History of Transgender

A time-line of transgender identities.

© 1999 Drs. Arianne van der Ven

Contents

Summery 2

Introduction: The development of gender as we know it
1- How does history relate to us? 3
2- From a one-gender system to a two-gender system, and on to ‘third sex’ categories. 3
Some specifics of gender transitions. 5

Part I: Sexology begins.
3- Transgender Identities before the 19th century 7
The early 19th century: Enters forensic psychiatry 7
The late nineteenth century: Inverts turn to Experts.
Enters sexology and the empirical case history. 8

Part II: Early 20th century The rise of Psychoanalysis and it 's denial of transgender identities
4- Developments in Medical technology. 10
5- Psycho-analysis’ erasure of transgender 11
6- The sixties and seventies: routine treatment of the empty
7- transsexual 12

Part III: Transgender becomes Real.
8- The emergence of transgender. 15
9- De-constructing gender, from gender identity to
“freedom of gender expression”. 15
10- Changes in transgender care. 17
11- The lack of transgender in Continental Europe. 18

References 19

Summery

This paper was originally written for the “Sex, Gender and Identity” program of The School for International Training (SIT) in Amsterdam. SIT is an US university and specializes in study abroad programs for students from American universities.

This paper discusses transgender identities during the last hundred and fifty years. The introduction to this paper describes how gender can be defined, and how our current day two-gender system evolved from a one-gender system in the late middle ages. This two-gender system started to produce “third genders” during the eighteenth century. It also discusses how current day gender transitions differ in depth and dilemma from a gay of lesbian coming out.

Part I discusses how during it’s first fifty years (1860-1910) psychiatry replaced sin with diagnosis, and the multifaceted image of the 18th century "sodomite", with a host of very specific inverted gender-identities. Among these gender-inverts we find the homosexual, the hermaphrodite (intersexual), the transvestite and the 'complete invert ' (transsexual). The last category suffering from 'seeliches transsexualismus ' (Hirshfeld 1912).

Part II describes the second fifty years of psychiatry (1910-1960), when psychoanalysis turned the table between gender and sexuality. To Freud gender was a simple matter of genital fact, and transgender practice (like cross-dressing or expressing transsexual longing) a mere denial of homosexuality. Transgender operations came to a standstill.

Part III shows how, after the absolute dominance of psychoanalysis waned in the 1960’s, psychiatry reinstated transgender identities, under the names of transsexuality and cross-dressing. In the 1980 's psychiatry gradually relaxed the many requirements imposed on transgenders to be eligible for complete and partial medical treatments. At the same time a TG community in the US reshaped itself, using inclusive terms like ‘transgender’ and political ones like ‘freedom of gender-expression’. This way the US TG community started to gain control over its representation in the media, and to influence it’s member’s view of itself in a non-psychiatric way. Under an even more inclusive term of Queer identities, some transgenders in the US reunited themselves strategically with the gay and lesbian community, while in Europe they largely stay apart.

The paper ends discussing how all the different interpretative discourses around transgender identity have their own contexts of validity and effectiveness, as well as unfortunate marginalizing effects on sub-groups of transgenders.

Introduction: The development of gender as we know it.

1- How does history relate to our genders?

Most introductions to gender-studies start telling us how basic one’s gender is. “The first thing they said when you were born was: “it 's a girl!” or “it 's a boy!” and “the first thing people notice about you is your gender” (quotations from a gender course). The two-gender order is pervasive indeed. This paper tries to give an insight into the historical development of the two-gender order and more specifically transgender-identity. Some people who read this paper may be questioning their gender.

Once, after a lecture I did on the topic of this paper at the University of Amsterdam, a TG member of the audience got up and said the material from this paper clearly showed the two-gender system to be a shared psychosis. She had 'stepped outside ' this psychosis and had decided against medical treatment. I felt s/he misunderstood what the lecture was about. No one should allow him- or herself to be critically influenced by a description of large societal developments through time, which have set the stage for today 's life. The depth of our own sense of gender is rooted in our personal histories. Most children grow up trying to be a good son or a good daughter, to a father who wants to be a good dad, and a mom who wants to be a good mom. Our earliest experiences and loyalties have been gendered. Then and now, we need to feel loved to feel secure. And whatever historians may say about the development of our shared reality, does not make it a good idea to step outside it. Our capacity to live an intimate life outside gender is limited. It is of no use to think that some development in Renaissance Europe is to blame. It may be useful however, to all of us

2- From a one to a two-gender system, and on to ‘third sex’ categories.

According to existing anthropological or historical literature, there has been no society without a cultural expression of biological sex. This cultural expression is called gender. Gender is many things, such as rules for gender-appropriate role behavior, dress and embodiment, social scripts for affective and sexual expression and even talents and interests that are thought to come naturally to either sex. If a woman lacks the capacity to nurture her child for example, other women may judge her more harshly than an equally incapable husband. When these expectations about one 's femaleness or maleness are used in a normative way they can also be called “gendernorms”, when used for self-expression they may be called the language of gender.

Prominent historian Thomas Laqueur says that while the two anatomical sex have always existed, this has not always meant two genders. During the Middle Ages, he says, in both Western and Near Eastern countries, women were not seen as a sex in their own right, but as not fully-grown males, in whom the penis had not descended. Women were seen as a lesser developed male, not as a woman with a different but equal place to men. The social status of women was comparable to children, and their social importance defined by their relationship to men. Women were not a gender or a sex in their own right. In other words, says Laqueur, there was not a two-gender system but a one-gender system. When renaissance doctors started dissecting corpses and found uniquely female reproductive organs, this had no impact on the cultural gender system. Having a different body does not mean having a different gender, just like a difference in height does not make one man a different gender from another man. It took something entirely different for women to emerge as a gender in their own right.

