Guest Blogger

A Tax Break Isn't Worth Having the Government Treat Being Trans as a Disease

Filed By Guest Blogger | February 04, 2010 4:00 PM | comments

Filed in: Living, Transgender & Intersex
Tags: GRS, medication, O'Donnabhain, srs, Thailand, transgender, transsexual

Editors' note: Alice Kalafarski is a law school graduate and transgender activist. She volunteers with Boston Area Rape Crisis Center (BARCC), SpeakOUT Boston, and spent a month with Maine's No on One campaign. Of all the places she helps out, she proudest to be a Camp Trans cat herder.

Alice-Kalafarski.jpgWhen we hear about a court ruling, the first thing we pay attention to is who won. We care a lot more about the practical impact of a decision than we do about which legal arguments won over the judges. However, you need to take a closer look at those arguments if you care about what courts will do moving forward and how the public as a whole will feel about the issue. I applaud the result of the O'Donnabhain decision, but I'm really scared it will reinforce the idea that being trans is a disease to be treated with hormones and surgery. A tax break isn't worth that kind of stigma.

The law isn't just about statutes and precedents; it's about how our society's rules affect how real people make the decisions that shape their lives. I'm one of the hundreds of thousands (or million+) of transgender Americans who lived through the current Gender Identity Disorder (GID) system. Ms. O'Donnabhain has the right to tell her story and explain why GID diagnosis helped her, but I should have my story heard as well.

I was closeted until I had a big trans-epiphany on November 14th, 2006. I was 25, and until then I'd been depressed, isolated, and almost completely asexual. I'd kept all of my dreams inside, so I hadn't crossdressed or done any of the other things commonly associated with being trans. I wanted to make up for lost time, and by December I decided to go full-time and start hormones; the student health center was very accommodating, and so were all of my teachers. In February of '07, I booked an appointment for genital reassignment surgery (GRS) with a surgeon in Thailand recommended to me by an acquaintance. I left in May right after the semester ended, and I paid $5,500 for surgery and the three-week stay to recover.

My parents were somewhat accepting of me being trans, but they wanted to stop me from getting surgery so soon in Thailand. They contacted gender specialist Diane Ellaborn, the same therapist O'Donnabhain used and the one relied upon in the court's decision, and they had her speak with me over the phone prior to leaving for Thailand. After just half an hour of speaking with me, Ms. Ellaborn said she could diagnose me with GID and get me any US surgeon I liked within six months; my dad even offered to pay for everything. I got rather upset at all this, and I said part of the reason I was going to Thailand was so I wouldn't have to put up with all of the GID nonsense. The stigma of being trans had kept me in the closet for 25 years, and I wanted to finally start making my own decisions about what to do with my life and my body.

At the time, I liked to think that I set the world's record for transitioning, but I know now that the physical changes are only a small part of the ongoing process to accept who I am and to get comfortable living my life. Looking back I also see how I made things harder on myself by rushing off to Thailand so quickly, but I don't have any regrets about deciding things on my own rather than letting a gender therapist decide for me. In traditional therapy, a large focus is on empowering the client to feel confident and self-sufficient; gender therapists take the exact opposite approach. They are the ones who decide if and when you'll make a permanent, major change to your body, and that's about as disempowering as you can get. Even if you get someone like Diane Ellaborn who'll give you a rubber-stamp, it's still disempowering to jump through all those hoops because you live in a society that demands the charade.

So let's be clear that we can't separate GID diagnosis from being trans. The judges who decided the O'Donnabhain case might not consciously accept it, but nearly any trans person who wants surgery can get diagnosed with GID. We can network amongst each other to find the therapists who'll diagnose us after a half-hour phone call, and we'll find the ones that can pull strings to get us any surgeon we want in six months. It might cost some money for 12 perfunctory sessions where we go through the motions of talking about how sad we are about our junk, but if you've got the cash you can get the diagnosis. It's a win for you to get the surgery you want, it's a win for the therapist that gets paid for those sessions, and it's a win for the surgeon who won't have any ethical qualms or legal hassles for taking your money.

The big losers in the system are the vast majority of trans people who don't go the GID-diagnosis-to-surgery route. The fact that GID is a mental disease keeps many of them in the closet trying to "cure" themselves; we lose many closeted trans people to suicide each year, and many who do emerge can carry the emotional damage of those years for the rest of their lives. Those that do come out often don't want surgery and suffer from a public perception that it's what every trans person who's "really a woman" (or man) will do. The system also doesn't do much to help trans people who want surgery but can't afford it. The holy grail of those pushing the GID system is that it will eventually make health insurers cover surgery, but in the unlikely event that does happen I don't think it will be worth the cost. As long as being trans means you're susceptible to a special disease that requires lots of painful and expensive surgery, we'll all be treated as if there's something wrong about being transgender.

Imagine yourself at a gay rights rally. What's your one-word response when a leader steps up and shouts, "What do we want?" I'd bet it's a resounding cry for "EQUALITY" or something similar. The gay rights movement has been making a fairly consistent push for equal rights for the past generation, and it's slowly captured the hearts and minds of most young Americans. But what message do trans people send with high-profile cases about getting money for surgery from the government or health insurers?

I do think that all trans people should get support once they decide what physical changes they need to make, but isn't that less important than directly confronting our nation's transphobia? In the long run, being trans in America will always really suck until we get just as much respect for our identities as cisgender people do -and nobody conditions that respect on genital status or any other physical trait. Although I support the result and believe all the activists and other people involved were well intentioned, the O'Donnabhain decision takes us farther away from when that day will come.


