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The Beat Goes On:

There Is Life After The 'Prelims'

Rosemary Grimshaw (previously Pearson)

Gendys Conference, 1996

This article is written as an addendum to the co-authored paper entitled The potential contribution of nursing to the care of clients with gender dysphoria. Preliminary Report which was presented at the Gendys 96 conference in Manchester. (Clegg et al 1996) The intention is to explain the background to the study, and to offer some insights as to why the findings of the preliminary report were not extended.

The author's personal and professional interest in "gender identity" began at undergraduate level through a dissertation which examined nurse's perceptions of clients' needs. This provided the knowledge base to undertake a role to provide adequate communication between the multidisciplinary team who formed the Leeds Gender Identity Unit. The role itself was given the title "nurse", because the post-holder held two nursing registrations, and for the purposes of employment, a professional "label" was required. Over the course of the following year the post matured into a specialist nursing role and it became obvious that the client's perception of this role within the clinic was very different to that of the "medical team members".

Before embarking on the study a great deal of consideration was given to the possibility that additional research on which to base practice might increase the theory practice gap and knowledge base held by the author. This did occur, not simply with managers but with medical staff, too. The difficulty appeared to lie in supporting the view that such a role should have a holistic base, as it appeared to challenge the traditional views of some of the medical members of the team. As a consequence, their behaviour seemed to demonstrate that they felt that their "professionalism" was being threatened. They responded by retreating into their own cultural belief systems, constructing arguments and defences through socio/medical theories. For example "these people", (ie., transsexuals) are forced into the professional stigma of being seen as mentally ill. Therefore the only facilities given by the profession, through the trust, is a psychiatrist. . . . and a room in the psychiatric wing. By way of contrast, a holistic perspective tended to view clients in terms of potential health. The "gap" did in fact widen and raised questions regarding the ethics of undertaking such research.

Many of the problems did not emerge until the research had been completed - the main issue being the dilemma of the "researcher" who was also known to the clients as the "clinic nurse". Although I was aware that I held two roles, the clients saw one person in me! Being given the opportunity to tell their life stories during an hour's taped interview - often for the first time - changed their perception of the "researcher". By simply telling their life stories often opened for them, deeply buried old emotional wounds. I received repeated phone calls requesting support. The clinical setting did not make allowances for this . The calls were received by the "practitioner/researcher" and I began to feel very unhappy at having to tell clients that the interview was simply a means of collecting data. My role as the specialist nurse within the clinic began to be viewed by the clients as "someone who they could talk to who understood their problems".

Due to a myriad of problems - principally a lack of resources and support to develop the nursing post, which compounded the continued emphasis on "curing a medical condition" - this meant that the necessary "caring or supportive" elements within the service were not developed and did not exist. This left the position of the clients exposed. Although pursuing data had every promise of a very informative study, for ethical reasons it was decided not to do so. The client's emotional needs had already come to be viewed as almost "expendable" due to the inherent communication problems surrounding the post as it stood. If support was to be given in the form of counselling, the limitations placed on the "nursing role" within the clinic meant this support could not be given through the clinic. The practice of counselling differs from medical or nursing practice in that it views the clients "holistically" and "respectfully". Through attending to how the internal environment copes or relates to the external environment in which the client lives, what the clinic refers to as the "medical environment". Counselling however, views the client in terms of potential health. By contrast the "medical models" need to know of any predisposition or potential mental illness - which began to be viewed by the myself as another means of re-enforcing the professional stigma of psychiatry.

Sources on the history of transsexuality in a number of different societies stimulated the author's curiosity as to the apparent oblivion within western medicine to the fact that the "third gender", or "transsexual", was not in fact constructed by western civilisation.(Benjamin, 1966) The "third gender" has been a part of indigenous societies since time began. The records of this have been passed down through an oral tradition rather than a written tradition. It is only recently that native peoples have begun to tell their own stories in written form. (Ross 1991) The interpretations of this phenomena have been masked and discarded when observed by the ethnographers and anthropologists of the Victorian era, who have relied on written or documented evidence. This written evidence and subsequent analysis have been informed by The Christian Church, Darwinism, Freud and Victorian attitudes towards sexuality which saw heterosexuality as normal and anything else as abnormal. Writers such as Morgan (1877) viewed indigenous nomadic societies who did not "write their histories down" as barbaric, uncivilised, and uneducated. The enforced and polarised view of sexuality and gender resulted in linear and reductionist evaluations being made of indigenous cultures. These assessments were based more on stigma and stereotyping (Goffman 1963) and the multi-oppressive systems in society (Bridget 1996) which seek to enforce "social norms" such as heterosexuality. (So historically oral traditions were seen as intrinsically inferior). These assumptions resulted in the dismissals of indigenous peoples' beliefs and arguably formed the origins of such views as "gender is social construct". In these terms an individual's perception of who they are, is less valid than that of society's. The children of native peoples were subjected to boarding schools and a regimented educational system, which imposed the dominant white Christian beliefs on their subsequent generations, who in turn began to view their indigenous value belief systems as "savage, barbaric and uncivilised".

