 2003 Kinsey Institute President, John Bancroft, spoke out at a
meeting of the International Academy of Sex Research to proclaim that
the book, "...is NOT Science". Dr Bruce Frier, a classical scholar and law

professor at the University of Michigan wrote in an Amazon.com review,
"This book is pretty awful by anyone's standards: voyeuristic in the
extreme, with little in the way of actual research or bibliography".

Unfortunately, it was notable that the vast majority were silent, or at
least very slow to react in support of the people who literally support
their careers. For the most part the campaign to challenge Bailey's
slander fell mostly on the shoulders of his victims.

Stanford University Professor Joan Roughgarden (a prominent and
published academic trans woman herself) rounded on the profession in
February 2004, describing the affair as "Psychology Perverted". She said,

"I wonder if many psychologists fully grasp the
image some of their colleagues are projecting---
psychology as a discipline without standards,
nourishing a clique of dumbly insensitive bigots."

"These psychologists don't seek to help people, but
to dominate them by controlling the definition
of normalcy."

"Their bogus categories and made-up diseases are
intended to subordinate, not to describe."

By 2004 critics were finding voice. In March 2004, four UK psychologists
felt sufficiently goaded by the criticisms now being leveled at the
professional community to write,

"We are particularly concerned that Bailey's work will
be seen as representative of scientific psychological
research, both by the trans community and by other
sections of the public."

"...the danger that Bailey's expressed anti-trans
opinions might be confused with scientific evidence
is particularly high in this case."

Yet these words only appeared a full year after the book had been
published ... after 12 full months of increasingly blunt criticism of
the profession. Psychologists were, it seems, slow in waking up to the
consequences of leaving their clients to roast.

The HBIGDA was particularly slow to react at first. Yet finally, and
belatedly, they roused themselves.

At the HBIGDA symposium in Ghent, Belgium, in September 2003, outgoing
President Dr Eli Coleman showed a slide of the infamous book's front
cover as he said, "We Need to Challenge Bad Science". He commented on
the need to "promote sound and ethical research" and of the need to work
with the trans community to "end antipathy and distrust of researchers".

This was a telling comment. It showed that leaders in HBIGDA could see
the writing on the wall. They could see the possibility of a tipping
point when the trans community might decide that the benefits of
accepting a degree of medical pathologisation were outweighed by the
disadvantages.

A few weeks later, HBIGDA's officers and Board of Directors wrote in an
open letter to Lynn Conway, Joan Roughgarden and other trans academics,

"The HBIGDA Board of Directors believes that a
relationship of trust and mutual respect between the
scientific and the transgender communities is essential
to further its mission to promote the health and well-being
of transgender and transsexual individuals and their
families. It is felt by many of our members that this
poorly referenced book does not reflect the social and
scientific literature that exists on transsexual people
and could damage that essential trust"

The latest review of the Bailey book in the August edition of the
Journal of Sex Research should be seen in that context, therefore (see
below for the full text).

Walter Bockting is a board member of HBIGDA, an Editor of the
International Journal of Transgenderism (http://www.symposion.com/ijt/ )
and has been in the trans care business for more than long enough to
understand the political history of trans treatment. He goes right to
the heart of the debate we've been highlighting in recent weeks when he
comments in this review:

"...the inclusion of gender identity disorder in the Diagnostic
and Statistical Manual of Mental Disorders (American Psychiatric
Association, 1994) has not resulted in broad health insurance
coverage for transgender care, more and more transgender
individuals perceive this diagnosis and the need to consult
with a mental health provider as unnecessarily pathologizing"

It's a welcome admission of the principal defence for keeping trans
people in the psychiatrists' book of mental disorders all these years.
And what a blow to the DSM's credibility. We're not in there for a good
clinical reason, but through the history of expediency.

The question is, are reviews like this, and their expressions of support
and common interest, too little or too late to repair the damage done
since March 2003 when J. Michael Bailey set out to define the views of
the psychology profession in the public's eyes?

Have trans people gone so far down the road of having to defend
themselves that the days of reliance on psychological patronage and
control are well and truly over?

Should the marriage partners be hastily booking a romantic getaway to
patch up their differences and learn to cuddle one another, or is it
time to bring in the lawyers and start packing separate boxes to move
out?

This week Kevan Wylie circulated our "Manifesto for care" to the various
representatives taking part in the RCPsych committee drafting new UK
standards of care.