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Alice, great to see you here! I must admit that I haven't read the actual decision, I imagine it probably does talk about GID as a disease a lot. But it should be possible to put forward a legal argument that recognizes transition related medical care as medically necessary without qualifying being trans as a disease.

I mean for example, plenty of health care is considered medically necessary but not a disease, such as pre-natal care. I'm certain if a cis person required genital reconstructive surgery and their doctor signed off on it as medically necessary then the IRS wouldn't have given it a second thought.

As for the "holy grail," it's a reality in a growing number of cases. City governments, university systems, Ontario, Cuba, I got my own insurance policy to cover it after just one year working with my union on it.

Trans health coverage is a matter of equality. Insurance companies regularly cover hormones and genital reconstructive surgery for cis folks. Before my insurance became inclusive, I was flat out told that they'd cover my HRT, just like any other woman, if I could prove to their satisfaction that I was female, but so long as they considered me male they'd only approve me for testosterone therapy. When cis men can get testosterone and cis women can get estrogen, but trans folks are denied the same treatment, that's clearly a matter of discrimination.

Hi Tobi, thanks for the welcome. I agree that there are great equality-based arguments to be made for covering many transition-related medical expenses, but the O'Donnabhain case was all about GID. On page 2 of the decision, the court holds that GID is a disease under the appropriate tax code section; hormones & surgery were covered as treatment for that disease.

http://www.glad.org/uploads/docs/cases/odonnabhain-tax-court-decision-02-02-10.pdf

In a very frightening way, this ruling gives the Zucker-Bailey-Blanchard crowd even more power that extends far beyond their DSM rewrite working groups.

If GID is delisted or becomes a phillia in the next revision, both the deduction and any insurance coverage that would have come about as a result could be taken away.

Turning to slightly different observations:

Does this ruling have any effect on the Americans with Disabilities Act? If so, it may be very much in line with the HBS/"of history" way of thinking. Senator Helm's amendment states that, "transsexualism and gender identity disorders are not, without a physical causation, considered disabilities". In light of the IRS ruling, one would think that the argument could be strengthened that TS is indeed a disability to be treated and when (if?) it has been sufficiently treated, life simply continues on to completion.

In light of all this, there seems to be a fascinating & growing legal distinction between the recognition and definition of transsexuals compared to gender expression (i.e., the rest of the transgender umbrella). One could conceivably extend that distinction all the way out to the gender expression of sexuality (since it is not a disorder). It would then need to be legally recognized as being of biological origin in order to gain full equality. But that might be a long, long hill to climb.

TS's have almost 20 years of recent neurological research that shows structural and chemical differences in physical development, structure and function, mostly neurological. Should the legal need arise to show that the condition is a difference of biological origin, delisting may only be a temporary setback.

No wonder a few of the G (& some LB) want the T kicked out of the club.

"After just half an hour of speaking with me, Ms. Ellaborn said she could diagnose me with GID and get me any US surgeon I liked within six months"

That gave me a laugh. Good luck shaking that tree until a letter falls out of it.

I guess the only question left to ask is this: "What would you rather have happen?"

I don't like feeling diseased any more than the next trans person, but I do recognize that treating my mind-body disparity costs a significant chunk of change. On an entirely practical level this tax change means that these gender-affirming measures are recognized as any other medical procedure: necessary, as well as tax deductible. Disease-model or no, this means we get a tax break. Money that previously went to the government now goes to your pocket.

Whether or not we have the GID model of mental disorder, the idea that transgender conditions are diseases or conditions, or which gatekeepers we have to go through to get our treatment, some portion of the financial burden will still be on our heads. This decision puts money back into the pockets of transitioners. I don't see where that translates to making transgender issues more or less palatable in the eyes of the public.

I lied: i do have one more question to ask. "Why is the affirmation of our equality as taxable citizens an admonishment of our identity?" I think you tried to attack that question here, but I don't yet feel convinced of the thesis. Sorry.

Well as I said up front, I applaud the result of this case but have a problem that it was won by reinforcing the GID system. That system tells anyone who wants to have trans-related surgery in our country to be diagnosed with a special mental disease, and easier way to say that is being trans means you must be crazy. Having the federal government endorse that system is a bit more than an "admonishment" of us in my book. I have no trouble with getting help for real mental problems -I spent years on medication and in therapy for depression. But I don't believe GID is a real mental illness, and I don't think you do either.

As for moving forward, Tobi mentioned some of the equality arguments that compare trans surgeries to procedures that cis people get covered, and I think that's a much more honest and accurate comparison. It might be harder to win with those arguments now, but a GID diagnosis won't be worth anything once more people realize that any trans person who wants surgery can get one.

Kathy Padilla | February 5, 2010 10:48 AM

I agree - though I think there's more nuance in the decision.

The majority recognised that the characterization of the condition as a disease was for federal tax purposes - they were clear that this was the extent of the ruling and it did not have broader implications regarding civil or other considerations of disease status. They were also clear that what the disease consited of was the discomfort associated with trans identity - not being trans - and that this discomfort is not a lifelong disease condition - that one no longer has a disease when that is resloved via treatment. That the discomfort that constitutes the disease is gone.