Many historians believe this happened during the late middle ages (around 1500) when the social unit of the hamlet was replaced by the social unit of the nuclear family, with one man and one woman, who knew who their own children were. This may sound strange, but in the social unit of the medieval hamlet, common people did not marry, sexuality and love were less romanticized, women and men could have more then one sexual partner, and no one really knew for sure who the father of a particular child was. The hamlet had to care for it. Also, women could do all the same kinds of work as men did and get the same rewards for it (food and shelter was all 99% of the population got). Marriage and forming a family was unimportant because no one left anything more to inherit then the hamlet could provide.
Marriage was invented in the eleventh century for the wealthy, like nobles and merchants, who for the furtherance of their lineage and the settlement of inheritance rights needed to document who was a real child and who a bastard child. A recognized child would inhere, a bastard child would not. Moreover, in the eleventh century most monks were still very adverse to sanctify something as mundane as a sexual relationship and needed much more compensation for their effort than common people could afford.

As production techniques and trade improved and wealth and property spread among many more people, the nuclear family became more and more dominant. In the really rich early capitalist societies, like 17th century Holland and England, family-life became the norm. In these families "woman" became the mistress of the man 's household, the mother of his children, and the bookkeeper of his daily expenditures. It is in these social roles that "woman" became a gender in her own right, signifying virtues like domesticity, orderliness, care taking, pliability and moral rectitude. Thus the two-gender system replaced the one-gender system, not because of biological difference, but because people started living in families. “Man” and “woman” are the effect of how people in our culture reproduce, share responsibilities and divide ownership after a death. We no longer live in a hamlet where no one knows who 's who to whom, which may not sustain itself if the rain won 't fall, and where sex is an act with no unique relationship.

Another historian, Trumbach, shows that as “woman” became a second sex, cross-dressing (which women usually did during the middle ages to travel safely between one protected town to another) and homosexual relationships became more often seen as a serious infraction on the natural gender-order. He says they were now seen as a form of gender-inversion. Trumbach shows how before the dominance of the two-gender system, homosexual men were seen as rakes, men so virile they had sex with women as well as men. Over the eighteenth century however, the image of the homosexual changes. No longer is the homosexual an extremely virile man, but a male with a female soul.
Another historian, Theo van der Meer illustrates this change, making use of the old Amsterdam secret confession books. These books contain the confessions of 230 arrested “sodomites", men whose sins were deemed too perverse for public scrutiny, and whose confessions were put away in a special locker in the bailiffs office. These reports show how towards the end of the 18th century, homosexual men begin to explain their desire for other men from their “feminine nature”. They show how in male sodomite subcultures female pronouns begin to abound (such as "Miss Pockeface", or even "Mrs. Shitpounder"). The authorities too begin to see sodomites as effeminate, which is reflected in the way most of them were executed (like women, they were garroted).
Researchers like Theo van der Meer believe that, as of the late 17th century, homosexuality is construed as a gender inversion, as a male acting like a female. Van der Meer and Trumbach say people began to believe that these men were essentially different from "real" men, who naturally love women. Because these men did not fit the two-gender system, they were seen as essentially different from other males, a “third” sex category. Trumbach also shows how an eighteenth century person could read this “third” sex or gender, not from an observed homosexual sexual act, but also from a number of other “feminine” interests (in fine clothes or in wearing female attire). In other words, as soon as a two-gender system was established, it was breached, and started to produce third gender categories, consisting of a heterogeneous assembly of sodomites (homosexuals), tribades (lesbians) and mollies” (transgenders). These minorities were harshly persecuted. Holland saw 230 executions of homosexual men in the eighteenth century, and only fifteen in all the centuries before. All of this due to a gender revolution!

Let 's take a pause and summarize. A significant body of historical studies suggests that by the end of the eighteenth century, men and women experienced each other as being essentially different in gender, not just in a hierarchical sense, but in a sense of each having unique natures, talents and spheres of expertise, suiting them perfectly for their roles and moral duties in a nuclear family. These new roles were seen as 'natural ' or 'God given ' and did not allow for homosexual or transgender behavior, and so these behaviors became more harshly persecuted and punished as before.

3- What do we talk about? Some specifics of gender transitions.

Transgenders are people who appropriate purposefully the language of gendered self-expression prescribed to the opposite genetic sex. Transgender practice is of all times and places, but to grasp the development of transgender identities throughout time, we have to take a closer look at some specifics of gender transition. Let’s take a modern day example.

A self-identified lesbian woman (let 's call her Cathy) was seen as feminine because her dress and role behavior said so. As Cathy 's role behavior became more expressly masculine she came to be seen as a "dyke" (which she thought she was). When she, in a lesbian bar, temporally adopted an expressly male dress (a male suit and tie) and embodiment (a false mustache and chest binding) she came to be seen as a "drag king". She could get away with all these roles in her lesbian environment as a kind of role-play, until she extended her cross gender behavior beyond the lesbian club. Her friends now saw her expressing a cross-gender identity and was no longer seen to be a 'lesbian woman ', but as transgender.
Losing her status as a lesbian woman meant the loss of her reference group, her lover and some of her lesbian friends. Taking her transgender identity to her work, her family and onto the street, was a bigger step than her previous coming out as a lesbian woman. During her lesbian coming out she could select the people to come out to. But there was no privacy in this transition, and no single relationship stayed the same. Moreover in her previous coming out she could assure her mother that she was still her daughter. While her mother had had to let go of the expectation of having grandchildren and had to get used to see Cathy with her girlfriend, she had been willing to do this for Cathy 's sake. But now she was asked to do more than this, and not for her girl but for a male called Alex, one she did not know.

