Friday, March 23, 2012

LGBT Hot Topics: Contrasting Views

Over the past few weeks, it has been fascinating to hear different perspectives from LGBT-identified individuals as well as allies on some often hotly contested topics, which I'll share below.

Issue #1: Philosophical Issues with the LGBT Umbrella
Some people feel that the increasingly long aconym referring to the queer community (I think the latest was LGBTQQIA) is not only unwieldy but has its own issues.  Several transgender individuals with whom I've spoken have vented concerns that lumping trans with LGB issues is problematic.  One trans woman stated that she feels uncomfortable going to a "gay center" for services because she identifies as a heterosexual woman.

This brings up an important point mentioned before; sexual orientation ≠ gender identity.  
People may exist on any part of the spectrum, and one aspect does not necessarily influence the other.
Considering how whom you love can be independent of how you identify on the gender spectrum, it makes sense why some people would take issue with making an LGBTQQIA mishmash.  Certainly, there  are positive aspects to providing blanket services to the queer community as a whole, in terms of ease of funding, nonprofit work, and political advocacy.  But there are also very unique issues related to same-sex loving vs. gender non-conforming folks, and there's something to be said for focusing efforts in a very intentional way through targeted approaches that meet each group's needs.  This is why the pride center has been working for this transgender-focused grant that would provide funding for services specifically to trans individuals of color, which would create more space to amp up programming to meet the needs of this vulnerable community.   

Issue #2: Pros & Cons of having an insular center that primarily targets LGBT patients
While the jury is out on whether its best for transgender folks to continue to remain under the same heading as those who are lesbian/gay/bisexual, there is also debate amongst people in the community about the ideal way for LGBT patients to receive care.  Should LGBT patients have the option to receive services in their own safe space, or should we focus on making LGBT-friendly spaces within the general mainstream in our efforts to destigmatize sexual minorities in society?

One trans activist adamantly stated that trans people need to be able to fit into society without fear, and she suggested that the best way to do that was to encourage integration of people in transition within heteronormative society, to not shield them but instead strengthen them by helping them develop their gender identity and expression within a real life context because that is where they need to successfully function on a daily basis.  I've had other trans people tell me that they appreciate the idea of having a trans safe space where they can be themselves and not have their guard up.  After hearing multiple viewpoints, I think it makes sense to offer opportunities for both, working with individuals' comfort level and supporting them with different contexts, depending on where they are in their transition.

There are definitely places that exist in NYC and other cities that are LGBT-targeted health centers (case in point: Callen-Lorde Community Health Center).  This is wonderful in so many ways because it provides a beacon, a safe space, a supportive environment for people to get care.  The point of contention here, though, is why do we need LGBT health centers to begin with?  A gay provider that I'm working with told me that he wishes gay were a non-issue and thinks that isolating the queer community through these targeted services is problematic and doesn't allow gayness/gender non-conformity to be normalized.  I totally get it.  I want to be an all-inclusive family doc who people can feel safe going to for care.  Of course, shouldn't people in the queer community be able to get care at any clinic?  In an ideal world, yes.  But unfortunately, there are so many LGBT-identified people who avoid going to the doctor because of negative experiences in the past.  It is heartbreaking that this is the case, and it's a whole other issue that I will discuss more in another post.

Issue #3: Transgender - psychiatric vs. medical diagnosis
Another point of great debate is the use of the "gender dysphoria" diagnosis to describe transgender patients.  Gender dysphoria is a psychiatric diagnosis referring to discomfort/lack of identity with one's biological sex.  And there's the rub-- it's being identified as a psych issue.  Trans people have told me, I don't like being thought of as mentally ill-- I'm not crazy, it's just my biological sex does not match my gender identity.  And it's true, making it a psych issue further stigmatizes a population that has already suffered so much discrimination and misunderstanding.  It hearkens back to the days when "homosexual" was a psychiatric diagnosis.  Who wants to go back to those days??

The problem is, this "diagnosis", however poorly constructed it may be, has been the key to opening the door for access to transition-related health care (hormones, surgery, etc.).  One trans activist said, I prefer this to the alternative, which is nothing.  By accepting their terminology and diagnostic classification, we get access to medical care.

But how about creating an alternative-- transgenderism as a medical issue?  I (along with many people in the trans community) would feel more comfortable if gender dysphoria would be considered a medical diagnosis.  For some great analysis on this medical vs. psych issue, please go here.  There hasn't been enough research done on transgenderism for people to understand the medical basis of the experience of gender non-conforming individuals.  By simply chalking it up to "mental illness", we are simplifying and stigmatizing the complex experience of transgender people all over the world.

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