The decision would seem to apply equally to transsexual & other types of trans and GV people as they recognise different types of GID and seperately approve of the elements of traiadic therapy.

When one says "treating GID" that doesn't mean that you will permanently have GID, rather that, for people who have issues about the gendered sexual characteristics of their bodies, this surgery has been proven helpful/even essential for many. It's treating the distress which comes from a particular physical state in some people. I don't see anything which says "if you experienced this and had to have surgery, therefore you will permanently be branded with the scarlet letters GID".

I paid out of pocket for my SRS (and paid a lot more than you did) and I think this is a very positive legal decision. What I do see (and sorry to bring up this issue yet again) is non-ops (and long term pre-ops) are still left with being stigmatized with GID, and I agree that's wrong. But quite honestly, in the practical world, this decision doesn't change that one iota.

I do have huge issues with ANYONE, transgender activists included, making a political issue against having SRS available to those who need it to further a specifically queer/LGBT agenda. This decision greatly helps many people who need it in being able to swing funding their SRS and that is what's important.

Btw, it's nothing new... trans people were able to itemize their surgeries for years until the GW Bush administration. This is restoring a right which was taken away. Of all the oppression trans people need to be concerned about, this decision wouldn't even be on my list.

I am re-evaluating my reaction to whether being trans should be classified as a disease or a mental illness.

Some years ago when I began transitioning, I thought "of course it's not a mental illness - I'm fine!!"

But having that attitude puts down people who are diagnosed with mental illnesses. In effect, I am saying "I don't have a mental illness, not like those OTHER people."

There shouldn't be anything wrong with having a mental illness. Lots of people are diagnosed with a mental illness, and none should be stigmatized because of it.

And what is a mental illness? One way of looking at it is that when you have a mental illness, it is difficult for you to make your way in the world. Being who you are is difficult. Things that other people find easy are difficult for you. This is a reality for trans people as well as people with other mental illnesses -- the world isn't set up to be friendly to us.

Also, just as anyone who is determined enough can get a GID diagnosis, so can anyone who is determined enough get a prescription for anti-depressives.

It seems to me that mental illness is the label that is put on people who don't fit into the way society is structured. And the fact that more and more people are labeled this way says a lot about our society and its values.

From the ruling:

-----

In the crash course on transsexualism that this case has forced on us, there are at least four approaches that those who’ve studied the phenomenon of such feelings have had. One response, curtly dismissed by the majority, is that this is a form of delusion:

It is not obvious how this patient’s feeling that he is a woman trapped in a man’s body differs from the feeling of a patient with anorexia nervosa that she is obese despite her emaciated, cachectic state. We don’t do liposuction on anorexics. Why amputate the genitals of these poor men? Surely, the fault is in the mind and not the member. - McHugh, “Psychiatric Misadventures”, Am. Scholar 497, 503 (1992)
For such psychiatrists, gender follows sex, is a fundamental part of human nature, and is not easily amenable to change. Those who take this view look at transsexual persons to uncover what they suspect are comorbidities--other things wrong with their patients that might explain the undoubtedly powerful feeling that they are wrongly sexed and whose treatment might alleviate the stress that it causes them.

A second approach focuses on the notion of “feeling female.” What does this mean? The answer adopted by the majority and urged by O’Donnabhain is that this is a shorthand way of saying that a transsexual person’s gender (i.e., characteristic way of feeling or behaving, and conventionally labeled either masculine or feminine) is strongly perceived by her as mismatched to her sex (i.e., biological characteristics). This, too, is highly contested territory--gender being thought by many, particularly feminists, to be entirely something society imposes on individuals. To such theorists, transsexualism is likewise a social construct:

The medical profession need not direct the gender dissatisfied to surgery. Counselling is possible to encourage clients to take a more political approach to their situation and to realize that they can rebel against the constraints of a prescribed gender role, and relate to their own sex in their native bodies.
-- Jeffreys, “Transgender Activism: A Lesbian Feminist Perspective,” 1 J. Lesbian Stud. 55, 70 (1997) (suggesting SRS be proscribed as “crime against humanity”); see also id. at 56 (citing Raymond, The Transsexual Empire (Teachers College Press 1994)).
Yet a third school of thought is that the origins of at least many (but not all) transsexual feelings--particularly those with extensive histories of secret transvestism--is that it’s not about gender, but about a particular kind of erotic attachment.
See, e.g., Blanchard, “Typology of Male-to-Female Transsexualism,” 14 Archives Sexual Behav. 247 (1985); Cohen-Kettenis & Gooren, “Transsexualism: A Review of Etiology, Diagnosis and Treatment,” 46 J. Psychosomatic Res. 315, 321-22 (1999) (summarizing research); Lawrence, “Clinical and Theoretical Parallels Between Desire for Limb Amputation and Gender Identity Disorder,” 35 Archives Sexual Behav. 263 (2006).

Scholars of this school regard SRS as justified--not so much to cure a disease, but because SRS relieves suffering from an intense, innate, fixed, but otherwise unobtainable desire.
See, e.g., Dreger, “The Controversy Surrounding The Man Who Would Be Queen: A Case History of the Politics of Science, Identity, and Sex in the Internet Age,” 37 Archives Sexual Behav. 366, 383-84 (2008).

These are all intensely contested viewpoints. The fourth and currently predominant view among those professionally involved in the field is the one urged by O’Donnabhain, and not effectively contested by the Commissioner: that the reason a transsexual person seeks SRS is to correct a particular type of birth defect--a mismatch between the person’s body and her gender identity. That mismatch has a name--GID--if not yet any clinically verifiable origin, and SRS (plus hormone therapy) is simply the correct treatment of the disorder.