When Alex switched his false mustache for a real one through hormone therapy, he lost passing privilege as female. But did this not mean he was now seen as male. He was seen as neither female nor male, an alien in either camp. People in the subway and his clients at work stared at him with blank eyes, and close friends still called him "her". He experienced a kind of existential void. To Alex, this was gender purgatory. Without passing privilege in either gender, social and sexual scripts did not work and not even his closest friends knew how to relate to him. He felt lonely, not from others but from himself. He felt a lack of self or an empty self. Until he had a mastectomy (breast removal) and through ongoing hormone therapy gained passing privilege as a male, he had a hard time accepting himself. This shows up another difference in gay or lesbian coming out and a gender transition. Gender transitions are a matter of self-creation first, and self-acceptance after.

This is anti-intuitive to many GLB and straight people, who have a self to accept or reject. However, in the case of gender transitions, the self in self-acceptance is a deferred one. It is a self without a body or mirror image, without self-presentation or social validity. It is necessarily an imagined self that has not been embodied, lived and tested yet. Many transgender who embark upon a transition have the exact same feelings as Alex, but return on their steps because they feel they cannot achieve passing privilege, and will always be alone and stared at. This may indeed be better because even when the old gender identity has been a front for an empty self, this empty self does have social validity, friends and family, an upbringing with gendered attachments and loyalties (as a son or daughter). In a full gender-transition it may well take between five to ten years before everything feels relatively settled and natural again. Five to ten years that Alex may need to truly become his mom’s son.

Finally, while today 's TGs are blessed with a host of medical possibilities in comparison with the historic one 's we 're about to discuss, we should realize that Alex 's more intimate self may never come into existence as funding for medical care may evaporate and operations may fail. If Alex would consider SRS (sex reassignment surgery) it could cost him between $10.000 and $60.000, and he has to consider the possibility of ending up in diapers for the rest of his life. Without any recognizable genitalia to speak off.
In the Netherlands about 30% of SRS surgeries result in genitalia which cannot be functionally used for achieving orgasm or anything resembling (heterosexual) intercourse. With a micro-penis of about 3 centimeters Alex and his partner cannot simply take from gay, lesbian or straight sexual scenarios for genital pleasure. He again needs to create his own genital and sexual experience. This is also true for Cathy 's Male to Female counterparts whose vaginas may be too numb, shallow or narrow to allow for sensation or penetration. They too need to invent their own sexual experience. And they usually do. As soon as Alex achieves "passing privilege" as a male, a transgender identity is no longer attributed, and every day social scripts become available again. Alex may not view himself as "just another male". "Alex" is the evolving result of his very personal transition process, with all the choices he made in the dilemmas he faced.

Part I: Sexology begins.

4- Transgender identities before the 19th century.

An anthropological and historical study like "Third Sex, Third Gender" shows how every known society with a third sex category, separated these people out from it’s "normal" people. The much-heralded Native American Berdache were carefully initiated, and usually had to live together in separate dwellings, doing prescribed tasks. Indian hijra 's lived in monasteries and were left unaided if they bled to death during the initiation (which involved the amputation of their sexual parts). Polynesian Mahu 's could only live at the border of town, having to perform sexual favors for boys approaching manhood. Their counterparts in Islamic and Christian cultures only survived in brothels, such was the fate of Moroccan zamel, Italian “femmenella”, Spanish “maricon”, Portuguese “veado”, Turkish kockes and the English Mollies. All of these were genetic males adopting some or most aspects of a feminine gender, almost all had sex with other males, and all had to live apart. It 's hard to tell whether they were transgender according to modern language, merely homosexual or both.

Gender and sexual ambiguity in women does not have such an outspoken history. Some theorists say that, as women 's biology enables them to bear children, they feel more dependent on family structures to have children grow up safe. This way, they say, women in many societies have been more defined by their dependence on familial relationships, while manhood was more defined by it 's more exclusively sexual part in procreation. As women get the kids, women feel responsible. We organize or suffer. We have to organize support on gendered relationships. Procreation has it’s rules, it needs an order, roles to fulfill. Biology makes women prone to gender rules.

5- The early 19th century: Enters forensic psychiatry.

As scientism progresses over the 19th century, physicians become a rising class. Particularly in France and Germany, a new branch of medicine, forensic psychiatry, starts busying itself with classifying "les passions" (the passions).
In 1841 for example French doctor Descuret published La medicine des passions. Passions discussed are “erotomania” (an excessive erotic imagination), as well as “nymphomania” and “satirasis” (excessive sexual desires in women and men). However, in his catalogue of passions sexual behaviors still get far less attention then drinking or playing cards for money. Physicians generally believe that sexual disorders are caused by too much masturbation, which would cause the imagination to go wild, and makes men and women stumble from one disorder (gender trouble and homosexuality) into a more serious one (gambling and playing cards).

In 1849 Claude France Michea states that perversions are 'inborn '. As such they are exactly like physiological failings. He’s also the first to classify philopedie (the love of boys in adult men) as a biological disturbance, describing it as a form of effeminacy. Michea finds support for his theory in the work of E.H. Weber, who was the first scientist to find remnants of the rudimentarily developed uteruses in men. With his new focus on biology, Michea takes sexology out of the realm of morality and makes it an appropriate field of study for scientists, who soon will come to study and catalogue “identities”, much as a botanist studies and catalogues flowers. Their instrument will be the same as in general medicine: the empirical case study.

6- Late nineteenth century sexology: Inverts turn to Experts.

Berlin was the center of late nineteenth century sexology. The male homosexual scene of late 19th century Berlin was rather visible compared to the ones in London or Paris. This was due to the abundance of homosexual men who used public cross-dressing to mark themselves as sexually passive. Many men would cross-dress on private parties, but also in bars and restaurants and at the daily masked balls. Male couples usually consisted of a masculine and a feminine defined part. Male prostitutes were usually playing top. They often were soldiers, who were to be found in half a dozen bars around the army barracks and in Tiergarten Park. Here masculine acting homosexual men were to be found alongside men in drag. It was against this social background that the most influential theories of both transgender and homosexual identity were formed.

