This section includes eighty-six short original essays commissioned for the inaugural issue of TSQ: Transgender Studies Quarterly. Written by emerging academics, community-based writers, and senior scholars, each essay in this special issue, “Postposttranssexual: Key Concepts for a Twenty-First-Century Transgender Studies,” revolves around a particular keyword or concept. Some contributions focus on a concept central to transgender studies; others describe a term of art from another discipline or interdisciplinary area and show how it might relate to transgender studies. While far from providing a complete picture of the field, these keywords begin to elucidate a conceptual vocabulary for transgender studies. Some of the submissions offer a deep and resilient resistance to the entire project of mapping the field terminologically; some reveal yet-unrealized critical potentials for the field; some take existing terms from canonical thinkers and develop the significance for transgender studies; some offer overviews of well-known methodologies and demonstrate their applicability within transgender studies; some suggest how transgender issues play out in various fields; and some map the productive tensions between trans studies and other interdisciplines.
Trans1 people have long been defined as pathological. To this day, gender transition processes are classified as mental disorders in diagnostic manuals, such as the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD). Meanwhile, trans people are exposed worldwide to dynamics of stigmatization, discrimination, social exclusion, and transphobic violence, including forms of physical and institutional abuse. Within the context of the current revision processes of the diagnostic manuals mentioned above, in recent years an international activism for trans depathologization has emerged, with former activist initiatives and critical trans academic discourses as precedents. Relevant aspects inherent to activist-academic depathologization discourses include the questioning of the current diagnostic classification of gender transitions, the demand of a recognition of trans rights, among them legal and health rights, the revision of the trans health care model, and the claim of an acknowledgment of gender/body diversity.
An example of an activist initiative focused on trans depathologization is STP, International Campaign Stop Trans Pathologization: an international platform that involves the participation of activist groups, organizations, and networks worldwide. STP coordinates the annual International Day of Action for Trans Depathologization every October, an event during which demonstrations and other activities in support of trans depathologization take place in many cities of different world regions.
Within a multiple field of contextually specific forms of trans depathologization activisms worldwide, STP demands the removal of current classifications that understand gender transitions as mental disorders in the DSM and the ICD. This demand is based on the observation of structural interrelations between dynamics of psychiatrization, discrimination, and transphobia and on an acknowledgment of the negative effects that a psychiatric classification has on the citizenship rights of trans people. The contemporary model of trans health care is criticized for limiting trans people's decisional autonomy by the imposition of an evaluation process and for reducing the diversity of gender transition processes and health care paths through the triadic model of diagnosis, hormone treatment, and surgery. The frequent requirements of a gender-transition–related diagnosis, hormone therapy, and, in some countries, genital surgery, sterilization, and divorce in order to attain legal gender recognition are denounced as contradicting fundamental human rights recognized by the Yogyakarta Principles (2007) and other international resolutions. Furthermore, trans depathologization activism seeks to gain a broader social recognition of gender/body diversity (STP 2012a, 2012b, 2013).
Indeed, the trans depathologization framework introduces a paradigm shift in the conceptualization of gender identities: from conceiving gender transition as a mental disorder to recognizing it as a human right and expression of human diversity. From this perspective, the conflict is not situated in the individual trans person but in a society characterized by transphobia and gender binarism. Thus the contemporary concept of trans(s)exuality is analyzed as a culturally and historically specific construction. Furthermore, the ethnocentric and neocolonialist character of Western-biased psychiatric classifications is put into question for rendering invisible the cultural diversity of gender expressions and identities worldwide and for imposing an exclusive framework of conceiving gender diversity. Trans depathologization discourses include awareness of the diversity of gender conceptualizations, expressions, and trajectories worldwide as well as the presence of context-specific circumstances and priorities within international trans activism.
A central issue in discussions about trans depathologization is the question of how to introduce a depathologization perspective without risking access to trans health care. Given that in some health care contexts, illness-based diagnostic categories are the requisite for public coverage of transition-related health care, there is a fear that depathologization would put access to these health care services at risk, thus fostering social inequalities in the access to trans health care. Trans depathologization activism conceives the right to depathologization and the right to health care as two fundamental human rights, suggesting various strategies in order to facilitate access to state-covered trans health care within a depathologization framework. These include the proposal of a nonpathologizing reference in the ICD that understands transition-related health care as a process not based on mental disorder or illness as well as the elaboration of a human rights–based framework for state-funded coverage of transition-related health care (STP 2012a, 2013). Most recently, the approval of the Argentinian Gender Identity Law in June 2012 created a precedent for legal gender recognition and public coverage of trans health care from a human rights perspective.
In the academic context, throughout the last decades an emerging trans scholarship has ruptured the traditional discursive exclusion of trans people from academia, thereby contributing critical revisions of pathologization dynamics in health care, social, legal, and academic contexts as well as new theoretical frameworks and conceptualizations (see, among others, Missé and Coll-Planas 2010; Stryker and Whittle 2006; Thomas, Espineira, and Allessandrin 2013). In addition, trans artists have created new imaginaries for gender/body diversity beyond the binary.
Depathologization discourses are related to a postmodern/poststructuralist deconstruction of dichotomous models, a questioning of medicalization and psychiatrization processes in Western society, postcolonial discourses, and discussion of health care models based on participation, social determinants of health, and human rights perspectives.
Finally, it is important to note that trans depathologization discourses do not conceive depathologization as only a trans-specific issue. The questioning of cis/heteronormativity and gender binarism, as well as the demand of a broader social recognition of gender/body diversity, is considered an important issue for all people. The current pathologization of gender transition processes is perceived as part of the structural violence inherent to the social gender order. It is also relevant to highlight the link between the demand of trans depathologization and a broader questioning of Western psychiatric classification systems and practices. Therefore, the depathologization perspective opens up potential alliances with other critical theoretical reflections and social movements, among them intersex, body diversity, and antipsychiatry discourses and activisms.
The authors are members of the coordination team of STP, International Campaign Stop Trans Pathologization.
1. In this text, the term trans refers to individuals who engage in gender expressions, trajectories, or identities different from the gender assigned at birth. The term trans(s)exuality is used to refer both to transsexuality as describing the current medical model of gender transition and to an activist reappropriation of the term, expressed by using the spelling transexuality (Valentine 2007). The use of these concepts takes into account their Western character, which may not correspond to culturally diverse forms of gender transition processes in different parts of the world.