I profess no expertise in weighing the merits of biodeterminism, feminism, or any of the competing theories on this question. But the majority’s decision to devote significant analysis to the importance of characterizing GID as a disease, and SRS as its medically necessary treatment, pulls me into such matters to give context to the majority’s analysis.

-----

That's about it for the other theories. We're insane, evil, or perverts.

And to treat us so we don't actually die would be to co-operate with a mental illness (because there HAS to be a "talking cure" according to their ideology, they've only been looking for it for 80 years, after all), or to commit a "crime against humanity" (again, because that's what their ideology says it is), or is justified because sexual deviants are people too. That plays real well with the voting public and legislature.

Notice a certain common thread that binds these three very contradictory views together? All three have been used as reasons to deny us basic human rights in the past - and will no doubt continue to be used in the future.

I guess we're lucky. Because those prejudiced against us can't agree on exactly why we're a Bad Thing(tm). Just that we are. And that rather undercuts their case, and strengthens our contention that the animus against us has no rational basis. I don't think even the Jews have been accused by Anti-Semites of being Evil, Psychotic, and Deviant.

It's been 8 years since Ms O’Donnabhain put in her 2001 Tax Return. It's taken 8 years, and untold expense, to claim the huge sum of.... $5,679. Actually less, the amount for breast augmentation was disallowed as having its necessity insufficiently evidenced in this particular case. So her refund will be less than $5,000.

Other TS people will now be rushing to file amended returns. Too bad the cut-off date is 3 years, so if they had treatment before 2007, they're out of luck.

For the rest - Many Happy Returns.

The incongruency of this ruling captures my frustration with the current system well. How can something diagnosed as a mental illness be most successfully treated as a physical illness?

If I'm reading your comment correctly by ommission what is missing is a way to shift diagnosis from the APA to the AMA (USA-centric, obviously; replace with your local authorities), no?

This is what has frustrated me from day one: What is essentially a biological or medical problem is being diagnosed by people that are as a group often either ignorant of or actively hostile to neurological, endocrinological, or other physiology based research and knowledge (not to mention experience) of the problem and treatment. As a profession they have largely been a failure in the treatment of transsexuals. Endocrinologists and surgeons have been heroes.

To gain access to treatment we must rely on people who are biased against seeing this as a primarily medical malady as they would lose a valuable income stream. In the case of researchers, they would lose a valuable topic which has proven elusive within their sphere for decades yet has revealed much to neurology & physiology. The discrepancy seems only to be growing in what the two fields are able to adequately cover with their models of causality and treatment. It's the classic "gatekeeper" argument but with the foil of the alternative of shifting from a mental illness to a physical illness.

We need better diagnostics and ones that do not rely on talking therapy. My fear is that the manual for such is about to be rewritten and it may not be in our best interest...

Well said, thank you and it needed saying. While Ms. O'Donnabhain rightfully deserved to have her tax deduction the effect is to set the cause of transsexual people back. It is the result of an attorney who cares only about winning and not how it that winning damages society generally. It is now all the harder to get transsexualism depsychopathologized.

The main hope on the horizon seems, ironically for Americans, to be Cuba which is creating policies that (1) Transsexualism is not mental illness AND (2) surgery is proper in cases of transsexualism. It seems to be the only nation so far to have grasped BOTH of those principles. Shame on WPATH for the ongoing stigma they are causing us. Extreme action is

Ok, the mis-information, mis-conceptions and out and out deliberate slight of hand here compels me to respond.

Transsexuality is a prenatally developed birth condition. Period. That's what all the actual science to date supports. There is not a shred of scientifically valid evidence that it is "mental" beyond the fact it is primarily seen by it's effect on "mental" understanding of one's self.

Dysphoric Imperative is the primary indicator of this medical condition. That means the absolute need to put the body and mind in congruence. If that is absent, one is not transsexual. This medical condition has a cure that is nearly 100% effective, surgical alteration of the body to match the internal sense of sex case membership.

SRS is a surgical medical treatment, but as such, it can be an actual treatment or it can be misused as cosmetic proceedure by those who do not have the condition it is a treatment for.

WPATH, as HBIGDA was originally set up to aid those with the medical condition in gaining access to medical treatment. That was the original purpose. Quickly the psychs turned it to promote their own agendas of gender as a social construct. Then it was further expanded to transgender rather than transsexual...at this point it essentially made itself meaningless, which is the place it's at today.

Classic transsexuals are basically trying to claim back a medical term for a medical conditon from identity politics where the medical meaning is basically erased. None of these positions here are possible if you understand the basics in place here.

Let me state this as clearly as I can: The original SOC was to assure you were NOT mentally ill when you presented for SRS. It was gradually subverted to a specific mental illness, GID. That model is discredited among actual medical practitioners.

Whenever I read American commentary on this subject, I am always amazed by the hysteria that is present in the backround. Not that things are perfect in Canada, but, as pointed out earlier, most of the single-payer provincial health insurance programs cover it. And when it didn't, a tax refund, as for any other physician service is available on a no questions asked basis. The politically driven tax system, so apparent in America, is not seen here.

Yes, for many years, I simply did not want to think of myself as a transsexual, though I knew, in the absolute core of my being that I wanted to be/was a woman, not the man I appeared to be.