In 1862 Karl Heinrich Ulrich, now widely considered the father of modern homosexuality, described his own homosexuality as an authentic female identity, hidden inside a male body. As he wrote in a Latin text: “I may have a beard, and manly limbs and body, yet confined by these, I am and remain a woman”. Ulrich could not imagine that two same sexed persons could love each other, so for homosexuality to occur, he needed a "third sex" he called Uranians. Uranians had “a female soul in a male body”. Ulrich also could not believe that two Uranians could love each other, and so he inferred that in every homosexual relationship there was one Uranist and a “real man” or a “real” woman. But Ulrich also needed the concept of a third sex because he felt he loved men as a woman does. His twelve publications, now seen as the first canonical homosexual self-documents, may also be seen as the first transgender self-documents.

Significantly, Ulrich published his theories to politically justify homosexuality. As Germany was in the process of uniting itself as one state, it needed to set up one law for the whole country. The laws of Ulrich 's state, Prussia, had no clauses against homosexuality, while in all the other states homosexuality and cross-dressing were a crime. Ulrich feared homosexuals and lesbians might now too be legally persecuted in his own Berlin, and his publications show how identity formation is often driven by political motives. And just like the 17th century Amsterdam homosexuals Ulrich chooses gender inversion to advocate for his desire.

The first psychiatric description of transgender identity came about in 1869, when a female patient wrote to a German psychiatrist, Carl Westphal, that she had felt like a man since childhood, had spent much of her live in mental institutions, and was now actively seeking medical help. “Ich mochte gern ein man sein”. Westphal publishes this case and many others, in the Archiv fur Psychiatrie und Nerven Krankheiten, diagnosing her and many others under his category of for sexual inversion: “die contrare sexual empfinding”. This diagnosis would be given to both homosexuals and transgenders.

In 1882 Kraft Ebbing published the first handbook for the now recognized science of sexology, the psychopatia sexualis. He too puts homosexuality on a scale of transgender identities. “In milder cases, there is simple hermaphoditism; in the more pronounced cases, there is only homosexual feeling and instinct; in still more complete cases, the whole psychical personality as well as the bodily sensations, are transformed so as to correspond with sexual inversion; and in complete cases, the physical form is correspondingly altered”.

Kraft Ebbing’s system was based on case histories. These case histories are often written by the inverts themselves, underlining the doctor 's empirical approach. The longest account of an invert in the psychopatia sexualis is by a Hungarian patient who felt as if he actually had undergone a sex change. A physician himself, he writes “I feel like a woman in a man’s form, and even when I am sentient to the man’s form, it is always in a feminine sense. Thus for example, I feel the penis as a clitoris; the urethra as urethra and vaginal ofrice... the scrotum as labia majora; in short, I always feel the vulva”. This embodied TG identification structures his heterosexual practice. During coitus with his female partner, he inverts genital morphologies imagining himself to have a vagina penetrated by the penis of his partner, a woman. His desire is so strong that he even prefigures the transsexual plot of surgical transformation: “I am sure I would not have shrunk from the castration knife, could I thus have attained my desire”.

In 1882 endocrinology (the study of how our hormonal system works) was not yet in existence. Inverts could only turn to plastic surgeons for help. The nineteenth century also saw the first medical sex reassignment operations; the best known of these was performed on Herman Karl, who was born as Sophia Hedwig, and who in 1882 had his female genitalia masculinized. How this was done is not clear from the literature, but it was enough to make him infertile and to allow him to officially change his sex to male.

In 1897 Hirschfeld founds the Wissenschaftlich Humanitares Komitee (Scientific Humanitarian Committee) in Berlin. In 1899 he starts publishing the “Jahrbuch fur Sexuellen Zwichenstufen”, (Yearly publication for sexual intermediaries) which will run until 1923, and will see the first mention of both the words “transvestiten” (cross dressers) and “seeliches transsexuellen”

Like Ulrich, Westphal and Krafft Ebbing, Hirschfeld too turned to the notion of gender inversion to explain homosexuality, cross-dressing and transsexuality. Like Ulrich he claimed there were many naturally occurring and normal variations of gender. Hirschfeld was the first to coin the term transvestitism in his book The transvestites, the erotic drive to cross dress. Transvestitism was one of four ways in which men and women might invert the usual characteristics of their sex of birth:

1- hermaphrodites: the primary sex characteristics do not correspond to the norm
2- other sex characteristics (man without beard growth, women without breasts and with a small pelvis etc.)
3- homosexuals (among homosexuals Hirschfeld also counted passive heterosexual men, as well as active heterosexual women)
4- Transvestites: who differ from their birth sex in dress, thought patterns, desires, emotions, and desired body image.

Later on Hirschfeld will add the transsexual to his list. Interestingly, Hirschfeld noted that there were so many ways in which his clients could combine elements of gender transgressive behaviors that it was better to speak about sexual intermediaries than to speak about any fixed and stable gender categories. Homosexual men could be transvestites or not, and transvestites could be homosexual, heterosexual or a-sexual. Hirschfeld forms the apotheosis of a 19th century form of sexology, in which clinicians recorded their clients ' stories and catalogued their differences. After him, clinicians stop recording and start interpreting, with dramatic results.

Part II: The early 20th century: The rise Psychoanalysis and it 's denial of transgender.

The first half of the 20th century saw two contradictory developments. The first is the development of specific medical technologies to help transsexuals. The second development is the rise of psychoanalysis and the complete erasure of transgender identities. The table between homosexuality and transgender are turned. No longer is homosexuality seen as a form of gender inversion, but transgender is now seen as a form of repressed homosexuality.

7- Medical technological developments between 1910 and 1960.

