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If they see
Breasts and long hair coming
They call it woman.
If beard and whiskers
They call it man;
But, look, the self that hovers in between
Is neither man nor woman.

Devara Dasminayya
(Indian Devotional Saint, tenth century)

When the United States of America was colonized, and transsexual Native Americans discovered, some of the documented language used to describe them was “sinful, heinous, perverted, nefarious, abominable, unnatural, disgusting, lewd” (Feinberg 1996, pg 22).  That was a long time ago and I wonder if we’ve come very far in our beliefs?   It’s this question and that of society’s impact on the mental health of transgendered people that I would like to look at. 

Going Nowhere Slowly

In Buffalo, USA, in the 1960’s, a woman wearing y-front trousers, jockey shorts or a t-shirt was considered to be breaking the law and faced arrest.  Her crime was not dressing to denote her gender (Feinberg 1996 pg 15).  In Kwazulu Natal, South Africa, in 2007, a woman was stripped naked and her home burned because she was wearing trousers.  Men in that township are demanding that all women wear skirts or dresses (source: Liesl Theron, Gender DynamiX).   It seems we haven’t come very far at all!
The mere fact that transgenderism is listed in the DSM (Diagnostic and Statistical Manual of Mental Disorders) gives me pause for thought.  I believe Arlene Istar Lev put it well when she stated “The difficulties that some gender variant people present within therapy – obsessive cross dressing, inappropriate acting out, social phobia, impulsivity, depression, anxiety, suicidality and self-harm behaviours – might be symptoms and sequelae of their social denigration rather than proof of their gender related mental illness” (2004 pg 4).  On the other hand though, Kelly Huegel in her book “GLBTQ: The Survival Guide for Queer & Questioning Teens” points out that a diagnosis of Gender identity Disorder enables people to get the mental and physical treatment they need, particularly to transition their gender (2003 pg 167).  

But Lev goes on to say that the difficulty lies “in the perspective that assumes psychopathology in all gender variant people without understanding the context of their difficulties” (2004 pg 190).  It is this context that I think is a core issue.

Growing Up

“When I was a kid, everyone else seemed to know they were boys or girls or men or women.  That’s something I have never known; not then, not today.  As a kid, I just figured I was the crazy one; I was the one who really had some serious defect”

Kate Bornstein

For transgendered children, strong feelings of being different and not fitting in can be experienced.  In teenage years what dominates is dealing with negative body image and difficult social interactions (Brown & Rounsley 2003 pgs 32 & 54).  We are also told that many young people become “frustrated and disappointed to the point that they find it increasingly difficult to function on a daily basis” (Brown & Rounsley 2003 pg 35).

A 1997 study of high school students in Iowa, USA, showed that students heard anti-GLBT (Gay Lesbian Bisexual Transgender) slurs on average 25 times per day.  In 2001, the Gay, Lesbian and Straight Education Network (GLSEN) National School Climate Survey found that 65% of GLBT students reported being sexually harassed, four in ten reported being physically harassed and 21% reported being physically assaulted (Huegel 2003 pg 30).  In South Africa studies have been carried out showing that the main source of victimization for GLBT scholars came from other learners (65%), teachers (22%) and school principles (9%).  When LGBT issues were raised in the classroom, 73% said it was portrayed in a negative light (research commissioned by Joint Working Group 2006).                                                                                                               

Growing up with Gender Dysphoria can lead to feelings of desperation and a sense of having nowhere to turn.  All of the above can lead to low self-esteem, parental conflict and alcohol and drug abuse.  Avoidance or withdrawal can seem like the safest route (Brown & Rounsley 2003 pg 55).  But as Jennifer Miller states, “keeping secrets requires energy that is debilitating, especially when it’s out of shame or fear” (cited by Leslie Feinberg, 1996 pg 143). 