I don't really understand the ideological fervour that propels the struggle to remove, I hate the term GID, but any reference to transsexuality from a medical diagnosis. There must be some alternative that isn't an artifact of bad theory that anything to do with gender identity--a conflation of both gender and sex--and that recognizes the medical need for us to conform our physical anatomy to our certain knowledge of our sex.

I believe too many comparisons to the struggles of gay and lesbian people, even to feminists, just distract us from our own necessary, principled and legitimate struggles.

But then, I don't know, in any part of my struggle, the moral panic that pervades American society and certainly encourages, if not drives, some of those marginalized by the need for conforming their physicality to identify with the struggle of others.

The simply question is, why must transsexual people become more than allies, but submit our struggles to the whims of others?

Why cannot the simple justice of our struggle, just as the simple justice of the struggles of gay and lesbian people on the one hand, and that of feminists on the other, be recognized as necessary and good and worthy of support on its own?

I am ambivalent about this ruling. We should think carefully before embracing it. I'm glad for Rhiannon, but I'm not sure whether I'm glad for the whole LGBT community. I also assume that the case may be reviewed by higher courts, and that may change the calculus significantly.

Thanks for writing about this. This is an important post, and I'll have to come back and read it again a few times to help sort out my thoughts.

Thanks Jillian! I'm eager to hear what you think.

The important aspects of this case are as follows:
It is a legal acknowledgement of the medical model
It restores that prior understanding of transsexuality as a medical condition with specific treatment modality that, frankly, was the norm prior to the gender theory nonsense that attempted to erase the condition. What's the problem here? The science supports this. The treatment works with near perfect results for those with the medical condition.

The medical facts on the ground are quite simple. Well over 300 separate and distinct studies confirm that transsexuality, as defined by a medical model that restricts itself to including the dysphoric imperative as it's expression, is prenatal and neurological. That is established medical/scientific fact now, it's no longer a theory any more than gravity is. The causes for that condition prenatally are not understood completely and almost certainly will turn out to be from a variety of causes rather than a single one, but the condition, it's being prenatal and neurological is established.

For some political reasons I frankly do not understand, some wish to continue to deny this. They endlessly muddy the waters of popular understanding by screwing with definitions, deliberately denouncing the facts, denying that the entire gender theory/gender as social construct nonsense is disproved simply be the very existence of classic transsexuality. If you could trans your internal sense of being male or female, transsexuality, frankly, wouldn't even exist and yet it does and has since the dawn of recorded history and beyond.

I am totally in favour of employment being based on the ability to do a job, period. I have no desire to see anyone denied human rights. But I will never support flights of fancy replacing facts on the ground to erase entire groups of people. And this decision was a step away from that nonsense and says nothing about "mental" conditions but speaks to medical ones.

There is no hierarchy of "legitimacy" except in the minds of those lacking essential self esteem.
Drop this stupidity and suddenly discussions on transsexuality vs transgender (an identity, not a medical condition) become possible. Cling to this false hierarchy and the gender wars will never end. It's that simple.

Jillian, the entire LGB community has nothing to do with this decision. It is not about sexual orientation, it's about whether or not transsexuality and it's treatments are legitimate medical ones. Period.

Frankly this is a political consideration screwing with medical ones to view it in light of greater LGB considerations and defies all logic to see it in any other light.

This medical legitimacy issue has been use to deny medical insurance coverage. In legal terms this battle has been fought and won many times but always with the insurance company demanding a "non disclosure" clause so only those who actually fight, win and everyone else is left in the dark. This is a major blow against that, a return to a prior situation (you could deduct SRS as a medical expense prior to the Bush administration)

What I cannot get is why you seem to fail to understand this.

rapid butterfly | February 5, 2010 10:53 AM

as a trans woman and an attorney, I tend to agree with Austen's comments and with vivian's, as well. These kinds of decisions have little bearing on the general public's view of transsexualism. But as to that, on the margin, if they help folks think - hey, this is the condition they have, this is the treatment, shouldn't be a bigger deal than a person having heart surgery if they need it - then that is a help to us as trans people making our way in the world of people who know precious little of us and don't really know what to make of us.

If some of us find it easier to afford SRS, then that is a real help. I believe it will help me, if the decision holds. I think it may help many of us. If it helps with insurance coverage, that is huge.

And I think vivian's view is well stated also. I think we as trans people ought to think carefully before we rush to distance ourselves from "those people", where "those people" are the mentally ill or the disabled. The issue really concerns the stigmatization and marginalization of, and an explicit or implicit disapprobation of, what is different.

"...I'm not sure whether I'm glad for the whole LGBT community."

Huh!!!

What in the world does this IRS decision possibly have to do with the whole LGBT community?

Or, for that matter, what has this even got to do with that sizable percentage of the transgender who are not surgery tracked?

This decision has nothing to do with sexual orientation (LGBT)...nothing whatsoever...so why can't surgery tracked transsexuals simply stand on their own in this matter without input from the whole LGBT community?

It is all about the rich vrs poor

Radical Bitch writes "There is not a shred of scientifically valid evidence that it is "mental" beyond the fact it is primarily seen by it's effect on "mental" understanding of one's self. Dysphoric Imperative is the primary indicator of this medical condition. "

Not even Kenneth Zucker or Paul McHugh would disagree with that. What they would disagree with is the innuendo that somehow mental illnesses are not medical conditions. Psychiatry is the branch of MEDICINE that diagnoses and treats diseases of the mind. Diseases of the MIND are not diseases of the BRAIN (that field belongs to neurology - a different branch of medicine).

