By Val Servino—
For a vast majority of the American public, Lesbian, Gay, Bisexual, Transgender, and otherwise Queer equality is a thing of the past. There exists the misguided belief that after the annulment of Don’t Ask, Don’t Tell, officially known as Section 571 of the National Defense Authorization Act for the Fiscal Year 1994, as well as California’s Proposition 8 and the Defense Against Marriage Act, the fight was over—not only over, but won.
However lovely a thought this may be, it is just that—a thought, with no actual substance to be found within the American reality. Transgender folk live within a largely hostile social climate, offered no medical coverage for psychologically necessary procedures, which are instead classified as cosmetic alterations that range from 100 dollars per month to upwards of 20,000 dollars per operation, plus travel costs, hospital fees, and post-operative care. Once therapist fees and other expenses such as clothing, chest binders or padding, and superficial genital modification implements accumulate, costs can raise as high as 80,000 dollars.
The argument against the cosmetic stance cannot be fought without trivializing the transgender experience as a disability, given its longstanding place in the Diagnostic and Statistical Manual of Mental Disorders, now on its fifth edition, which downgrades trans-status from a disorder to “gender dysphoria.” This term is widely used within the transgender community to describe acute sadness or anger towards the body, or specific parts of the body, that do not match one’s ideal image. This new diagnosis extends only to those who experience this unfortunate phenomenon. Those given care under past DSM manuals were diagnosed with Gender Identity Disorder, which encompassed all those with feelings of gender variance. Such diagnosis is required for any transitional procedures, such as hormone replacement therapy, known as HRT, or sexual reassignment surgery.
While many bureaucratic obstacles stand in place to make the transition from one’s assigned gender to one’s actual gender, no legislation stands to protect the civil liberties of transpeople at the federal level, and only 45 percent of the national transgender community is protected by legislation at the state level or lower. That percentage is made up by sixteen states, plus the District of Columbia, and 143 cities and counties both in and out of those states. Employment discrimination is illegal on the basis of gender identity in only eleven states and seventeen jurisdictions. This leaves 173.8 million people out of the 316.6 million people estimated to be living in America unprotected against hate crime, and 243.8 million vulnerable to wrongful termination—that is, if they are ever offered the position.
It is illegal for a transgender person to use the bathroom of their choosing unless their birth certificate or other legal documentation reflects the “correct” equipment, so to speak—or they live in Colorado, Iowa, the state of Washington, San Francisco or Washington, D.C. International travel is not particularly wise for the LGBTQ-identified, as not all countries extend anti-discrimination policies to such persons. Instead, many extend punishments as mild as pecuniary fines and as unforgiving as death.
If a transgender person wishes to serve in the military, they must do so in secret. A trifecta of military doctrines such as Article 134 of the Uniform Code of Military Justice, known as UCMJ, The DODI 6130.03 Medical Standards for Enlistment, Appointment, or Induction, and the Standards of Medical Fitness combine to create a particularly unwelcoming environment. For example, section 3-35 of the Standards of Military Fitness titled, “Personality, psychosexual conditions, transsexual, gender identity, exhibitionism, transvestism, voyeurism, other paraphilias, or factitious disorders; disorders of impulse control not elsewhere classified” states, “a. A history of, or current manifestations of, personality disorders, disorders of impulse control not elsewhere classified, transvestism, voyeurism, other paraphilias, or factitious disorders, psychosexual conditions, transsexual, gender identity disorder to include major abnormalities or defects of the genitalia such as change of sex or a current attempt to change sex, hermaphroditism, pseudohermaphroditism, or pure gonadal dysgenesis or dysfunctional residuals from surgical correction of these conditions render an individual administratively unfit.”
This wording is also present in the Medical Standards for Enlistment, Appointment, or Induction. The language lists ‘transsexualism’ as a sexual paraphilia and mirrors language from the DSM-III. The third Diagnostic and Statistical Manual of Mental Disorders was published in 1980, thirty-three years ago.
“In short, military policy does not reflect current diagnostic criteria or standards of care,” explained Jacob Eleazer. He is a Transgender Military Service Initiative research fellow at the Palm Center, and a research assistant at the University of Louisville’s Department of Educational and Counseling Psychology, studying Trans and Sexuality: Teaching, Advocacy, and Research.
Eleazer continued, “Under this regulation, transgender persons are deemed psychologically unfit and are subject to administrative separation. Administrative separation is unique in that service members are discharged for medical reasons, but they are not provided a medical discharge—which provides the opportunity to apply for disability and medical treatment.”
These issues have become particularly relevant in recent months, after Pvt. Manning’s revelation that she is a transgender woman and would like to transition while imprisoned at Fort Leavenworth. The media’s reaction to such news was particularly resonant of the American opinion at large; many major and minor news organizations continued to use Manning’s birth name and incorrect pronouns even when discussing her transgender status.
A topic often brought to the table was the case of Michelle Kosilek, a transgender woman imprisoned in Massachusetts. The state paid for her vaginoplasty, or sexual reassignment surgery, after a long court battle. The difference was that she had begun her transition prior to incarceration.
The Bureau of Prisons Health Services Manual states, “It is the policy of the Bureau of Prisons to maintain the transsexual inmate at the level of change existing upon admission to the Bureau. Should responsible medical staff determine that either progressive or regressive treatment changes are indicated, these changes must be approved by the [Bureau of Prisons] Medical Director prior to implementation. The use of hormones to maintain secondary sexual characteristics may be continued at approximately the same levels as prior to incarceration, but such use must be approved by the Medical Director.”
However, Navedo v. Maloney established that while prisoners have the right to medical care, the Bureau of Prisons is within its rights to depart from superior standards of care, so long as the level of “deliberate indifference” is not reached. Another case ruled that stopping hormone treatment was cruel and unusual punishment. De jure is not de facto. Essentially, thou giveth and thou taketh away.
Nevertheless, Chelsea Manning is not only ineligible for care under federal law, but as a military prisoner, she is subject to a vastly different set of rules and regulations. It is yet unclear whether the conversation Manning began in her coming out will end in policy change, but one can only hope.