See http://www.pfc.org.uk/medical/cb-eval1.htm (HTML version)

Or  http://www.pfc.org.uk/medical/cb-eval1.pdf (Formal copy)

Many thanks to Kevan for recommending that his professional peers should
study our invitation to rethink things from the ground up.

One can only hope that the practitioners on the committee wake up and
smell the coffee, if they have not already done so. For we are truly at
a turning point following the events of the last couple of years.

Bockting summarises it with commendable succinctness:

"...being transsexual means sometimes not knowing who to trust"

Absolutely! Except that I would delete the word "sometimes".

Trust is most certainly at an all time low between trans people and
people who would like to be involved in their care. It has sunk SO low
that much of the debate on the trans side is how to diminish or
eliminate the control dependency that arises from the system of
psychiatrists' letters for surgery. The talk is increasingly about
divorce, because there is so little faith in the possibility of
reconciliation.

And yet our "Manifesto for Care" is focussed quite squarely on how it
might be possible for trans people and care professionals to work
together in TRUST and mutual respect towards shared goals for
individuals and the trans population as a whole.

Will things change? Will the RCPsych committee members be prepared to
put EVERYTHING about current practice on the table for close appraisal?
Will they create a manual that seeks to limit innovation and diversity,
or can they do the VERY brave thing, put their illuminated scrolls in a
museum, and start designing a care system framework for TODAY, based on
principles and aspirations which everyone can subscribe to?

Walter Bockting demonstrates that you CAN arrive late at the party and
be welcomed. Just make sure you bring a damned good bottle of wine.

- Christine Burns
August 21st, 2005

===================================================
BIOLOGICAL REDUCTIONISM MEETS

GENDER DIVERSITY IN HUMAN SEXUALITY

The Journal of Sex Research
Volume 42, Number 3,
August 2005: pp. 267-270

===================================================

The Man Who Would Be Queen: The Science of Gender-Bending and
Transsexualism, by J. Michael Bailey. Washington, DC: The Joseph Henry
Press, 2003, 233 pages. Cloth, $24.95.

Reviewed by Walter O. Bockting, Ph.D., University of Minnesota Medical
School, Program in Human Sexuality, Department of Family Medicine and
Community Health, 1300 South Second Street, Suite 180, Minneapolis, MN,
55454; e-mail: bockt001@umn.edu.

Web version transcribed by Prof Lynn Conway and published at:
http://tinyurl.com/cfh5p

===================================================
 
The Man Who Would Be Queen is the most controversial book on
transsexuality since Janice Raymond's The Transsexual Empire (1979) and
is the latest challenge to what already was a fragile relationship
between the scientific and the transgender communities. What is all the
fuss about? What does the book say, why is it so controversial, and what
does this controversy tell us about sex research with stigmatized
populations like the transgender community?

What the Book Says
------------------

Bailey argues that there are essentially two types of male-to-female
transsexuals who can be distinguished on the basis of their sexual
orientation. The first type is homosexual transsexuals, extremely
gender-transposed (feminine) men whose sexual object choice is toward
men instead of women. According to Bailey, their primary motivation to
change sex is to attract more men sexually: "Those who love men become
women to attract them" (p. xii).

The second type is autogynephilic transsexuals, meaning paraphilic men
whose sexual object choice is toward the image of themselves as women.
For this group, the primary motivation for changing sex is to become the
object of their desire: "Those who love women become the women they
love" (p. xii). According to Bailey, the sexual attraction to men that
this latter group may report is secondary to their idea of what it is
like to be a woman (i.e., interested in men). The sexual attraction to
women that autogynephilic transsexuals may report is deemed less than
genuine; they envy, rather than love, other women. As Bailey explains,
"Autogynephilic transsexuals might declare attraction to women or men,
to both, or to neither. But their primary attraction is to the women
that they would become" (p. 147).

By fitting all male-to-female transsexuals into this typology, Bailey
attempts to fortify theory and research that postulates a biological
link between gender identity and sexual orientation, between gender
transposition (demasculinization and feminization) and homosexuality. As
Bailey states, "Succinctly put, homosexual male-to-female transsexuals
are extremely feminine men" (p. 146).