Having a diseased mind (also known as a mental illness) is a medical condition. Everyone who has a mental illness thereby has a medical condition. Transsexualism is also a medical condition.

It is were possible to treat the MIND to remove the transsexualism then transsexualism would be a mental illness. But it is not possible and trying so to do only injures health. One day (not yet) it may be possible to treat the brain to cure transsexualism, but that will still not make it a mental illness.

Please look at it like this - suppose a person has two legs each of which is of normal length but they are of unequal length. So which leg is the diseased leg? The longer one or the shorter one? The only thing wrong with either leg is that it is not the same length as the other leg. The answer is - the diseased leg is the leg we propose to treat, and we decide which leg to treat based on the liklihood of promoting health.

So it should be with transsexualism. What is wrong wrong wrong it to say the mind is diseased when it is proposed to treat the body. And the reason to treat the body is that doing so promotes health, in the end there is really no other reason to do it. And no reason to say that GID belongs in the DSM except as a means to injure health of patients and promote the wealth of pyschologists. And the wealth of tax lawyers and tax judges, which brings us back on topic.

What you are describing would essentially need to legally define transsexuals as the equivalent of people with an intersex condition. Obviously, this would have to be done with a different label, so as not to lose the moral high ground when it comes to appropriating self-identity labels.

It would seem an easy enough task: pick a nice clean ADA fight that clearly presented TS as a parallel to some intersex conditions that require treatment. Of course the physiological differences are neurological rather than genital. The point is that any psychological treatment is secondary and like gays is meant to treat adjustment and stigma and the like. But hey, I'm don't argue these things for a living.

Although I try to restrain thinking with my gut, I have a feeling that such a thing be would be great for all transsexuals of mainstream middle-to-upper class socioeconomic privilege but make life a true (but mercifully short) living hell for all those without sufficient privilege to make it to SRS fast enough.

Quite the moral dilemma, isn't it?

Sara,
It is not a classist decision. This decision is legal confirmation of the medical model. What that means are two main points, one specific to your concern is that it will make it possible to attack insurance denial of SRS expenses directly and if the universal health care is passed, that removes class considerations from getting SRS.

The second is much more important in that it is a federal level legal decision that reinforces the already established by DOJ legal opinion medical (physical causality) nature of transsexuality which means a further case might not be required to exercise ADA full civil rights protections.

Frankly, the only reason I can conceive of to not celebrate this decision is if one is opposed to classic transsexuals getting civil rights and recognition.....and that would be pure bigotry.

And I strongly suspect that is the motivation to questioning this as a good thing.

@Sara,

That SRS can't be subsidized and available for all of those who really need it is a travesty. It is a necessary medical procedure for transsexuals and there's no reason it shouldn't be available in the US as it is in most of Canada and many EU countries. (when I say SRS I mean MTF SRS or FTM meta or phalloplasty).

But I think it's kind of delusional to say that most people under the trans umbrella who don't get SRS purely don't get it for financial reasons. There are a lot of 'non-ops' out there who could afford it, who've paid for many other transitional procedures (multiple plastic surgeries, silicone injections) or who've spend large amounts of money on clothes and other parts of their lives who could afford SRS. It's more affordable now than it ever has been ($5500 is less than most used cars, and it's available from mainstream surgeons in Thailand for $8-10K and FTM metas in Belgrade are quite affordable and of high quality).

The majority of non-op people don't get it because they aren't transsexual and they want to keep their birth genitals as they are. They still like having sex with their current genitalia and there's no reason they should have to apologize or made to feel 'less-than' for that—just don't say they're transsexual, because they aren't.

What I don't like are attacks and intimations by LGBT/Queer activists how getting SRS is somehow automatically supporting the binary, classism, racism, self-mutilation (I hear that one all the time) or is a bad simulation of female anatomy (which I've heard non-ops say), will be non-orgasmic (which I've also heard non-ops/cis people say???) or is a dangerous operation (which is isn't). These are all justifications for transphobia. Furthermore, I'm tired of hearing non-ops say they aren't getting surgery because the results aren't good enough. Well, guess what, the results have NEVER been perfect and they never will. Transsexual women got SRS for decades when the results were far from great... but they still felt the need to do it and got the surgery. I don't hear FTMs ragging on top surgery because it leaves scars... they do it anyway. So why are so many non-ops ragging on genital surgery that's not perfect (and actually, metas are pretty good these days)... it's because they're not transsexuals, they're cissexual. There IS a difference.

If it were up to me, all direct transitional costs should be able to be itemized but, at this time, they're not. This decision is a first step—I hope it goes farther in future.

Just FYI (and for others as well), the current situation is Canada is that SRS is covered in British Columbia and Ontario. In BC, we need approval from two psychiatrists who work for the province. I'm not sure how it works in Ontario, but as far as I know, you still have to go through CAMH (ugh). The government of Alberta delisted SRS several months ago. Other provinces do not cover SRS, at least not fully, although there are some movements afoot to change this. At present, however, although BC and Ontario have large populations, I think it's incorrect to say that SRS is covered for most Canadians in their home provinces.