In 1918 Hirschfeld describes a breast amputation on a 25-year-old woman who wants to live as a male. He also tries to use “femininer und masculiner preparaten” (hormones) to help transvestites feminize or masculinize their bodies. The treatment fails because endocrinologists cannot isolate hormones well enough yet. In 1921 he refers two of his Male to Female clients for castration to Dr. Muhsam in Berlin, who in 1926 operates on two Female to Male clients, removing the breasts and ovaries. In 1932 Dr. Abraham publishes “Sex change in two male transvestites”, describing the procedure for castration, penectomy and the first creation of a neo-vagina. The attempts of another doctor fail as Danish painter Lily Elbe dies in Berlin following complications upon an operation to create a neo-vagina. In 1936 Dr. Bogoras publishes his first attempts at phalloplasty (creating a penis) from a skingraft. In 1946 Michael Dillon, an English F to M doctor and transsexual, describes his own hormonal and surgical treatments over the thirties. He was the first TG to be successfully treated with hormones as well as surgery.

In 1953 the world wakes up to these new possibilities as Dr. Hamburger operates on Christine Jorgensen in Copenhagen. This is the first US case, and the first to attract extensive media attention as well as broad rejection from the medical and psychotherapeutic establishment.
In 1957, Dr. George Burou, residing in Casablanca, invents the first “penile inversion” operation, using not a skin flap but the skin of the penis to line the neo-vagina. For a decade "going to Casablanca" is short for having M-F Sex Reassignment Surgery.
Over the nineteen eighties Male to Female sex reassignment surgery is perfected, including the creation of a neo-clitoris (from a part of the glans of the old penis) so orgasm can be retained after SRS.
In Female to Male sex reassignment surgery, the creation of a functional penis, capable of erection, has yet to be developed. However, testosterone treatment leads to the growth of the clitoris. In an operation called "metadoioplasty" the enlarged clitoris is often wrapped within a skin transplant and together with an elongation of the urinary tract, formed into a micro penis. The effects of testosterone treatment in F to Ms are usually much more dramatic as the effects of estrogen treatment in M to Fs. This makes the capacity for passing usually much better for Female to Male transsexuals, which greatly helps their social and psychological adaptation as well as their economic situation.

8- Psycho-analysis’ erasure of transgender

Anyone reading Freud 's work is struck by his love for the form of the case study. But contrary to the 19th century sexologists, Freud did not let his subjects speak for themselves. Freud 's main interest was in tracing the repression of unacceptable sexual and aggressive impulses into a realm he called "the unconsciousness". Here our most highly energized desires which could let off steam in the masked form of dreams and metaphor, symptomatic behaviors and slips of the tongue. He felt his clients needed "interpretations" and "confrontations" to be gently prodded on to their personal truths. And through his “interpretations” he became the real author of his client 's story. He became the real author-ity on what their spoken and unspoken words said, of what their text meant.

The most important goal of human existence, Freud felt, was to maximize pleasure, more specifically sexual pleasure. So in most of his interpretations Freud looked for sexual meanings of dreams and behaviors. In his treatment of transgender subjects, for example in the Schreber case (1911), he always interpreted their gender expression as a covert expression of homosexuality. Freud, and the psychoanalysts following him until this day, deny the existence of transsexuality. As Freud says:

“The mystery of homosexuality is therefor by no means so simple as depicted in popular expositions, e.g. a feminine personality who loves men but is unhappily attached to a male body (...). The supposition that nature in a freakish mood created a third sex falls to the ground”. Freud, Psychogenesis of homosexuality in a woman (1920)

Freud’s disciples quickly agreed:
“The reason why such a capable scientist as Hirschfeld could have overlooked this important trait of transvestitism in his voluminous studies is to be found in the fact that he dispensed with the technique of deep psychological analysis. But we know that the so-called heterosexual transvestites have only masked their homosexuality”
Gutlieb and Stekel (1920)

As Psychoanalysis made transgender behavior a sign of something else, analysts started to free associate on the meaning of cross gender behavior, right down to today. Fenichel (1931) saw “transvestitism” as an expression of castration anxiety. Transvestites would enact a “phallic woman under whose skirts resides a reassuring penis”. Stoller (1971) thought a mother who was filled with hatred for men initiated transgender behavior. She would seek revenge by femininizing her son. If this happened at an early age the son became transsexual, if it happened after say six years of age the son became a transvestite.

So what was Freud 's view on the genesis of gender? For Freud the primal scene of gender is when a naked boy and girl see each other. "In a flash" as Freud says, "the girl realizes the inferiority of her own genitalia", while the boy realizes the superiority of his. As of this moment the girl suffers from penis envy, and sees herself as castrated. Her only solace is that some day she may give birth to a boy, thus creating her own phallus. This is the basis of her identification with the mother and her desire to mother kids of her own in the future.
In Freud 's view gender is completely determined by the presence or absence of the penis. In his view gender is genital fact. For Freud, transgender cases like Mr. Schreber 's simply had to be one of fantastic denial. He declared Mr. Schreber psychotic and psychiatrists who follow him, like Jacques Lacan did so as well. Even when Lacan had not treated one transsexual client in his life, he was thoroughly convinced they had to be "sick to the level of psychosis".

Due to the pervasive influence of psychoanalysis, transgenders saw themselves as homosexual. For example Micheal Dillon, the F to M medical doctor and first transsexual who got surgical as well as endocrinological treatment, called himself a homosexual rather then a transvestite or an invert. This speaks volumes for the dominance of psychoanalysis in the psychiatry and sexology of the nineteen twenties to the seventies.

9- The sixties and seventies: routine treatment of the empty transsexual.