This is not a new typology. It was coined by Ray Blanchard in the 1980s
and has been widely published in the scientific literature (e.g.,
Blanchard, 1987, 1989). However, Bailey's book is accessible to a lay
audience through its non-academic style that, especially to the
uninformed reader, makes a very convincing case that the gender
diversity found within the transgender community can be reduced to these
two types. The book contains eleven chapters divided into three parts.
Part one is about childhood femininity among boys, part two about
femininity and masculinity among gay men, laying the foundation for part
three: the typology of homosexual versus autogynephilic transsexuals.

Unfortunately, the book fails to offer a balanced and well-cited review
of the scientific literature that would have shown that the diversity
found within this community cannot as easily be reduced to the two
types. Bailey dismisses clinical experience and ignores research that
provides evidence of much greater diversity in gender identity, gender
expression, and transgender sexuality. For example, to explain accounts
that do not conform to the typology, he states: "Autogynephiles who
claimed to be homosexual transsexuals could account for the apparent
cases of homosexual transsexuals who practiced erotic crossdressing" (p.
173).

Why the Book is Controversial
-----------------------------

Bailey criticizes scholars who support a social constructionist
perspective on transsexuality for giving ideology precedence over
science. What he omits is that gender transposition theories have been
challenged in the scientific literature on psychological, sociocultural,
and biological grounds (Coleman, Gooren, & Ross, 1989). Bailey further
limits his focus to male-to-female transsexuals. However, research on
female-to-males attracted to men shows that they do not fit as easily
into the reductionistic typology (Bockting & Coleman, 1991; Coleman &
Bockting, 1987; Coleman, Bockting, & Gooren, 1993).

Another point of controversy is Bailey's portrayal of scholars and
clinicians who provide transgender-specific health care and who provide
access to sex reassignment services according to the Harry Benjamin
Association's Standards of Care (Meyer et al., 2001). According to
Bailey, these professionals are ignorant of the homosexual versus
autogynephilic typology of transsexuals. Bailey offers several
explanations for this. He argues that the two types of transsexuals
rarely mix, that gender clinics only see heterosexual (i.e.,
autogynephilic) transsexuals because homosexual transsexuals tend to
obtain their hormones on the black market, that clinicians take their
clients' self reports at face value when they shouldn't, and that "sex
researchers are not as scholarly as they should be and so don't read the
current scientific journals" (p. 176).

These claims do not mirror the experience of the majority of scholars
and clinicians in this field (see www.hbigda.org and
www.symposion.com/ijt ). They do see male-to-female transsexuals
attracted to men who mix with male-to-female transsexuals who are in
satisfying intimate relationships with women. Members of both groups
pursue sex reassignment to alleviate a gender identity conflict, not to
attract more men or to satisfy their paraphilic sexual desire.
Clinicians also see a number of male-to-female transsexuals who are
genuinely bisexual and attracted to both men and women. Clients'
self-reports are verified when necessary (e.g., by including in therapy
significant others, family, and friends). Although every field has its
more or less informed workers, many scholars and transgender-specific
health providers (as well as their transgender clients) stay abreast of
the scientific literature in the areas of transgender identity and
sexuality.

Bailey's perceptions might have been skewed by his lack of contact with
the health professionals in this field (he is not a member of the
Benjamin Association) and his reliance on very limited field work with a
very small sample of transgender informants in Chicago gay bars.
Perhaps it is his lack of extensive clinical experience with
transsexuals that prompted his criticism of clinicians and prevented him
from recognizing that sex and gender are more diverse than is generally
assumed.

The reality is that many individuals are encountered in clinical
practice who do not fit the typology of homosexual versus autogynephilic
transsexuals. These individuals continue to challenge our limited
understanding of gender and sexual identity development. Autogynephilia
does exist, but in light of this limited understanding, the term is
better used as a descriptive phenomenon present in the lives of certain
transgender individuals rather than elevated to one of only two
essentialist etiological types. It is difficult to understand a clinical
population based on limited field research and a read of the literature;
it takes extensive clinical experience under supervision to understand
and treat clients presenting with such issues as autogynephilia.
Moreover, research in nonclinical settings has revealed a greater
diversity in gender identity and expression across cultures and
throughout time (e.g., Herdt, 1994).