Quebec is covering SRS again. If Ontario, BC and Quebec cover SRS, then it is covered for most Canadians. I've heard mixed stories about people from Ontario having to go to CAMH. Some say you still have to go there but I've heard accounts of people who went to other clinics and still got it covered. While it is currently delisted in Alberta, it's not impossible it will be reinstated... it's more a function of the current government than a permanent situation. I've known a number of people who've gotten SRS (including phalloplasty) who live in Edmonton.

From what I have heard, Quebec is not yet covering SRS officially. They're doing it in a kind of backhanded way, which is fine for those getting covered or reimbursed, but since it's not official, it's not safely in place yet. Hopefully that will change in the near future. And yes, if Quebec does cover SRS, then I think we're probably at the point of being able to say "most Canadians." I'm hoping Bill Siksay's private member's bill can force the other provinces to acknowledge a medical necessity that must therefore be covered under the Canada Health Act. We're not there yet.

This is an excellent comment and summary of the situation, Gina. Nice :)

Henry, there is no mind separate from brain. When drugs are used to treat mental illness, such as depression, they are acting on the brain -- changing patters of serotonin reuptake, or whatever. You're right that all these conditions are physiological, but there is no necessity to posit "mind" separate from brain. That has no basis in reality.

What makes transsexualism different than mental illness is that it does not respond to talking cures or psycho-pharmaceutials. It responds to a change in life circumstances, hormone replacement therapy, and surgical reconstruction.

Erica Keppler | February 6, 2010 4:27 AM

An interesting perspective. Basically, by my understanding, what you are saying is that a disease is defined by its treatment. You are saying that disease is a subjective concept, the perception of which is created by, or at least heavily influenced by, the capacity of modern medicine to treat it. A rephrasing of the definition of "disease" might go something like, "a condition for which there is a treatment that will improve the health of the individual experiencing it." If defined that way, then a disease does not exist in the absence of a treatment for it that nets some kind of improvement of the health of the individual. This would mean that as treatments are developed, diseases come into existence to which the treatment may be applied. In a sense, that means medicine creates disease every bit as much as it cures it. There was a time in human history, most of human history in fact, when there was no disease at all because there were no treatments of any kind.

The way you have described it, the improvement in health does not necessarily need to be directly related to the condition the treatment seeks to treat. For example, medical marijuana used to treat glaucoma may cause one to feel that their health is improved while not doing a damn thing about their glaucoma. Is glaucoma a disease because there's marijuana to treat it? Heck, viewed that way, virtually any human condition can be described as a disease if you treat it by smoking a joint.

I think there are some situations where the idea of perception of disease being guided by available treatments has some merit, but I don't think it's applicable to a very broad range of circumstances. If someone is hurting, they don't need to be told that a treatment is available to know they've got a problem. Identifying a problem almost universally precipitates the development of a solution or treatment for it. I just don't think arguing that the treatment defines the disease is going to fly in many quarters. It's a noble attempt, but I don't think it's got legs.

Angela Brightfeather | February 5, 2010 2:34 PM

All wrong and all right I say.

Being Transgender or Transexual is a common right of that person and no lawyers, doctors or politicians should have any right to say that someone is mentally or physically sick in the mind or body because the individual feels that way.

Tax laws are tax laws and they can be changed or modified as they want, and they are every year. But being Transgender/Transexual is not an individual thing that can be changed. Hell they can't figure it out or the reasons for it, let alone change it. It's real hard to change something you can't understand in the first place, but it's real easy to pass laws against things you don't understand and fear. So here we are, as usual, debating the relavancy of our lives and our need to be who we are, when no one but ourselves has the right to do that.

Being Transgender/Transexual is something that is natural in some people and there is a good reason for that to happen. If you want to argue the politics or the medical, or the legal side of that, nothing in those arguments should override the fact that it is a natural thing and people in search of seeking a balance in a society that insists on making it criminal, perverted or mental, has no more to say about it than why Giraffes have long necks and Giraffes or that water flows downhill. We are Transgender/Transexual because we are made that way and the only thing about that which drives us mentally up the wall, is that other people don't think we should be that way. They are as wrong about it as any group of people who think that Giraffes should have shorter necks and then try to pass laws that say that they must be shortened to be acceptable.

We seek our happiness as Transgender/Transexual people in the way that we feel we must. No one can tell us what we hear and feel inside that drives us to our own sense of balance. They can't tell us it is wrong if it has nothing to do with them. Letting the IRS into our lives to make decisions about what we do is just plain wrong. We allow it at our own peril and I have never seen an IRS check or return that has convinced a Transexual that they have done the right thing by going ahead with SRS. If they want us to get some money back because a scaple is involved in the process with a doctor on the end of it and they recognize that as being mandatory or justified in some way, that's just fine. But the ruling should not come with any provisos that they now have some kind of right to set standards in our lives that some of us don't want to, or should, have to live up to.

No one can listen to the music in another person's mind that makes them truly happy, let alone think that they should hve the right be the conductor.

Angela.....

This decision has zero to do with transgender.
This decision has zero to do with being gay.
This decision effects classic transsexuals and possibly those AGs who have surgery.

Surgery......a medical tax deduction for surgery, specifically, as it was addressed in the decision, genital surgery only. The beast implants were disallowed as cosmetic, which is correct, that part is.

This is a transsexual specific decision.

What part of that is so bloody hard for you to grasp?