In 1963 Henry Benjamin published “The transsexual phenomenon”, which enabled the clear diagnosis of transsexual versus the transvestite and led to more acceptance in the medical and mental health care establishments. Over the sixties and seventies a great number of “gender clinics” sprung up in Europe and the US, usually connected to an academic hospital.
This led to the growth of a transsexual community apart from a cross-dressing community, which also started to organize and define itself. Two oppositional identities emerged: the essentially male cross-dresser, versus the entirely cross-gendered transsexual. Transsexuals and helping professionals like Benjamin had developed a discourse, which entirely essentialized them as cross-gendered. For the “transsexual candidate” this meant:

1- S/he says s/he’s is born in the wrong body, feels disgust when seeing it, never uses it sexually, and does not masturbate. There’s absolutely no ambivalence about a genital operation.
2- S/he has known to be born in the wrong body since early childhood
3- S/he always played the games of the other sex
4- S/he hated wearing gender appropriate clothes
5- S/he’s sexually attracted to the same birth sex
6- S/he’ll kill hirself if s/he will not get the genital operation
7- S/he wants a gender appropriate profession (F to M’s construction work, M to F’s beautician).
8- S/he conforms to sex-stereotypical behaviors (M to F are submissive and demure, F to M’s are self-asserted)
9- S/he’s physically able to pass in the other sex-role (M to Fs are not too small, M to F’s are not too large).

Benjamin 's transsexual has no human ambivalence, no fear of operations, no adaptive self which tries to cope with given genital realities, no defense mechanisms against socially undesirable behaviors like dressing up as a girl when being a boy. Benjamin vacates the transsexual self of all dithering and doubting and paints us a shockingly empty human being.

If any of the above requirements were not fulfilled, a medical indication was withheld. After living and working in-role for two years or longer (the “real life test”), a medical indication for sex reassignment surgery could follow. This treatment of transsexuals led to frequent and severe post-operational depressions, as doubts, ambivalence and feelings of depression could not be shared with helping professionals. It led to many tragic treatment outcomes.

In the emerging TS community, like the Berdache society described by Ann Bolin (1988), a "hierarchy of cross gender realness” developed. Those who passed best and were furthest on the transition track and never expressed any doubts, were at the top of the hierarchy, those who did not pass well were at the bottom. Behaviors which were not deemed gender appropriate were strongly disapproved. Doubt and depression were not only punished by helping professionals, but also by peers. The transsexual community became imprisoned in their own liberating discourse. Moreover, this treatment set transsexuals completely apart from the cross-dressing as well as the gay and lesbian communities, in which they had been a fixture for centuries. This further helped to masculinize an increasingly assimilationist and mainstreamed gay community, as well as feminize an increasingly mainstream and assimilationist lesbian community (Califia, 1997).

It is now difficult to see Benjamin’s assessment system as part of a liberating discourse. But the sixties and early seventies psychology schools were still dominated by psychoanalyst or "psycho-dynamic" theory, which fumigated heavily against medical treatment for “giving in to the disease”. Other movements, such as some gay and feminist movements joined the psychoanalysts, calling transsexuals “the dupes of gender”, people who adapted their bodies to a sexist society. With strong criticism coming from all quarters, the few helping professionals willing to work with transsexuals had to demonstrate their prudence. One of the reasons for a long real life test was to build extensive documentation of the persistence of the client’s unwavering wishes for transition. With this documentation in hand doctors could defend themselves against attacks from their colleagues as well as from clients who might regret their decisions after a disappointing SRS operation.

It is also important to realize that transsexuals had, for almost a century, made use of every possible gender stereotype just to convince doctors to give them access to medical treatment. Their self-presentation and stories ("I always felt like a girl, I never masturbated, I want to be a good house wife") were a strategic tool to obtain surgery. This is not to say that all TSs lied to their doctors. In Benjamin 's time only the most severe cases of transsexualism found their way to the doctor 's waiting room. And it is their stories which Benjamin translated into 'science ' and into requirements for a diagnosis giving access to medical care. Any new client had to repeat these stories to be a "true transsexual". In Foucault 's terms this was a serious case of "reverse discourse" (in which a minority 's emancipatory discourse is used to discriminate amongst it).

However small the number of transsexuals, they became an important reference figure for many people to identify against. The technological possibility of a change of sex made everyone 's gender-identity potentially less stable. The gay and lesbian scene pitted itself against the figure of the transsexual, and essentialized sexuality as the only difference between gays and lesbians and mainstream society. Gender ambivalent figures like the “queen” and the “diesel dyke” were no longer seen as adequate representatives of the GL community. On the other hand, transsexuals essentialized their gender identity as a medical condition. After treatment there was nothing to set them apart from mainstream society. The figures who became most marginalized were the transgenderist and the cross dresser.
Part III: Transgender becomes Real.

10- The emergence of transgender “I drew one cc of hormones into a syringe, lifted it above my naked thigh - and then paused. My arm felt restrained by an unseen hand. (...) No matter how I tried I could not do what I had done a hundred times before. I stood up and looked in the bathroom mirror. The depth of the sadness in my eyes frightened me. I lathered my morning beard stubble, scarped it clean with a razor. The stubble still felt rough. As much as I loved my beard, I felt trapped behind it. My face no longer revealed the contrasts of my gender. I could see my passing self, but even I could no longer see the more complicated me beneath the surface... I hadn’t just believed that passing would hide me. I simply became a he - a man without a past.”
Leslie Feinberg, Stone butch blues (221-222)

Feinberg here describes a complex embodiment of a split subjectivity. Passing might be a source of joy for the transsexual, but it is the deathtrap of the transgenderist, who’s gendered difference is exactly in the presence of both male and female characteristics. For Jess, the main character in Stone Butch Blues, passing as a male brings a loss of self and community, the stone butch community. Jess holds off from the transsexual’s destination of one integral bodily sex. In Jay Prosser 's (1997) words: "Her real me can only emerge at this point of passage, after hormones and surgery have transgendered her, and before they have definitely transsexed her. She makes the intermediate space of crossing her permanent, lived reality."