Although some members of the transgender community endorse the typology
outlined in the book (e.g., Lawrence, 2004), Bailey's book has elicited
a storm of criticism and personal attacks by his informants and by
transgender community activists (e.g., Conway, 2003-2004). Allegations
include violations of ethical research conduct such as lack of informed
consent and dual relationships. The informants and their peers have
stated that the book inadequately represents the reality of their
experience. In the book, Bailey explicitly states how much he respects
his informants, yet information from transsexuals that contradicts his
theory is dismissed as self-justification, identity politics, and lies:
". . . they are often silent about their true motivation and instead
tell stories about themselves that are misleading and, in important
respects, false" (p. 146).

Self-report bias certainly does exist, but the subjectivity of gender
and sexuality is just as valid and undeniable as its biological
manifestation. The book proclaims to be "free of ideology," yet a
biological, essentialist perspective is simply another point of view.
Due to his narrow biological orientation and dismissal of the social
constructionist and clinical perspectives, Bailey may have
under-appreciated the psychosocial and cultural context (one of intense
stigma) in which his transsexual informants actualize their gender
identity and sexuality.

What the Controversy Tells Us About Sex Research with Stigmatized
Populations
------------------------------------------------------------------------
-----

The impact of this controversy is not limited to Bailey and his book.
Instead, it is yet another blow to the delicate relationship between
clinicians, scholars, and the transgender community. The establishment
of mutual respect and trust among these groups has always been
complicated. After Hirschfeld (1910) medicalized transvestism and
transsexualism, clinicians attempted through psychodynamic and behavior
therapy to change transsexuals' gender identity to make it match their
sex assigned at birth (for a review see Gelder & Marks, 1969, or Kuiper,
1991).

With Christine Jorgenson's widely publicized sex change and Harry
Benjamin's book The Transsexual Phenomenon (1966), the tide turned away
from conversion therapy, but clinicians took on the role of gatekeepers
controlling access to sex reassignment. In 1979, the sex reassignment
program at Johns Hopkins University closed on the basis of a study that
evaluated the outcome of sex reassignment (Meyer & Reter, 1979), a study
that since has been criticized for being methodologically flawed and
politically motivated (Money, 1991). In that same year, Janice Raymond
published The Transsexual Empire (1979), in which she attacked
transsexuals' claim to womanhood and went so far as to equate sex
reassignment with rape (see Stone, 1991). This history has made many
transgender persons wary of scholars and clinicians.

Finally, because the inclusion of gender identity disorder in the
Diagnostic and Statistical Manual of Mental Disorders (American
Psychiatric Association, 1994) has not resulted in broad health
insurance coverage for transgender care, more and more transgender
individuals perceive this diagnosis and the need to consult with a
mental health provider as unnecessarily pathologizing. The controversy
surrounding this book adds to the challenge of delivering transgender
health services and threatens the partnerships and participation of the
transgender community required to conduct research to promote
transgender people's well-being.

Research as well as clinical work with the transgender community has to
take into account the stigma that transgender and transsexual
individuals experience because of their gender nonconformity. Such
stigma contributes to a dynamic that Freire (1970) called the pedagogy
of the oppressed, in which transsexuals struggle to question existing
norms and validate their unique experiences of gender. In this context,
being transsexual means sometimes not knowing who to trust. Bailey
appears to have underestimated the power of this dynamic and the
vulnerability of his research participants. At the same time, the
transgender community needs to be reminded that the vast majority of sex
researchers and clinicians are on their side, that they experience
stigma associated with the transgender focus of their work, and that
they cannot do this work without the cooperation and support of the
transgender community.

Science can be part of bringing about desired social change for
stigmatized populations such as the transgender community. For example,
research on the efficacy of sex reassignment contributed to the decision
of several health insurance companies in Minnesota to cover
transgender-specific medical care. The Benjamin Association has issued a
number of legal briefs to support the civil rights of transgender
individuals. Advocacy is an important task of professionals working in
this field. It is unfortunate that Bailey and his supporters seem to
confuse such advocacy with a less-than-critical stance toward patient
self-reports and toward attacks launched by members of the transgender
community against this book.

What the Book Could Have Been
-----------------------------

An up-to-date, evidence-based discussion of the broader scientific
literature on transgenderism and transsexuality, written in a manner
accessible to the general public, would have been a valuable
contribution. The book could have educated readers about the
increasingly visible diversity in gender and sexual orientation among
the transgender population and discussed the implications of this
diversity for our understanding of sexual identity. It could have shown
how the approach of clinicians has changed from trying to identify the
"true" transsexual toward client-centered, transgender-affirmative
health care. Bailey could have called for more research to explore the
next frontier in the study of gender. He could have illuminated how
science can play a role in promoting transgender rights and sexual
health. Alternatively, Bailey could have stuck to research on sexual
orientation with which he is more familiar rather than have ventured
into the study of gender, an area he appears to know less about.

