Report: The Dr. Yamauchi Lecture on Gender Identity Disorder

In his two hour lecture, Professor Yamauchi reviewed the history of GID in Japan, from its beginnings to the current situation today. The causes of GID cannot be discussed without considering how a person's gender identity is determined. There are numerous theories regarding this, including the role of biological factors such as one's brain structure or genes, or social and psychological factors. However, Professor Yamauchi is in favour of the argument that it is abnormalities in the sex hormones in one's fetal life which create the discrepancy between the body's physical sex and one's self-awareness.

It was in 1995 that the issue of GID in Japan underwent a radical change. A doctor wanting to carry out a sex-reassignment operation submitted a petition to the Saitama Medical School Ethics Committee regarding the ethics involved. Until then, the issue had been a taboo in the medical world and such an ethical decision was a first in Japan. The Saitama Medical School started a specialized research group from scratch and, in the following year, submitted their findings - that GID should be formally regarded as a disorder requiring medical treatment. Professor Yamauchi spoke about his dilemma at the time, due to the unavoidable necessity of labelling the condition as a "disease" in order for it to be recognized as requiring medical treatment.

In accord with the guidelines of the Japanese Society for Psychiatry and Neurology, Japan now has a three stage treatment process for GID - following a diagnosis by a psychiatrist, the patient receives psychiatric and hormonal treatment, as well as surgery under the care of a medical team. In 2003, due to active pressure from GID sufferers, a special exemption law was enacted at unexpected speed so that those diagnosed with GID could formally change their gender entry on the family register. However, the current law still does not meet the needs of GID sufferers in many respects. For example, gender registration cannot be changed if the GID patient has children. Other unresolved issues include the training of GID specialists and improvement of medical facilities, the provision of financial aid for treatment that is not covered by insurance, support for patients and their families, and measures for dealing with Gender Disphoria Syndrome.

Professor Yamauchi broadened the discussion to include how the concepts of "masculinity" and "femininity" are created through the interaction of socio-cultural factors with the biological context, such as the way differences in brain structure can affect a person's aggression or sense of space, and the role of sex hormones in determining functional differences. GID patients have shown him that gender can no longer be viewed in the traditional dichotomy of 'male' and 'female', but rather, it can be regarded from a variety of perspectives, such as biological sex, gender identity, gender roles, or sexual orientation.

This lecture made me see how uncertainty regarding gender came to be labeled as GID and regarded as a medical disorder, and how its recognition and acceptance in society has greatly improved the quality of life of GID sufferers. However, I still have a number of reservations. The concept of GID itself, as well as its medical and social treatment, presumes the existence of the male/ female dichotomy of biology, gender identity, and gender roles. This seems to conflict with Professor Yamauchi's claims for the diversity of gender, as opposed to the traditional dichotomy.

For example, it is said that GID sufferers feel an aversion to their own sexual organs and other gender-related features of their bodies. Such people seek medical aid in order to bring their physical gender characteristics closer to their psychological gender identity. The fact that this discrepancy is not left alone but rather, the person's biological sex is brought closer to their gender identity, is based on the presumption that 'normally', the two features match up. However, in reality, such people differ greatly in the extent to which they want to change their bodies. For instance, some people may want to remove their breasts but keep their female sexual organs, while others may wish for a different gender identity in society but do not wish to change their bodies at all. According to Professor Yamauchi, only about ten percent of sufferers actually seek a sex change operation. This shows that not all sufferers wish to bring their bodies in line with their gender identity. Although the guidelines specify that such diversity should be recognized, this is not reflected in the special laws. The gender change law in the family registry comes with the following condition: a person must have changed their appearance so that parts of their sexual organs match up to their gender identity

In addition, the stipulation that GID sufferers seek a gender role which is opposite to their biological sex and in line with their gender identity presumes the equivalence of gender identity with gender roles. This would mean that if a person is biologically male but identifies themselves as female, they would have preferred girls' games like playing house rather than rougher boys' games in their childhood and, even as they grow older, they would prefer female speech and actions in the workplace or the home. However, it is not uncommon to find women without GID who may be biologically female and identify themselves as female, but feel unsuited to acting out female roles. Such cases suggest that gender identity and their preferred behaviour are not necessarily the same, even for people whose psychological and biological genders differ. They may psychologically be female, and biologically wish to become female with medical assistance, but they may not wish to wear skirts, that is, their personality may not be feminine. Such people would not be unusual. However, official GID diagnosis takes for granted that a sufferer would try to act out the role demanded by society for their particular gender identity.

Above all, I think that this dichotomized view of gender conflicts with the reality of those people who feel some kind of gender. ambiguity The definition of GID as "wanting to become the opposite gender" is based on the idea of a male/ female dichotomy. If so, to what extent is the sufferer male or female? How about a person who is born with female sexual organs and changes their physical appearance through hormone therapy to be more male? Is he/she a man or a woman? How about someone who is now regarded as male in society but is also still regarded as a mother by their children? How about a person whose gender identity, clothing, and behaviour are female, but does not outwardly appear (their figure etc) to be so? I feel that there is a limit to this male/ female divide when the reality is that each individual has different needs and ways of achieving a comfort level with gender.

In this way, the definition of a "Gender Identity Disorder," as well as it treatment in the medical world or in society, is founded on the concept of a gender dichotomy and the view that biological sex, gender identity and gender roles are equivalent. I think that this does not adequately take into account the individual diversity of gender. The recent advances in the medical treatment of GID and the corresponding changes in the legal system have made it easier for people to be more accepted in society for their male/ female gender identity even if it may differ from their biological sex. However, in reality, people who feel an ambiguous gender often do not necessarily wish to fit into the male/ female gender dichotomy. Thus, it is necessary to take such people into account and respect individual gender preferences. As Professor Yamauchi himself mentioned as a topic for future debate, there is a need on the medical and social front to establish a way of dealing with those people who don't quite fit under the GID label. I think that it is also important to broaden the debate to consider the gender dichotomy problem and to question the conventional view of the relationship between biological sex, gender identity and gender roles. Only then can we hope to establish a social environment which recognizes and respects the individual diversity of gender.