I think that part of transition, no matter what kind of transition, is that it is a selfish process. Speaking as a person who was a sighted person and now I’m losing it and having to learn to be in the world in a whole different way, to me that’s a selfish process. It’s pretty much all I can do sometimes to deal with that. And it’s hard to have something so absorbing in your life, and be a couple. And at the time that Tom was having his transition about gender, I was having a transition about becoming a middle-aged woman, losing my vision, and my children growing up and leaving home. And then Tom had lived in a relationship but in his own space, alone, for a long time. So then there was another transition as we started spending a lot of time mostly here. He had this whole apartment to himself. So some of those things are unique to a couple that has a transgender person in it, and definitely there is a part of this process that I can’t enter. It’s a personal process. I can be feeling fine about his body, that I like his body, even as it changes, but he could be having different feelings at different times about his body. And that’s not about me, but it has an effect on me.
Q: Have you noticed any significant changes in Tom after transition?”
I wasn’t in a relationship with Tom before, so I don’t know what his communication style was. But we have a really different style of communication, in that mine tended to include more words than his does. And compounded by the problem of losing my vision, I need more words, and talking in a way more than some people might. I also think there is also the whole thing of what Tom refers to as a kind of adolescence. And a lot of guys talk about it that way. It’s very confusing to be in a relationship with someone who is on the one hand six or seven years older than you are, and has gray temples, but also has another adolescent part, trying to figure out things like how to be a man. It is this process you have to go through. Then there’s this whole phenomenon that Tom mentioned of having to talk about it [transition], in a lot of detail. I think it’s really interesting. So there is a way that I really like talking about it, but I also like that more time has passed and he’s had more experience, that if we go into a social situation, there is a range of topics, not just that one.
I think that’s a struggle that I’ve heard from other partners, friends, and allies close to people in transition. It’s really key that you maintain a boundary, and that you continue to put energy into yourself. You have to hold your own place, and that seems especially important and also difficult to get that balance. And then the other thing is when Tom was really early in transition, we didn’t have the kind of ease that we have now. Because his body had changed, and so the perception on the street of him—how he looks on the outside, how he feels, and who he feels himself to be … there’s no incongruity—they take him as a male. And so when I first started going out with him, those changes weren’t as dramatic yet. If we had been somewhere more rural, not the Castro, not San Francisco, I think that even at that point most people would have taken him as a male. But because of the consciousness here that a woman can look a lot of different ways and a man can look a lot of different ways, there were people who did spot him and see him as female still. And I know that was really hard for him. You have a kind of protectiveness in that you don’t want the person you love to be hurt, and there’s nothing you can do about that.
Six
CHILDHOOD, INTERRUPTED
I wonder what my parents imagined would happen to me in a mental hospital. They wanted the doctors to tame me but they didn’t ask, and the doctors didn’t say, exactly what this process entailed. It was the doctors who came up with the idea that I was “an inappropriate female”—that my mouthy ways were a sign of a deep unease in my female nature and that if I learned tips about eyeliner and foundation, I’d be a lot better off. Who would have told my parents this? Not me. Once I was locked up, I lost interest in holding a meaningful conversation with my parents.
In 1974 millions of Americans were suddenly cured of mental illness when homosexuality was deleted from the Diagnostic and Statistical Manual of Mental Disorders (DSM), often referred to as the “bible” of psychiatry. This reference book, which today runs to nearly nine hundred pages, defines and classifies more than three hundred mental disorders. The DSM is used not only by psychiatrists, but also by courts, schools, and social service agencies in making decisions about matters as varied as child custody, criminal liability, placement in special education classes, and receipt of Social Security benefits. The DSM also profoundly affects the way that we as a society think about mental health and disease. “Defining a mental disorder involves specifying the features of human experience that demarcate where normality shades into abnormality,” write sociologists Herb Kutchins and Stuart Kirk in Making Us Cray, a study of the rhetoric of science in the practice of psychiatry. This boundary shifted dramatically for gay people in the late seventies, after activists inside and outside the psychiatric profession called into question the scientific merit of the diagnosis of homosexuality as a pathology.
As early as 1956, the psychologist Evelyn Hooker showed that gay men did not exhibit signs of psychopathology in their performance on a series of three testing instruments often used to provide evidence of mental health. After the Stonewall riots, in 1968, gay activists began to picket and disrupt the annual convention of the American Psychiatric Association (APA) and other professional meetings, demanding to be heard. From 1970 to 1974, activists within the psychiatric profession and without forced the profession to examine its basic assumptions about human sexuality and the way that it defined pathology. Ultimately, a majority of APA members conceded that their views on homosexuality were based on moral considerations rather than scientific ones. In 1974, when ballots were mailed to the members of the association asking them to vote on a decision of the board of trustees to delete the homosexuality entry from DSM, 58 percent of the ten thousand psychiatrists who replied voted in favor of the deletion. For a few years, an alternative diagnosis of “ego-dystonic homosexuality” (individuals unhappy with their own homosexuality) was retained, but then this, too, was dropped in the 1987 revision of the DSM.
The deletion of homosexuality from the manual was viewed as a major victory for gay rights groups, who knew that their revolution would not advance very far as long as homosexuality was certified as a pathology in the DSM, as Kutchins and Kirk note in a chapter chronicling the review process that led to the decision. However, in medicine as in law, the transgendered were left behind when gays and lesbians entered the mainstream. Homosexuality may have been deleted from the DSM, but “gender identity disorder” has taken its place as the diagnosis most frequently assigned to children and adults who fail to conform to socially accepted norms of male and female identity and behavior. “When the DSM-III came out, the first edition without homosexuality, the gay community was so happy and so empowered that by the time the DSM-IV came out, nobody was watching anymore,” activist Dylan (nee Daphne) Scholinski told me in 2004. “Since then the category has just grown broader, mostly because they’ve combined all the old categories.”
The DSM serves as a kind of dictionary of psychopathologies. It is used both as a diagnostic tool and as a justification for insurance coverage. Without a DSM diagnosis, insurance companies will not reimburse mental health treatment, either inpatient or outpatient. “DSM is the psychotherapist’s password for insurance coverage,” note Kutchins and Kirk. “All mental health professionals must list a psychiatric diag-nosic label, accompanied by appropriate code number, on their claims for insurance reimbursement.” Since its inception in 1952, the DSM has been revised five times, though the 1980 publication of DSM-III is viewed as the most significant for a number of reasons. First, it is much more comprehensive than previous editions, with many more diagnoses. “The DSM-III Task Force was predisposed to include many new diagnostic categories,” say Kutchins and Kirk. The reason for this was twofold: The practice of psychiatry was moving out of the hospital and into outpatient settings, and practitioners were seeing a much broader range of problems. At the same time, third-party (insurance) coverage was becoming more common, and coverage required a diagnosis. These two factors working together account for the sudden increase in diagnostic categories in the DSM-III—suddenly many more people were susceptible to a DSM diagnosis (and thus eligible for insurance reimbursement for treatment) than previously.