Conclusion
----------

This book's primary strength is simultaneously its major weakness: It is
a powerful and eloquently described synthesis of available data that
supports a reductionistic, biological theory of gender identity and
sexual orientation, but without adequately recognizing the role of
psychosocial and cultural factors (such as social stigma and cultural
constructions of gender) in the development of gender identity. Hence,
the book will appeal to those who share Bailey's essentialist point of
view while alienating those who favor a biopsychosocial perspective.

We need a book that is as well written as this one, but that is more
comprehensive and leaves room for what is yet to be discovered about the
diversity in gender and human sexuality. In the interim, we can let the
evolving stories of transgender individuals speak for themselves.


REFERENCES
==========
American Psychiatric Association. (1994). Diagnostic and statistical
manual of mental disorders. (4th ed.). Washington, DC: American
Psychiatric Association.

Blanchard, R. (1987). Typology of male-to-female transsexualism.
Archives of Sexual Behavior, 14, 247-261.

Blanchard, R. (1989). The classification and labeling of nonhomosexual
gender dysphorias. Archives of Sexual Behavior, 18, 315-334.

Bockting, W. O., & Coleman, E. (1991). A comment on the concept of
transhomosexuality, or the dissociation of the meaning. Archives of
Sexual Behavior, 20, 419-420.

Coleman, E., & Bockting, W. O. (1988). "Heterosexual" prior to sex
reassignment, "homosexual" afterwards. A case study of a female-to-male
transsexual. Journal of Psychology and Human Sexuality, 1(2), 69-82.

Coleman, E., Bockting, W. O., & Gooren, L. J. G. (1993). Homosexual and
bisexual identity in sex reassigned female-to-male transsexuals.
Archives of Sexual Behavior, 22, 37-50.

Coleman, E., Gooren, L., & Ross, M. (1989). Theories of gender
transpositions: A critique and suggestions for further research. The
Journal of Sex Research, 26, 525-538.

Conway, L. (2003-2004). An investigation into the publication of J.
Michael Bailey's book on transsexualism by the National Academies.
[Available online at
http://ai.eecs.umich.edu/people/conway/TS/LynnsReviewOfBaileysBook.html
].

Freire, P. (1970). Pedagogy of the oppressed. New York: Continuum.

Gelder, M. G., & Marks, 1. M. (1969). Aversion treatment in transvestism
and transsexualism. In R. Green & J. Money (Eds.), Transsexualism and
sex reassignment. Baltimore, MD: The Johns Hopkins Press.

Herdt, G. (Ed.). (1994). Third sex, third gender: Beyond sexual
dimorphism in culture and history. New York: Zone Books.

Hirschfeld, M. (1910/1991). Transvestites: An investigation of the
erotic drive to crossdress. Amherst, NY: Prometheus Books.

Kuiper, A. J. (1991). Transseksualiteit: Evaluatie van de
geslachtsaanpassende behandeling. Amsterdam, The Netherlands: Vrije
Universiteit.

Lawrence, A. (2004). Autogynephilia: A paraphilic model of gender
identity disorder. Journal of Gay and Lesbian Psychotherapy, 8(1/2),
69-87.

Meyer, W. III, Bockting, W., Cohen-Kettenis, P., Coleman, E., DiCeglie,
D., Devor, H., et al. (2001). The standards of care for gender identity
disorders, sixth version. International Journal of Transgenderism, 5(1).
[Available online at www.symposion.com/ijt/ ].

Meyer, J. K., & Reter, D. J. (1979). Sex reassignment follow-up.
Archives of General Psychiatry, 36, 1,010-1,015.

Money, J. (1991). Serendipities on the serological pathway to research
in gender identity and sex reassignment. Journal of Psychology and Human
Sexuality, 4(1), 101-113.

Raymond, J. G. (1979). The transsexual empire: The making of the
she-male. Boston: Beacon Press.

Stone, S. (1991). The empire strikes back: A post-transsexual manifesto.
In J. Epstein and K. Straub (Eds.), Body guards: The cultural politics
of gender ambiguity. New York: Routledge.

 

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