The Riddle of Gender

At Michael Reese, Scholinski learned that she was first diagnosed with gender identity disorder in third grade, when she was sent to a school counselor by a teacher who had noticed her depression. “We played games together,” says Scholinski, and one of the games was “The Career Game.” “She held up cards with a picture of a policeman, a farmer, a construction worker, a secretary and a nurse, and I said which ones I’d like to be: police officer and construction worker. She looked at me with a curious face like a mother robin. She was the first one who said I had a problem with my gender. I didn’t know what that meant, but later I found out that she thought I wanted to be a boy.”

At each of the three psychiatric facilities where she was incarcerated, the staff took careful note of Scholinski’s appearance and mannerisms. “Daphne presents a tomboyish appearance with jeans, T-shirt and a manner of relating which is not entirely feminine,” wrote the staff at Michael Reese in Chicago, where her psychiatrist asked, “Why don’t you put on a dress instead of those crummy jeans?” At Forest Hospital in Des Piaines, Illinois, she at first pretended to be a drug addict because it provided some sort of explanation for her family’s difficulties. “Drug addiction offered itself to me like a blanket of forgiveness. It’s a disease. It’s not my fault. My parents too would be absolved of blame. We’d have something to tell ourselves and the world that seemed a lot more understandable than my daughter won’t wear a dress, my mother doesn’t want me around, my father beats me, she’s plain out of control, I don’t know why I stole the money. “But one day she confided a secret to her journal (“p.s. I think I like girls”), which was read by the staff and led to her being transferred out of rehab and subject to a new treatment plan focused on “identity issues and sexual confusion.” This included spending time with a female peer each day, combing and curling her hair, experimenting with makeup, and “working on hygiene and appearance.” After being made up by her roommate, she looked in the mirror. “I sneaked a glance, and it was a jolt. My beige face gave me a creepy dead look. The blue eye shadow, the blush—I looked like a stranger.” With a staff member eavesdropping outside the door, “I told myself that I didn’t care if I looked like a dead stranger.” To pacify the staff and gain “points” that could be traded for a few precious moments outside alone, she said out loud, “I love my eyeliner. I like my blue eye shadow.”

Persevering in order to gain more points, Scholinski strove to become a more pleasing “girly-girl dead stranger.” She let her roommate, Donna, make her up each morning, curl her hair, and paint her fingernails. She wore Donna’s blouses instead of T-shirts and a pair of new jeans, and hugged male staff members. Donna, trying to be helpful, pointed out that Scholinski’s walk, an athlete’s walk, “a strong walk with my weight in my feet,” was not very feminine. “Donna wanted me to walk skittery, like a bird. Like the pigeons in the park near my mother’s apartment, strutting, with their chests sticking out, their tail feathers wagging. She said, Try this. She came up behind me and placed her hands on my hips. She knew I was in deep about the femininity stuff, she was trying to help, so I tried too. I took a step with my right foot. She moved my hips to the right. Left foot, left swing of my hips. Step, swing, step. I thought, Forget this.”

Fed up with the “femininity discussions,” she told her psychiatrist that she really was a drug addict. “I’d rather be a drug addict than walk around with this crap on my face.” But before the staff could alter her treatment plan again, she was transferred to the Wilson Center in Minnesota. At Wilson, the goal of treatment was “for Daphne to come to terms with herself as a sexual female human being.” By the time she was released from Wilson, a few weeks after her eighteenth birthday, Daphne Scholinski had spent three years in psychiatric facilities, from September 1981 to August 1984. Just before her discharge, her final psychiatrist said that all of her problems were “in remission except for my gender thing.” Looking back on those three years a decade later, she says, “I still wonder why I wasn’t treated for my depression, why no one noticed I’d been sexually abused, why the doctors didn’t seem to believe that I came from a home with physical violence. Why the thing they cared about most was whether I acted the part of a feminine young lady. The shame is that the effects of depression, sexual abuse, violence: all treatable. But where I stood on the feminine/masculine scale: unchangeable. It’s who I am.”

