YOU ARE HOLDING 1.5 CEs IN YOUR HAND! How it works: Read this CE program, complete the post-test on page 18 and mail it to the Chapter office with your check. Score 80% or better and NASW will mail you a certificate for 1.5 CEs. It’s that easy! Transgender Emergence: Understanding Diverse Gender Identities and Expressions Arlene Istar Lev, LCSW, CASAC (New York) workers are beginning to recognize the basic lack of civil rights Learning Objectives: with which transgender people live, and that effective psychologi- 1. To increase social workers’ cal treatment often requires advocacy and community organization skills in addition to clinical expertise. understanding of gender identity and transgenderism. As transgender people emerge from a veil of shame and societal 2. To increase comfort in working with stigma, social workers are encountering gender-variant people in transgender, transsexual, intersex, diverse settings – schools, hospitals, mental health clinics, and and other gender-variant people work-related environments – highlighting the need for transgender 3. To develop and enhance specialized education to become integrated into the generalist education all social workers receive. A decade ago, when social work students skills for provision of services were asked to define the word transgender, they had rarely heard to transgender people and their of the word. Currently, students routinely bring case material from family members. their field placements into the classroom describing clinical con- tact with gender-variant children and youth in the school system, I. Transgender: An Overview and adult transsexuals transitioning their sex and coping with relat- Transgenderism, a subject that was virtually unheard of a decade ed job loss, marital problems, and financial stresses. Occasionally ago, has become a focus of increased media attention, and an area students will also seek advice on upheavals in their own work en- of interest for social workers as well as the lay public. Helping vironment as a social work colleague begins the often awkward professionals of all types (physicians, psychologists, social work- transition across the gender binary. Social work programs, educa- ers, and educators) are now grappling with understanding gen- tional institutions, and training curricula are beginning to address der-variant behavior and cross-gender expression. Students and the vision outlined in the NASW policy statement in order to bet- experienced social workers alike are requesting specialized edu- ter prepare social workers for a wide range of professional situa- cation regarding sex and gender issues in order to be better pre- tions where expertise in gender variance will be required; this con- pared to provide quality and effective treatment to those requesting tinuing education program is part of this evolution. their services. In response to these concerns this issue of FOCUS Continuing Education will offer an in-depth examination of trans- Transgender Emergence gender issues. The subject of transgenderism is one that produces an array of re- actions; many people find themselves confused and uncomfortable Professional Responsibility dealing with the idea of transsexualism and “sex change” surgery. The National Association of Social Workers has adopted a clear There is sometimes an emotional mix of an almost morbid curios- and coherent policy position on Transgender/Gender Identity is- ity on one hand, and profound revulsion on the other. Sometimes sues that emphatically states”… people of diverse gender expres- when issues of transgenderism are raised, socially as well as clini- sion and identity … should be afforded the same respect and rights cally, there is often a shifting of people’s eyes, a raising of the eye- as those whose gender identity and expression conform to soci- brows, and a sudden change of conversation, even among people etal expectations” (Social Work Speaks, 2000, p. 302). This is a who are quick to tell you that they are not judgmental about this is- progressive and vital step for our profession especially since the sue. Cross-gender behavior can invoke a sudden and piercing hu- policy specifically “…encourages the development of supportive mor that is intended to hurt. Rarely do people engage in intellectu- practice environments for those struggling with transgender issues al inquiry about transgender issues -- a fascinating, intriguing topic (both clients and colleagues) [emphasis mine],” recognizing that that could surely engage intellectuals into scholarly discourses on social workers are not just impacted professionally, but also per- far-ranging topics from brain chemistry and law to anthropology sonally. and organizational development. Even people who do not harbor negative feelings about gender-variant expression often do not un- derstand the intense, emotional journey that transgender people Policy statements are foundational for organizational development travel in order to simply present themselves publicly in an authen- and instrumental in determining professional training goals and tic manner. priorities, but they are often more visionary than functional. Social workers in the field may idealistically agree that transgender and transsexual people deserve “respect and rights,” but may not have In the last decade people who identify as transgender, transsex- the necessary knowledge base or feel they have the clinical acu- ual, or intersex have come to be a visible political force, a topic men to implement respectful treatment strategies. Many social of discussion in the public forum as well as a consumer market. Television talk shows, mainstream movies, and tell-all biographies The psychological and social work professions are in the process have flooded the media. As transgenderism becomes a part of pop- of revisiting previous conceptions of gender-variance as psycho- ular culture, transgender people—and their families—are becom- pathological issues. Viewing transgenderism outside of a patholo- ing increasingly aware that they are living within a culture that has gizing model initiates a new cultural conversation that examines degraded and marginalized them, but even worse, has psychologi- the essential nature of biology and gender, and the social construc- cally pathologized them. tion of sexuality and culture. The mental health problems that have been associated with transgenderism may not be etiologically re- The history of gender-variance and the mental health communi- lated to the gender-variance per se, but caused by the social and ty is a history of diagnostic labeling and pathologizing mental dis- political ramifications of being a member of a despised group. orders within a medical model that assumes that cross-gender ex- Instead of examining transgender people through a lens of disor- pression, by nature, is a mental illness. For the past 200 years, der and dysfunction, clinicians need to ask what it means to be a western civilization has relegated gender-variant people to the healthy functioning gender-variant person in a society with strict realm of the psycho-medical establishment for analysis, treatment, gendered spheres, where transgression of traditional roles can have and “cure.” This complex field of sexology has generally pathol- serious social consequences. ogized all human sexual and gender variations outside of hetero- normative male/female sexual expression. Same-sex intimacy has This perspective shakes up fundamental assumptions about sex only recently emerged from the intense scrutiny of the psychologi- and gender, and shifts the paradigm from two sexes that are op- cal community within the past few decades, although lesbian, gay, posite and different from one another to a conception of sex and and bisexual people continue to struggle for full equal rights. gender identities as potentially fluid. Transgenderism describes the meeting ground where the social construction of gender intersects Social justice strategies, based on knowledge and experience with the individual’s personal psychological experience of gender, with other successful civil rights struggles, have become the fo- and where biology is not the only determining factor of identity. cus for many transgender activists who are challenging the view Within this newly emerging paradigm, transgenderism, transsexu- that they are mentally ill simply because their gender is not nor- ality, and intersexuality are portrayed as normative human varia- mative. Transgender and intersex people are struggling to define tions. themselves and the parameters of their own lives outside of an ill- ness model. In many ways the transgender liberation movement is shaking the foundations of the mental health system in much the same ways Gender-variance and cross-gender experience are not new psycho- that the civil rights movement, the feminist movement and the gay logical or medical “conditions,” nor is it a recent social or legal di- liberation movement have done. Transgenderism, like the ongo- lemma. Gender-variant people, those known today as transgender, ing discussion of race/ethnicity, women’s roles, and same-sex in- transsexual and intersex, have always existed throughout human timacy, challenges deeply held social constructs about human em- history and transculturally across all nations and ethnic groups. bodiment within social and cultural contexts. If gender variance is Long before the advent of modern synthetic hormones and surgical a mental health condition, then it, by definition, requires therapeu- reassignment,