If we are to view the socio/medical argument as valid - that western medicine has constructed the transsexual, - is it not equally valid to examine how other societies construct and relate to transsexuality? In North America, in Lakota society (Sioux) the transsexual is referred to as "Winyanktehca", (a two souls person). (Schutzer 1994, 1995) A multidimensional physical representation of a spiritual form who within Lakota society represents a profound healing, a reconciliation of the most fundamental rift which divides humanity - "gender". While in the south, the Zuni tribe uses the word in Native American "Ihamana". It occupies the same place in their society as the "Winyanktehca" in Lakota. (Roscoe 1991)

A British sociologist Ken Plummer (1981) does not see "Ihamana" as relevant to the Euro/American 19& 20th century construction of homosexuality and sexuality. However before dismissing the Zuni or Lakota view of "Ihamana" or "Winyanktehca" it may be pertinent to ask whether they can see something western society cannot. Principally this view shows us the continuity between the past and the present. In Native American culture the child actors do not passively await labels to be applied to them, but actively play a part in shaping their identity, while having the knowledge that their society makes it possible for them to be respected in their choices. They decide their own gender role, irrespective of what their external sex shows itself to be. The inclinations expressed by a boy/girl or a girl/boy are intrinsic and spontaneous. (Roscoe 1991)

Through my experience of conducting the research, I have become aware that the issues involved here were much more complex than simply those which were identified through the lens of the socio/medical paradigm which had informed the pilot study. Clients were placed in a position where they had to prove their "sanity", and were often too intimidated to discuss human emotional issues. The idea of further research into the experiences and perceptions of the clients was shelved until adequate support could be given to them. The insights which had evolved through the "hands on experience of the qualitative research which used a phenomenological approach" were combined with those of an American doctor of psychology, Dr. Schutzer (NapeWasteWin) and were brought to the attention to Leeds MIND*who supported the idea of providing a facility, independent of the NHS Trust, which could direct the necessary supportive counselling and psychotherapy to clients and their families, in addition to raising awareness of the need for this level of support.

MIND is the acronym
for a British charity:
National Association for
Mental Health.

This project was given the name T.A.S.K. (Transsexual Awareness and Self Knowledge.) The aim was to compliment existing services which were provided within the NHS clinic. Sadly the project was viewed as a direct threat to the authority of the NHS Trust who provided the Leeds Gender Identity Service. Perhaps what was most disturbing was the pervasive and negative attitudes demonstrated by an NHS Trust toward client need, especially when that Trust claimed to be concerned with mental health. (As opposed to mental illness).

Treatment by a psychiatrist served to maintain the "power base" which, more often than not, saw the professional intervention as "alleviating the suffering caused by an illness". Consequently the guiding principals of supported self diagnosis and rehabilitation are lost. (HBGDIA Standards of Care 1997) The medicalisation of transsexuality places more and more emphasis on the skills of the surgeon as he/she "cures" the condition. The transsexual label takes precedence and the human emotional needs are left unattended. Within the Leeds Gender Identity Clinic psychological preparation for surgery and realistic post-operative advice are at best overlooked. More realistically these requirements are neglected and more often than not, their acquisition is discouraged. If the client has only limited knowledge they may well believe the medical professions PR of "creating a new person" and thus have developed unrealistic expectations of the outcomes.

Reference List

  • Benjamin, H., (1966)The Transsexual Phenomenon New York: Julian Press
  • Bridget, J., Lucille, S., (1996) Lesbian Youth Support Information Service (Lysis): Developing a distance support agency for young lesbians. Journal of Community and Applied Social Psychology
  • Clegg, P., Pearson, R., (1996) The Potential Contribution of Nursing to Clients with Gender Dysphoria: Preliminary Report. in Gendys (1996) Fourth International Conference Report.
  • Goffman, E., (1963)Stigma: Notes on the Management of a Spoiled Identity Harmondswoth: Penguin
  • Morgan, L.H., (1877) Ancient Society, or Researches in the lines of human progress from savagery, through barbarism to civilisation. New York: Henry Holt and Co.
  • Pearson, R., (1994) Does Leininger's theory of nursing (Cultural Care Diversity and Universality) address the needs of gender dysphoric individuals? Unpublished Undergraduate Dissertation: Leeds Metropolitan University.
  • Plummer K., (ed.) (1981) The Making of the Modern Homosexual. London: Hutchinson
  • Roscoe, W., (1991) The Zuni Man-Woman, University of New Mexico Press.
  • Ross, A.C. (Ehanamani) (1994, 7th ed) Mitakuye Oyasin: "We are all related". Published by Bear.


Schutzer NapeWasteWin (1994) Winyanktecha - Two Souls Person (1994) Conference of the European Network of Professional on Transsexualism, Manchester, England, Published by co-ordinated of the gender team, Free University Hospital Dept. of Endrocrinology/Andrology, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands


Schutzer NapeWasteWin (1995), The Growing Rend in the Fabric of Western Society, XIV Harry Benjamin International Gender Dysphoria Symposium, ed. by Friedemann Phafflin Deutschland Forschungsgemein scaft, Supported by Lilly Deutsch GmbH, Rhone-Poulenc Rorer Pharma GmbH


Standards of Care for the hormonal and Surgical re-assignment of gender dysphoric persons (Original draft 1979 revised 1/80 & 3/81 - Current revision in print) The Harry Benjamin International Gender Dysphoria Association Inc
Grimshaw, R., (1998) The Beat Goes On: There is Life After The "Prelims' ".
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