In their critical analysis of the DSM and the way it is used to create psychiatric diagnoses for “everyday behaviors,” Kutchins and Kirk point out how difficult it can sometimes be to distinguish an internal mental disorder from a patient’s reaction to external environmental Stressors. DSM’s role as a coding tool for insurance companies generally resolves this difficulty, they say. “The limited evidence suggests that individuals are given DSM diagnoses when family, marital and social relationships are clearly the problem; that treatments are shaped to adhere to what is reimbursable, rather than what may be needed; and that troubled individuals are getting more severe and serious diagnoses than may be warranted.” These diagnostic distortions are not the fault of the DSM, Kirk and Kutchins say, but a symptom of the way in which we try to craft medical solutions to social problems. Critics of the DSM diagnosis of gender identity disorder make the same argument. “No specific definition of distress or impairment is given in the GID diagnosis,” says Katharine Wilson. “The supporting text in the DSM-IV Text Revision (TR) lists relationship difficulties and impaired function at work or school as examples of distress or disability, with no reference to the role of societal prejudice as the cause. Prostitution, HIV risk, suicide attempts, and substance abuse are described as associated features of GID, when they are in truth consequences of discrimination and undeserved shame.”

Dylan Scholinski spoke eloquently about the lifelong effects of shame when I spoke to him in 2004. “The stigma attached [to the GID diagnosis] is devastating” for a child or adolescent, he said, as we sat in an outdoor cafe below the Washington, D.C., row house where he keeps a second-floor art studio. The most emotionally devastating aspect of being institutionalized for gender identity disorder was the message that “there was something so wrong with me that I couldn’t be out in the world,” he said, “that all these different types of people are out there walking around the streets, but I couldn’t do that, I was so dangerous. I felt lethal,” he says now, looking back on Daphne’s adolescence. “Like I was the bomb always waiting to go off in people’s lives.”

Scholinski points out that though his primary diagnosis in the various institutions where he spent his adolescence was gender identity disorder, the psychiatrists and therapists who met with his parents told them “they were working on my depression. Well, I was depressed because the world was treating me poorly, but their plan was to get me to act more feminine so that the world wouldn’t treat me so badly— instead of realizing that if you try to make me be something I’m not, I’m going to be even more depressed. I never felt worse than on the days when I forced myself to wear makeup and had people telling me, ‘Wow, you look really pretty today’ “ he says with feeling.

In its Standards of Care for the Treatment of Gender Identity Disorder (SOC) in both adults and children, the Harry Benjamin International Gender Dysphoria Association notes that “the designation of Gender Identity Disorders as mental disorders is not a license for stigmatization or for the deprivation of gender patients’ civil rights. The use of a formal diagnosis is an important step in offering relief, providing health insurance coverage, and generating research to provide more effective future treatments.” However, it must be asked whether the present classification of gender identity disorder as a psychopathology meets these goals.

First, the designation of GID as a mental health problem does provide, and has provided, a license for stigmatization, and has undoubtedly contributed to the difficulty that gender-variant people have encountered in passing legislation protecting their civil rights. It is disingenuous to pretend that the deletion of the entry on homosexuality from the DSM has not greatly improved the status of gays and lesbians, or that the continued inclusion of gender-variant people in the DSM has not retarded their efforts to be recognized as healthy, functional members of society. Indeed, Dylan Scholinski says that since writing The Last Time I Wore a Dress and becoming an activist, he finds that “some of the toughest people to convince” that kids are still being institutionalized for gender identity disorder are gays and lesbians. “It’s like it brings up people’s worst fears,” he says. “People don’t want to believe that these kinds of things can happen now, they think that we’re beyond that. I tell them, ‘Well, maybe it didn’t happen to you, but it did happen to me.’”

Second, the diagnosis of gender identity disorder does not facilitate insurance coverage of medical or surgical procedures for people desiring hormonal or surgical treatment; it does not guarantee coverage of anything other than mental health treatment by a psychiatrist or a psychologist. “DSM is a red herring. It barely covers anybody,” says Dr. Dana Beyer, a retired surgeon who underwent sex-reassignment surgery in 2003. “Why we feel the need for this crutch is beyond me. This DSM crutch. But it’s the only recognition that it’s medical—it just happens to be in the psychiatric field, which causes more problems than it’s worth. So why can’t we just shift it from the psychiatric problem to congenital or genetic or developmental or whatever? That should be easy. But again it becomes a turf war. The psychiatrists don’t want to give it up. You’d think they’d want to get rid of us. But no, they don’t want to do that. As far as insurance goes, that’s a crock; it doesn’t cover anybody.”

Finally, rather than “generating research” or research funding, the classification of GID as a mental disorder seems instead to have limited the research done on physiological mechanisms for gender variance, or on the