Brynn Tannehill

The Killing Joke: Sarah Silverman & Trans Stereotypes

Filed By Brynn Tannehill | October 15, 2014 12:00 PM | comments

Filed in: Media, Transgender & Intersex
Tags: comedy, GCS, gender confirmation surgery, health care, Sarah Silverman, satire, stereotypes, trans health care

killing_joke.jpgBy now most people who follow LGBT politics have heard about Sarah Silverman's video for the National Women's Law Center. Some have called it transphobic, others have spoken out that they see nothing wrong with it, and that it was just meant to be absurdist to be funny. I'm not outraged over this, not angry. Think "tired and exasperated."

This video reinforces a number of false stereotypes about medical care that are harmful to the transgender community. I'm not surprised that these persist: less than 10% of Americans have a friend or family member who they know is transgender. However, the assumptions in the video are part of the cultural narrative that makes it so hard for transgender people to get access to medical care.

And lack of access has been repeatedly shown to be the #1 predictor of suicidality and suicide attempts in the transgender community.

Without further ado, let's break down exactly what the video got wrong.

1.) 1. It assumes people can get GCS whenever they want.

People who undergo GCS (gender confirmation surgery) must endure a rigorous process beforehand. This includes hours of counseling, letters from at least two evaluating mental health professionals, and living continuously in a their desired gender for at least a year before surgery.

These minimum standards are set by the foremost body of transgender health experts (the World Professional Association for Transgender Health) in the Standards of Care 7. No reputable surgeon will perform GCS on an individual who has not met these criteria.

2.) It assumes gender is based on genitals.

Gender is between the ears. Even with a penis, Sarah Silverman would just be perceived as a woman with a penis, by both herself and by others. In reality, the wage gap comes from gender stereotypes, not from sex itself.

3.) It assumes that GCS would close the wage gap.

The video states that women earn 78 cents to a man's dollar. Another study found that transgender men increase their pay by 7.5% when they transition. That bumps the 78 cents up to 84, still well short of what men earn.

In short, you're still paying the transgender tax, and the female-assigned-at-birth tax. It's also worth noting that transgender women lose 32% of their income when they transition.

There is clearly sexism here, but no matter how you look at the numbers, the gender non-conformance tax is far larger than the benefit of being seen as male.

4.) It assumes changing your gender wouldn't drop your salary to zero.

It's currently legal to fire someone for being transgender in 32 states, and it happens frequently when they transition. Even when people fight these firings and win, it marks them as someone who sues their employer and makes it very difficult to find work again. Ask some of the pioneers in transgender workplace discrimination suits how difficult finding work became after they won their lawsuits.

More, after the break.

5.) It assumes Sarah would be okay with having a penis.

In reality, this would almost certainly gender dysphoria, and she would experience mental trauma and reduced quality of life. Existing halfway between genders is stressful. Chloƫ Sevigny, who played a transgender assassin on Hit & Miss, found wearing a prosthetic penis unbearable. "I cried every day when they put it on," she said in an interview. This, for a prosthetic that she knows isn't real, and comes off when the day is over.

When lesbian journalist Norah Vincent tried to live as a man as a social experiment, it took less than a year before the strain caused her to have herself voluntarily committed.

When straight, healthy people try and pull off what transgender people do on a daily basis (live in the wrong gender), the strain is enough to make them suicidal too. Gender dysphoria negatively affects sexual functioning, self-esteem, body image, socioeconomic adjustment, family life, relationships, psychological status, and general life satisfaction. This is supported by numerous studies (Murad M., 2010, DeCuypere, 2006, Kuiper M. 1988, Gorton 2011, Clements-Nolle K., 2006).

In short, if Sarah somehow did get GCS, it would probably have a severe, negative impact on every aspect of her life and mental health.

6.) It assumes female-to-male GCS is easy.

sarah-silverman-psa.jpgThe video handled GCS as if it were something easy enough to be done on a whim. In truth, there is a dizzying array of surgeries available utilizing different techniques, some of which require multiple skin grafts and several rounds of surgery. I also know, from my FTM friends who have undergone some versions of GCS, that recovery can be very challenging.

This is part of the reason why many transgender men choose not to undergo GCS. They still experience all the pros and cons of being a transgender man at work regardless.

For a review of transgender male GCS myths, I highly recommend Mitch Kellaway's excellent article.

7.) It assumes she could afford GCS and/or get coverage for it.

Obtaining access to medically necessary care is usually a tremendous challenge for transgender people. Most health plans exclude all transgender-related health care, or reimburse at a rate that many doctors refuse service. Only 28% of Fortune 500 companies have transgender inclusive health benefits. Many transgender people end up paying for most of their health care needs out of pocket, and not just those related to GCS.

In all likelihood, someone able to get GCS would likely have to start with a good salary to begin with.

8.) It assumes GCS is cosmetic or medically unnecessary.

Neither assumption is true. Every major medical, psychological, psychiatric, and therapist organization in the U.S. has issued statements supporting the medical necessity of GCS. The court system is increasingly acknowledging this, with five Circuit Courts having ruled that withholding transgender-specific health care from prisoners is a violation of the 8th Amendment, because it is medically necessary.

GCS isn't cosmetic either. AMA Resolution 122 states:

An established body of medical research demonstrates the effectiveness and medical necessity of mental health care, hormone therapy and sex reassignment surgery as forms of therapeutic treatment for many people diagnosed with GID .... Health experts in GID, including WPATH, have rejected the myth that such treatments are 'cosmetic' or 'experimental' and have recognized that these treatments can provide safe and effective treatment for a serious health condition.

9.) It assumes people watching the video know all of the assumptions above.

Satire can be incredibly socially progressive when the audience is somehow wiser than the characters in the skit. They have to know why something is a dumb idea, or wrong, or enforcing a misguided stereotype. Whether it's Saturday Night Live, Mel Brooks, or In Living Color, great comedy and satire clearly illustrate biases and perceptions in a way that highlights their stupidity and shows how much damage that stupidity causes.

Most people, though, know very little about GCS, and even less about trans masculine people. Instead of breaking down stereotypes, the video reinforces them. It takes existing confirmation bias and tells the audience, "Yeah, run with it." Great satire doesn't come at the expense of a group that lives in desperate poverty as a result of prejudice.

Access to medical care for transgender people isn't a joke. It can be a matter of life and death. Access to medical care reduces suicidality in transgender populations by 67-84%, and greatly improves their quality of life.

There are already so many myths about GCS out there that are used to deny us access to health care, and this video perpetuates many of them.

I'm not outraged, I'm just exasperated and tired. Exasperated that supposed allies missed the point; tired of explaining over and over again how myths, misconceptions, and confirmation bias are a lethal combination to the transgender community.

And Sarah Silverman's video is part of the killing joke.

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