I just finished a lovely short novel by Julian Barnes, The Sense of an Ending, which won the Man Booker Prize in 2011. It's a beautifully evocative disquisition on the unreliability and fragmentation of memory and the self-delusions that we create for ourselves to maintain our personal narratives. Time, being an entropic phenomenon, wears away not only our bodies but the stories we tell ourselves about ourselves, and we seem to always be buttressing up those narratives so as to maintain our cognitive and emotional coherence. This book is one of mystery, a mystery that may or may not be answered in its last paragraph. Like most lives, that of the protagonist remains both historically and morally ambiguous up to the end. We can only glimpse a sense of his ending, and of ours as well.
The timing was particularly apt for me, as I've spent the past month immersed in personal nostalgia and remembrances: the 75th anniversary of the founding of my high school, which we called Science but which is known today as Bronx Science; a bar mitzvah celebration for the oldest grandson of former neighbors in Chevy Chase, Md., the patriarch of the family being a former president of the American Psychiatric Association; a stint as a panelist on the National Transgender Panel at the Equality Forum in Philadelphia; and, finally, my 35th Penn Med reunion at the old Bellevue-Stratford Hotel in Center City, Philadelphia, the source of patients we treated in 1976 with a mysterious illness that was later christened "Legionnaire's disease." It was immersion in living memory, with evidence in the guise of my colleagues and friends reporting just how stable, or not, my memories have been over the decades. They often remembered people and events I had forgotten, as I had captured moments of their lives forgotten by them. We know enough about memory formation today (though still remarkably little) to understand that it's the emotional content of an event that plays a major role in how a memory gets created. So examination of comparative memory caches is really a comparison of which life events had the most emotional resonance for various individuals. An incident that caused a burst of joy or shame in one would be completely ignored by others.
That's a storyline from my life, and I imagine that's true for many other trans (and gay) persons. I carried the shame of my difference within, quietly; as a result, I viewed the world and lived my life with a far different emotional barometer than did my friends and neighbors. It is often said that the whole point of the LGBT civil rights movement is to normalize our lives. I certainly act with that as a major principle in mind: normalization for the sake of creating a level playing field so that all can then become remarkable. So in a more deeply existential manner, the point of coming out and living free and equal is to allow all to live and create historical narratives on that level playing field; to not have to create memories based on shame and fear; to allow a life and its remembrance to be based on the emotions that we all have as human beings but which are grossly distorted by the closet.
Trans personal narratives also play out in another manner, and this past weekend's publication of the DSM-5 highlights that as well. Transgender persons are no longer required to have themselves defined as pathological to gain access to health care. The new "gender dysphoria" diagnosis (replacing "gender identity disorder") is not stigmatizing in and of itself, and does not impose a lifetime mark of Cain on the individual. Today one can gain access to health care without said diagnosis, and with the introduction of the Affordable Care Act, it should get much easier across the country. The persistence of the offensive diagnosis of "transvestic disorder," with its absurd, Freudian categories of autogynephilia and autoandrophilia, can and should be completely ignored by cross dressers. Just stay away, and let Professor Blanchard fade away into oblivion.
It was not that long ago, however, that trans women needed to revise their personal narratives to receive a diagnosis as a "true transsexual" and thereby qualify for health care and surgical reconstruction. Johns Hopkins, which offered the first university-based gender-reassignment program, had very strict rules about qualifications for transition. Put simply, only hyperfeminine women whose primary desire was to be penetrated by a man need bother to apply. When I sat down to fill out their intake questionnaire back in 1971, it seemed to me that 90 percent of the questions were about sexual activity and sexual desire. There was no sense that being trans was a form of being intersex, a basic type of human identity, and completely unrelated to sexual desire. That one could be a gay trans woman was worthy of ridicule, and divorce was required before surgery would be considered.
So to qualify for transition, one had to reconstruct one's life narrative to fit those criteria, and, as a result, trans women got the reputation in the psychiatric community of being liars. That is to some degree the bedrock upon which Dr. Blanchard concocted his Freudian theory, and it's not a great way to develop trust or determine the truth about people's lives. That basic level of mistrust is what still sometimes determines trans persons' relationships with the mental health community even today.
Our narratives, like those of all human beings, are subject to fragmentation, and, yes, we are all subject to some degree of self-delusion. To minimize that, and to provide gay and trans persons with the fundamental human right to self-determination, we must be afforded the right to our own narratives and histories.