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© 2004 American Public Health Association
LETTER |
Elizabeth Fee is with the History of Medicine Division and Janet Laylor is with the Office of the Director, National Library of Medicine, Bethesda, Md. Theodore M. Brown is with the Department of History and the Department of Community and Preventive Medicine at the University of Rochester, Rochester, NY. Michael Gross and Robert Sember are associate editors of the Journal.
Correspondence: Requests for reprints should be sent to Elizabeth Fee, PhD, Bldg 38, Room 1E21, 8600 Rockville Pike, Bethesda, MD 20894 (e-mail: elizabeth_fee{at}nlm.nih.gov).
Mathy’s letter continues a process that began with unusually vigorous discussion among several of the editors regarding the specific Images of Health contribution to which Mathy refers. It reinforces our rationale for venturing to address a topic that often elicits controversy yet deserves increased attention. Referring to the biographical particulars of a single individual, while not the usual way of framing discussions of policy or evaluation of services, may nonetheless provide insights not otherwise readily available. To clarify: Apart from presenting the intrinsically interesting experiences and reflections of a well-known, personally affected individual living at what Mathy describes as "the extreme end of the gender identity disorder (GID) continuum" (a description that most likely would not appeal to Dr Richards), we intended to suggest that the editors of the Journal appreciate the importance of addressing the health and widely varying experiences of transgender persons.
We see this topic as important not least because it illuminates so starkly the extent to which intersections of and relationships among genetic and anatomic sex, gender identity, and sexual orientation remain problematic for many people, not just for those in the transgender community. As an illustration of one pathway toward "lasting personal comfort with the gendered self in order to maximize overall psychological well-being and self-fulfillment," bounded as it was by available therapeutic options and located in a specific historical and political setting, Dr Richards’s story was intended to foster an ongoing, context-sensitive exploration of the multiple pathways to well-being and fulfillment of the gendered self.
The intent of Mathy’s letter remains puzzling, as does the source of its ad hominem vehemence. For example, one author, a member of the Board of Directors of the International Foundation for Gender Education, is dismissed as "a contractor." The main point of the Images of Health column was to support the availability of both skilled counseling and an array of options, including sex reassignment surgery when indicated, for transgender persons. Nothing in Mathy’s letter, which mostly comments on diagnostic categories, supports the writer’s disagreement with our assertion that legal restrictions on sex reassignment surgery deserve scrutiny. The bulk of the letter is devoted to refuting the characterization of transgender identity as psychopathology, an association the Images of Health column never made.
We do not concur with the implication that clinical credentials are a prerequisite for contributing to policy discussion, nor would we trivialize as "anecdote" the contributions of individual experience to policy deliberations.
Reference
1. Harry Benjamin International Gender Dysphoria Association. The standards of care for gender identity disorders (fifth version). Available at: http://www.hbigda.org/socv6.pdf. November 23, 2003.
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