This is borne out by Zucker and Bradley (1995) who found that children of both sexes, aged 6 to 11, with gender identity disorder, were “more likely to demonstrate mental health problems than were matched controls, primarily in the area of internalizing symptomatology (e.g., depression or anxiety)” (cited by R Carrol in Leiblum, 2007 pg 481).  Zucker and Bradley found the same applied when adolescence was reached, with high levels of behavioural disorders being common, in particular conduct disorder, attention-deficit disorder and anxiety disorder (2007 pg 481).

The High Price of Authenticity

In 1993, American teenager, Brandon Teena had a minor brush with the law.  Police discovered and reportedly exposed that Brandon was born female.  A short time later he was attacked and stripped in front of a woman he had dated, then kidnapped and gang raped.  Police refused to press charges.  Soon after, Brandon was shot and stabbed to death.  Would he be alive today if he were not transgendered and if his privacy and rights had been respected?  (Feinberg 1996 pg 132).

In Johannesburg, South Africa, 2006, Marco Ndlovu was attacked and beaten.  One of her attackers wanted to strip her to prove whether she was a man or woman (Forum for the Empowerment of Women 2006 pg 9).  Juliet Viktor Mukasa was born female in Uganda 31 years ago.  Her gender identity was male and her relationships lesbian.  When she was 23 her brother, with the knowledge of their parents, set up a man to rape her, believing that this would “cure” her (source: Gender Dynamix).

Leslie Feinberg (1996 pg XII) describes her experience in the following way - “those of us who cross the cultural boundaries of sex and gender are paying a terrible price.  We face discrimination and physical violence.  It takes so much courage to live our lives that sometimes just leaving our homes in the morning and facing the world as who we really are is in itself an act of resistance”.   James Green, the editor of FTM International (cited by Feinberg, 1996 pg 145), says “we’re still dealing with individual basic survival.  People would like to not fear losing their job, not have to fear the loss of their social relationships, the loss of their children.  It’s just that basic”. 


If the life experience of a transgendered person were one of being accepted and supported, would they have a lower incidence of associated mental health disorders?  Would we still classify gender dysphoria in the DSM?  According to Arlene Istar Lev, “etiological theories and psychomedical nosologies serve only to further compound the isolation and social ostracism that is the inheritance of those who are labeled mentally ill” (2004 pg 5).   I did not find definitive answers to my questions, but my reading left me with an abiding sense of sadness for people with an issue that I felt society exacerbated.

“It is not gender which causes problems, rather it’s the imposition of a gender on an individual by another”

Nancy Nangeroni


BROWN, ML % ROUNSLEY, CA (2003) “True Selves – Understanding Transexualism”
Jossey-Bass: CA, USA
FEINBERG, L (1996) “Transgender Warriors”
Beacon Press: USA
HUEGEL, K (2003) “GLBTQ  The Survival Guide for Queer & Questioning Teens”
Free Spirit Publishing Inc: USA
ISTAR LEV, A (2004) “Transgender Emergence – Therapeutic Guidelines for Working with Gender-Variant People and Their Families”
The Haworth Press Inc: New York, USA
LEIBLUM, S (2007) “Principles and Practice of Sex Therapy”
The Guildford Press: USA
GENDER DYNAMIX: Web: www.genderdynamix.org.za
Forum for the Empowerment of Women Newsletter, July 2006-November 2006
Quote by Nancy Nangeroni cited by Feinberg, Leslie (1996 pg 163)
Poem by Devara Dasimayya found in “Transgender Emergence” by Arlene Istar Lev
Quote by Kate Bornstein cited by Huegel, Kelly (2003 pg 172)


BARLOW, D & DURAND, VM (2005) “Abnormal Psychology”
Thomson Wadsworth: USA
BOENKE, M (2003)  “Trans Forming Families”
Oak Knoll Press: USA
SCHEFER, T; BOONZAIER, F; KIGUWA, P (2006) “The Gender of Psychology”
UCT Press: South Africa
Research initiative of the Joint Working Group conducted by OUT LGBT Well Being in collaboration with the UNISA Centre for Applied Psychology



By: Debra Wucherpfennig


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