Kiriamaya is reminding everyone tonight of the paper authored by Janice Raymond that was commissioned by the National Center for Healthcare Technology, titled “Technology on the Social and Ethical Aspects of Transsexual Surgery”, and I would like to offer some additional commentary and background, because this information is not as widely disseminated as perhaps it ought to be.
The National Center for Healthcare Technology (NCHCT) was a short-lived, quasi-governmental body funded by the Department of Health and Human Services (HHS) that existed from 1979 to 1982, under the administrations of Jimmy Carter and Ronald Reagan. According to information provided by Dennis Cotter, the NCHCT had a staff of 20 and a budget of $4 million/year and was authorized in 1978 by Section 309 of the Public Health Service Act to conduct and sponsor assessments of health care technologies and to coordinate such efforts within HHS. The effect of this overview paper, as such documents were called by NCHCT, was the removal of governmental, and eventually, private medical insurance coverage of any and all medical treatments relating to cross-sex transition, and even in many cases, medical treatments which might have been efficaceous at treating other illnesses because they may have had some use in transition-related therapy.
At the time the paper was delivered to NCHCT, in June, 1980, Janice Raymond was credited as “Assistant Professor of Medical Ethics and Women’s Studies, Hampshire College/University of Massachusetts Amherst, Massachusetts”. There is no information listed for Raymond at the University of Massachusetts website, but according to her Wikipedia entry, she currently serves as Professor Emerita of Medical Ethics and Women’s Studies, having retired from her teaching duties in 2002. Also according to that entry, her academic qualifications include a Ph. D. in Ethics and Society from Boston College in 1977, a Master’s degree in Religious Studies from from Andover Newton Theological School in 1971, and her Bachelor of Arts in English Literature from Salve Regina College in 1965. It should be of note to readers that Salve Regina College and Andover Newton Theological School are both religious institutions, Roman Catholic and American Baptist/United Church of Christ, respectively. Raymond was also at one time a member of the Roman Catholic non-cloistered women’s religious institute known as the Sisters of Mercy.
You may find it curious that the person commissioned by NCHCT to produce an expert opinion on the necessity and efficacy of transition-related healthcare would come from a background of involvement with the Roman Catholic church, an organisation with a long-standing and publicly acknowledged antipathy to sexual and gender minorities, and that furthermore, this same person would not possess a single medical, let alone psychiatric qualification that would allow that person to serve as an expert on matters of medical concern.
It is not known to me at the present time who was responsible for the decision to select Raymond. I do not know who was in charge at NCHCT in the months and years preceding June 1980, but I do know that the Secretary of Health and Human Services serving during this period of the Carter Administration was Patricia Roberts Harris, an African-American woman, the first such to have served as a United States Ambassador. I don’t know if she had any influence on the selection, nor am I privy to any information about her personal politics.
What I do know is that the paper produced by Raymond contained highly controversial language concerning transsexuality, language that is not only long deprecated, but was certainly not settled opinion even in its day, with the possible exception of within the small, but vocal, circles of academic radical lesbian feminism. In this paper Raymond:
- Uses inflammatory positioning of sexual reassignment surgery as “mutilation”.
- Dismisses established medical and psychological practice in favor of her own, personally developed but uncritically challenged, version of ethics.
- Compares the desire of transsexual women to access transition-related healthcare to hypothetical desire of people of color who may have imagined changing the color of their skin to avoid the stigma assigned to people of color that is common to the oppressively racist cultures.
- Asserts, despite any medical or psychiatric certification whatsoever, that the challenges posed by transsexual lives are not medical or psychiatric concerns, but more properly concerns of sociology.
- Positions medical and psychiatric assistance to transsexual people as actually detrimental to the health of transsexual people.
- Portrayed falsely inflated fears of gender clinics being used as mechanisms of societal enforcement of behavioral norms.
- Invokes fears of predatory medical practice for the purposes of obtaining profit at the expense of transsexual people.
- Conflates sex with chromosomal type, reproductive capacity, and falsely claims that recognition of the need for transition-related healthcare amounts to reification of the argument that gross biology is the sole important determiner of gender.
- Falsely claims pre-eminence of an experiential basis for gender based on an individual’s position within society, rather than on that individual’s own psychological and physical makeup.
- Equates transition-related therapies with heroin abuse and addiction.
- Derides surgical therapies for an inability to necessarily affect psychiatric conditions, as if this were ever a concern in the first place. This flies in the face of all previous research, particularly that developed by Harry Benjamin, who advocated only the employment of such therapies as were sufficient to alleviate the symptoms of dysphoria in each individual case.
- UNETHICALLY misrepresents previous research relating to sexual reassignment surgery and its possible effects on post-transition happiness.
- Claims that transition-related therapies are experimental and dangerous, and have led to causation of disease, without any significant evidence to back up the claim aside from two cases reported by a single source in which it was speculated by the treating practitioner that cross-sex transition-related hormone replacement therapy was responsible for causing breast cancer in the two patients
- Calls for the “elimination of transsexualism” via attritive legislation.
- Insists that feminists who do not experience transsexualism be given authority to help restrict and regulate the right of transsexual people to access appropriate healthcare.
In the wake of this paper, the federal government removed all support for funding access to appropriate cross-sex transition-related healthcare, and in short order, private insurance firms followed suit. It has been an uphill battle ever since for us to regain that access, an uphill battle that has now stretched into a fourth decade.
That such a paper was ever allowed to be commissioned from a person who had absolutely no medical or psychiatric credentials, let alone clinical experience treating transsexual patients is utterly appalling, and a travesty of justice on scale which I cannot even begin to assess. It is not hyperbole to suggest that untold thousands of deaths have been caused by the removal of healthcare options and the subsequently reinforced societal stigma that this paper succeeded in pursing.
It is not unreasonable to suggest that people who purport to provide medical and psychiatric advice, especially at the policy-making level, be required to demonstrate direct competence in that field, rather than hiding behind to aegis of “medical ethics” or “bioethics”, as does Raymond’s younger replacement, Alice Dreger, who holds a Ph. D. in “History and Philosophy of Science” from Indiana University, yet dispenses psychiatric and medical advice concerning transsexual and transgender people, and intersex people even more prominently, in the same vein. I think most rational people would agree.
Hope remains, and springs eternal, as well. People such as Janice Raymond and Alice Dreger are not the entirety of those in positions of power over the provisioning of healthcare for trans people. Progress may be slow, but it inexorably grinds away at the tombstones Raymond and her compatriots, such as Adrienne Rich, prepared for us and for our sisters so long ago. Eventually, they will wear down to sand and be washed away, forgotten in the flow of time, and we will stand tall above the graves of our lost sisters, never again to bow to the hatred of woman upon woman. So say we all.
Some day, cis people will no longer be seen as the experts on trans people. Trans people will be the experts on trans people. Some day, only intersex people will be seen as the experts on intersex people. We are that now, of course, but some day we will be recognised. We will endure.