However painful, Jess, like Feinberg wants to be read as a he/she, one who is neither seen as a man or a woman, one who will inadvertently be discriminated against in gay, straight, and transsexual community. One of the most painful themes in her book is her feeling of homelessness. When Jess jumps out of the two gender boxes of male and female, it is not a political act to be laid off at any opportune moment. Jess really is transgender (even before the first coining of the term), and it leaves her mourning the loss of an imagined home at the other end of transition.

In 1982 a San Franciscan GP, Dr. Virginia Prince, first coined the term transgender. After years of organizing cross-dresser clubs around the US, she had gradually come to live full time in the female role, feminizing her body through hormone therapy, a definite no-no in the cross dressing community she had helped to organize. Dissatisfied with the gap between cross-dressers and transsexuals, she introduced the term transgender as an inclusive term for both. Over the eighties and nineties a rapprochement took place.

11- De-constructing gender. From gender identity to “freedom of gender expression".

Transgender has become a name for a discourse that no longer sees gender as a binary or a one-dimensional continuum. Transgender looks at all aspects of gendered self-expression (see fig 1). Body image is as important a dimension of gender as ever, but aspects like self-presentation (dress), role behavior, affective relationships, and self-labeling are seen as equally constituent aspects of any personal gender system. On every one of these dimensions one can grow into a range of masculine, feminine or an intermediate positions. This concept of gender as a complex system of expression, that everyone should be free to live and explore, allowed for reconciliation between cross dressers and transsexuals. No form of gender expression was any less real or important as another. Their common battle cry would now be “freedom of gender-expression”.

In Derrida 's terms one could say that transgenders had de-centered the terms masculine and feminine enough to be able to have a personal understanding of gender that would not turn into their next prison ( a process he calls "handiwork").

Transgenders were also helped by a political environment. Reagan 's non-responsiveness to the AIDS crisis broke the assimilationist tendencies in GLB politics. Groups like ACT UP began to stress visible difference and being "queer". Gays and lesbians found a new appreciation for the defiantly public difference some transgender identities pose to mainstream society. Diesel dykes, fairies, and dragqueens became fashionable again.

Also a feminist post-structuralist critique further destabilized the notion 's of "woman" and "lesbian" as natural core identities to which all class, ethnic and other meaningful differences would be secondary. The work of post-structuralist thinkers like Derrida and Foucault was incorporated into feminist thought by Judith Butler. She did away with the legitimacy of essentialized identities. In her writings even our very embodied sex became a willed, shaped, trained and purposeful effect, a matter of practice and contingency rather then a cause unto itself (Butler 1993). "Woman" had become less of a given subjectivity, and more of a self-willed creation. Its as "unnatural" as make up. As Trumbach says, no single cultural identity can take refuge in nature anymore.

All of this may be seen as high brow theory that negates the reality of million 's of women around the globe. But this paradigm-shift also allows for lots of new coalitions to be build. The transgender battle cry for "freedom of gender expression" fitted in very nicely with these broader developments in lesbian, feminist and gay circles, but also in an even wider population. As Nancy Nangeroni (former head of IFGE in Boston) said: “gender norms are a preoccupation of every person, not just TGs. Everyone who’s ever been afraid of not being a good mother, father, son or daughter, has to battle with these norms. Just like every man who hates himself for not making a career, or every woman who hates herself for taking up too much space.”

This wider importance of “freedom of gender expression” enabled transgenders to become well-articulated activists for their own cause, and build coalitions with gay and lesbian and feminist organizations. It made many transgenders recognize the fight for women’s and gay and lesbian rights as their own. They now successfully participate in women’s organizations such as NOW, and in GLB organizations such as the HRC. Their yearly campaigns at almost every state house in the US, as well as in Washington DC have provided a new kind of visibility, as well as some measure of political respectability.

It is important to note however that the discourse of “freedom of gender expression” has also led to the marginalization of a group of transsexuals and cross dressers who still adhere very much to the discourse of essentialized gender identities. For many it is difficult to go through the pains of transition without the belief that they will come out as “real women” or “real men”. Almost no one can see him- or herself happily stitching together a personal gender the night before SRS surgery, or when being attacked on a nightly street for being a woman, a leather man or a cross-dresser.

It seems that we have to be able to take refuge in a discourse which serves our personal goals, and that there is no one particular discourse which can liberate all people all of the time, and many which can serve some people some of the time. As Sedgewick has argued for the GLB community, the transgender community needs both essentializing and de-essentializing discourses to provide adequate support for all its members all of the time.

For many “transgender“ has become shorthand, not for de-constructing gender as a binary, but for de-essentializing gender and sex altogether. Writers like Baudrillard have construed the trans figure as a “semiotically dense emblem in the rhetoric of the end of the millennium”. Sometimes trans-people are used to show how the borders between male and female are eroding, and how current order will give way to future disorder. However, as Jay Prosser notes, every gender crossing shows how essential gender really is. Moreover, if we want to achieve real improvements for women, we 'll have to allow for semi-essentializing discourses from women talking as women. The transgender movement is not out to destroy gender, just like the GLB movement was not out to destroy sexuality. The transgender movement reaffirms gender as maybe the most fundamental language for self expression, and at the same time destabilizes every normative notion about gender, just like homosexuality does for sexuality. Feminists and GLBT people all fight against the oppressive cruelty with which society imposes sexist gender norms. That is why its logical to create coalitions between these movements. They are all part of a humanist movement which traces its roots back to Socrates.

12- Changes in transgender care.

