The Bind of the Binary: How Gender Affects Us All

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Understanding and accepting gender diversity as a natural state of being is crucial in protecting the wellbeing and lives of trans and non-binary people.

If you were to write two lists of characteristics headed ‘male’ and ‘female’ (and I would encourage you to do this briefly), we often find these characteristics fall into two extremes. Males are supposedly ‘dominant’, ‘loud’, ‘strong’, ‘rugged’; females by contrast something like ‘passive’, ‘quiet’, ‘sensitive’, ‘warm’, ‘pretty’, ‘small’. We may then ask ourselves, do we fit either of those binaries? Perhaps more importantly, do we know anyone that does?
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Probably not. However, these stereotypes have the effect that many of us often feel that we are ‘failing’ at our gender. Failing to a woman may mean not feeling attractive enough, petite enough, being unable to carry a child. Men similarly may feel they are not athletic enough, successful enough or they may encounter these feelings through experiencing infertility. Feeling that we do not fit the mould of our gender expectations is not the preserve of people who attend gender clinics and affects most of us at some point. Gender issues exist on a spectrum. And like other issues of intersectionality (race, age, ability), individuals who are unable to entirely fit the cis, white, able-bodied mould are likely to find themselves excluded by mainstream society in one way or another.

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We might ask at this point why we as a society should offer gender-affirming surgeries if gender is merely a construct.

1) It is a construct with life altering consequences for how we are treated (by colleagues, family, partners, etc).
2) There are also (in many people) significant embodied experiences which individuals cannot ignore. If health care providers can offer a surgery which supports people and drastically improves the quality of their lives, we should do so.

In their book ‘trans like me’, C.N. Lester describes embodied experiences as a proprioceptive sensation (our sense of where our body is in space- e.g being able to touch our own nose), but the expected organ not being there, almost like a phantom limb. The tragic case of David Reimer further demonstrates the knowledge our own bodies hold of what they should be. His penis was removed by accident during a circumcision and he was raised as a girl, but identified as male from the age of 7. The case suggests that keeping someone locked in the gender they do not identify with is futile and morally reprehensible.

It helps to think of trans as a natural state, similar to pregnancy, which may require medical or surgical intervention (although in many cases trans people do not require medical intervention). The treatment of trans individuals has parallels with that of non-heterosexual individuals historically. We would not now ask a non-heterosexual person detailed questions about ‘why?’, ‘what happened to you?’, ‘are you sure?’. We would accept their reality and move on with whatever the more salient issue for treatment was. However, the othering of trans experience continues to
perpetuate socioeconomic and health inequalities by denying access to vital treatments. 

Under the current system, trans and non-binary people must undergo clinical assessment to determine their suitability for medical and surgical treatments. This is not due to greater risk of people ‘changing their minds’ or being uncomfortable with one’s gender being a mental illness (as we have seen gender difficulties exist within all of us). Medical treatments for gender incongruence (the diagnosis which must be made to obtain these treatments) carries higher satisfaction rates than many other health-related surgeries (e.g. Davies, McIntyr, Rypma & Richards, 2019; Dehjne et al, 2014). They also allow trans and non-binary individuals to live happier lives.

People who transition experience mental health problems at a similar rate to cisgender individuals (although there is some evidence to suggest slightly higher rates of anxiety and depression as a result of minority stress, discrimination in jobs, etc.). As a society, we should be able to understand gender (and sexuality) as part of a broader spectrum of human diversity, separate from mental health. By not addressing and educating ourselves about these issues, not only do we do a disservice, (and possibly harm) to trans and non-binary individuals in our communities, but also limit our reflexivity and ability to support individuals with the thorny issue of gender which ultimately affects us all.

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Good places to start if you would like to learn more:

BPS (2019). Guidelines for psychologists working with gender, sexuality and relationship diversity.

Beattie, M., & Lenihan, P. (2018). Counselling skills for working with gender diversity and identity. Jessica Kingsley Publishers.

Lester, C. N. (2017). Trans Like Me: A Journey for All of Us. Hachette UK.

Mermaids (for gender diverse children) www.mermaidsuk.org.uk

Richards, C., & Barker, M. (2013). Sexuality and gender for mental health
professionals: A practical guide. Sage.

Roche, J. (2018). Queer sex: A trans and non-binary guide to intimacy, pleasure and
relationships. Jessica Kingsley Publishers.

Snorton, C. R. (2017). Black on both sides: A racial history of trans identity. U of Minnesota Press.

Stonewall (LGBT inclusion charity and resources) www.stonewall.org.uk