Erica Keppler | February 5, 2010 4:49 PM

I will preface by saying that I have read extremely little of the comments attached to this article, so my comments are made independently of any conversation that my have gone on before me. You all are quite prolific, which I applaud you for, but, with apologies, I don't have time (sitting here at work) to reciprocate the kindness of reading the words of others that is clearly being extended to me as you read this.

It is a big problem that transgenderism is defined in the medical literature as a mental illness. Having it defined as such makes it a weapon to be used against us by people who want to hold us down or deny our rights to make choices over our own lives. I have one friend who lost all custody and even visitation rights over her children in a divorce because her ex dragged out the DSM-IV and pointed at this being a mental illness. I participated in a debate at a local community college board meeting where a right wing activist used this to argue against discrimination protections for trans people saying that they are mentally ill and such protections would only keep them from seeking professional help for their mental condition. It will be difficult for the trans community to move forward toward full social equality as long as this medical diagnosis is hanging over our heads.

However, I don't agree that gaining a tax deduction for our medical treatments will forever keep us locked in to that diagnosis. I think progress within the psychological professional fields and legal matters such as taxation might bump into each other on occasion, but they move relatively independently. This medical diagnosis may have been useful in gaining this tax deduction, but I can't imagine a legitimate, respected psychologist saying that this view of mental health must be preserved for tax reasons. Progress in that area will continue unaffected by this decision. This decision, thus having been made, with any luck will persist even after the diagnosis goes away. It seems to me to be the best of both worlds. Gain the deduction while it's still called a mental illness, and enjoy the benefit even after it's not.

I would also have to take issue with Alice seeming to align tax deductions with motivating people to suicide. Please. That's just sensationalism. It's not the availability of tax deductions or the lack thereof, or even specifically the existence of a DSM-IV designation of it being a mental illness that makes gender dysphorics take their own life. It's being trapped in a life they find intolerable coupled with family and society who they fear will reject them if they express who they really are. Few of those people who take their own lives are probably even aware that there is a defined mental diagnosis for this condition. That's something you discover after you start down the road of transition. All they know is that the people close to them would never tolerate them transitioning, so they take their own lives instead. Having the IRS legitimize the cost of transition is a step in the right direction to getting the rest of society to tolerate us as well, which will prevent more suicides from occurring in the future. It's just one small step of the larger march of progress.

Alice, IMHO, has managed to find a big dark cloud to lay over this silver lining by attempting to closely couple two concepts which are only very loosely associated. Lighten up. Rejoice in the small victories, because that's how victory is going to come. It's not going to be one grand, triumphant event. Progress is going to be measured in inches and sometimes feet. Savor this hard won foot.

CailleanMcM | February 5, 2010 9:40 PM

I feel that this is a huge step forward, federal recognition that Transssexuality is a medical condition that has an established, medically accepted, medical treatment. And I say that as a physician myself

So I changed my sex. Big deal. I don't get why that needs scientific studies, pyschiatric evaluations, or brain scan research.

I don't have a "condition," a birth defect, or a mental illness. I don't need to justify myself by blaming it on a prenatal condition, or a female brain, or any of the myriad of excuses people use to say "I know it's shameful, but it's not my fault!"

I paid for everything myself. No, it wasn't easy, but it was important enough for me to find a way. I don't want any handouts. This was all my doing from beginning to end.

And I did everything possible to assimilate socially AND physically as a female. I'm not playing around with gender stereotypes or mixing male and female body parts. I make no claim to "being a woman inside" or being a classic trannsexual or any of the identity politics people justify their actions with.

My reasons really don't matter. What DOES matter is that I did what was required to assimilate, and by consequence (not demand, not assertion, not "presentation") I'm considered female.

So I don't want other people, be they the government or a "community," to project their own unresolved shame upon my motives and actions, stripping me of the responsibility for my choices.

Angela Brightfeather | February 5, 2010 10:19 PM

Sorry Radical Bitch, but I don't believe in your concept of "classic Transsexuals". I am sure it does exist, but I am also sure that it is not the only kind of transsexual that exists. In fact, I have always thought that your rants about it have been exclusionary, elitist and downright steeped in self interest. You certainly have the right to identify yourself like that, but I object to your constant use of your own definitions to deny others their degree of Transsexual awareness or honesty.

Having an opinion does not give you a license to define our community and being Transgender is most certainly a part of the whole picture, and it always will be.

Angela,

Transsexuality is a medical condition and not an identity and no amount of continued insults and bull from you will change that.....ever.

You clearly do not have dysphoric imperative so you clearly are not a transsexual. That is not bigotry, hatred, a rant, elitist or any of the other assorted insults you trade in.

The harm you and yours have done to the civil rights of women of history is something you will eventually be held accountable for.

I realize you being in the tooth fairy and gender as a social construct. That viewpoint, which should have died immmediately more than ten years ago when John Money was exposed as the intellectual fraud he was has justified the continued mutilation of countless intersexed infants as well. There is considerable blood on your hands.

Some of us live in the real world instead of the other side of the looking glass called "trannyland" where black is white, penises are womanly and those with corrected female bodies are lesser women than say a weekend drag queen.

Again, I offer proof in this link of who traffics in hatred: http://ariablues.blogspot.com/ scroll down and look at the pictures if you cannot take the time to read.

fourth paragraph should start
"I know you BELIEVE in the tooth fairy....."

RB,

Specifically who at Aria's site "traffics in hatred"?

Zoë

cut and paste that url.....it's NOT aria blue's site