In the US in particular, more and more transgenders became professional health care providers for their own community. Due to transgender activism, most US gender clinics are slowly taking on policies of early access to hormone therapy as an essential aid over the first and most difficult stages of transition.
Surgery on demand is still a big no-no, as it is clearly not indicated for everyone who asks for it. For example, clients who have known sexual abuse over childhood may hate their own bodies so much, that they may want to shape it such a way that this can never happen again (e.g. by having a mastectomy).
In the most advanced US TG treatment settings TG’s now counsel and assess each other, while mental health care professionals facilitate. Clinical assessment is no longer aimed at finding out the one true gender identity of a client, but rather at finding what way of expressing gender feels true to the client, and is feasible within the client’s living environment.
Often the possibilities for gender expression are limited, either by the wishes of a significant other, the work environment, the lack of a TG community, or by financial restrains. When a person does get an opportunity to experience the other gender role, sometimes an avalanche of change sets in leading to a full transition, in spite of all the good reasons one may have for adhering to one 's original gender. At other times clients grow through many middle grounds, finding a new balance at every stage in the life cycle. Some clients start cross-dressing after leaving the parental home, or begin living part time with the help of a low dosage hormone therapy and electrolysis after a divorce, or only become a fully "out" transgender person in all contexts after retirement, etcetera.
An important responsibility for the care provider is to have the client meet a wide range of other TGs who can act as role models, and who may help explore a wide range of TG lifestyles, before any permanent surgical steps are taken. Among U.S. gender specialist TG has slowly become seen as an emerging identity rather then a fixed core identity. The final bodily destination is found over time, based on real experience rather then any one ideal picture.

12- The lack of transgender in Continental Europe.

For almost a century now Dutch gays and lesbians have successfully applied an assimilationist emancipation strategy. Cross dressers and transsexuals have taken the same path since the seventies. Just like gays claimed the same rights as heterosexuals because they were “just the same, except for our sexual orientation” transsexuals claimed rights, saying they were “just the same, except for being born in the wrong body”, and cross dressers said they were “just the same except for my hobby”.

This way heterosexist gender norms remained unchallenged, even within the GLBT communities themselves. In fact, the rhetoric of "we are just the same except for..." created a huge separation between the three groups. No group wanted to have to deal with the other 's faults. The gay community "gender cleansed" itself into a community of real men and women. Transsexuals tried to blend into hetero-society as well they could, after being catapulted from one sex to the other in a fully reimbursed medical treatment. Cross dressers got some subsidies to organize their evenings. This way Dutch society assimilated its “deviants” in a painless and civilized way... without the majority ever giving the experiences of these minorities any intellectual relevance for themselves.

Transgender care in the Netherlands and Europe is still reserved for transsexuals. The notion that the needs of the so-called "transgenderist" (someone who does not want a full medical transition, including SRS) are equally deserving as those of the transsexual just does not get heard. There is a great lack of expertise, as Europe has no gender specialists the way the US has. Also, in a socialized health care system, hospitals and insurers are an extension of regulatory governmental bodies, which are ultimately checked by cabinet ministers and parliament. All the care that is not described in a reimbursement plan is simply not allowed at a Dutch hospital, sometimes creating an atmosphere of oppression for those whose needs are not covered. Moreover, it 's very difficult for small groups to make themselves heard in slow moving bureaucracies without clear responsibilities, topped by fast changing political control. While in the US a transgenderist may only need to find a the ear of a sympathetic gender specialist to get help, in Europe we need a lot of time.

While from a US perspective these defects in the health care system may seem just too impractical to live with, one might also wish US transgenders got their healthcare for free. Free services need extensive control to remain effective.
We might even wonder if queer and transgender identities would ever have emerged in the US if its GLBT movements had had the same measure of success as their assimilationist Dutch counterparts. Just suppose US gays and lesbians were given the same rights as straight people, including the rights to marry and live without job discrimination and hate speech. What would we need a queer identity for? How could queer still be seen as a site of resistance? What can be resisted if the system voids itself of tangible oppression What do you think?

Some References:
Ann Bolin: In search of Eve. Bergin and Garvey, 1988
Benjamin H. The transsexual phenomenon. Julian Press, 1966.
Boswell, holly. The transgender paradigm shift toward free expression. In Bullough,
Bullough and Elias: Gender Blending. Prometheus Books, 1997.
Bornstein: My gender workbook, Routledge 1998
Butler. Bodies that matter: on the discursive limits of "Sex". Routledge 1993.
Pat Califia. Sex changes, the politics of transgenderism. Cleis Press 1997.
Dekker and Van de Pol. The tradition of female transvestism in early modern Europe,
Saint Martins Press 1989.
Leslie Feinberg: Stone Butch Blues. Firebrand books 1993.
Gert Hekma, “A female soul in a male body”: Sexual Inversion as Gender Inversion in
19th Century Sexology, in Third Sex Third Gender (ed. Gilbert Hert). Zone Books 1994.
Israel G.I. and Tarver D.E., Transgender Care. Temple University Press 1997.
Thomas Laqueur Making Sex: body and gender from the Greeks to Freud. Harvard
University Press 1992
Theo van der Meer: Van de wesentlyke sonde der sodomie.
Namaste Invisible lives, the erasure of Transsexual and transgender people. University of
Chicago Press 2000.
Transgender Tapestry, monthly of the International Foundation for Gender Education.
Jay Prosser, Second Skins, the body narratives of transsexuality, Columbia University Press, 1998.
Simon, W. Postmodern Sexualities, Routledge 1996.
Stoller, R. Sex and Gender : The Development of Masculinity and Femininity. Maresfield
Library 1975.
Wilchins, R.A. Read my Lips, Firebrand Books 1997.

References: Ann Bolin: In search of Eve. Bergin and Garvey, 1988 Benjamin H Jay Prosser, Second Skins, the body narratives of transsexuality, Columbia University Press, 1998.