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- [Woman At Lectern] Good evening.

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- [Audience] Good evening.

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- Thank you.

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I am delighted to welcome you

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to our Annual Conference lecture

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and the 35th year of
our Day-Garrett Awards.

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We're especially pleased to welcome

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our honored guest, Dr. Betty Morningstar,

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Dr. James Herbert Williams,

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their families and friends,

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our faculty field advisors,

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field agency representatives
and supervisors.

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And our lecturer for this
evening, Dr. J. Michael Bostwick.

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Annual Conference is one of our

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most important summer events.

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It is a time when we
celebrate the achievements

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of our Day-Garrett Award recipients,

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and recognize those who have made

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significant contributions to the school.

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Also, it is a time when we're able to join

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with all of you to work together

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in advancing professional education.

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During our Annual
Conference we explore ways

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of continuing our dialogue,
as we affirm the excellence

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of Smith's clinical social work education

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and ensure its responsiveness

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to people throughout the years.

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We thank you for being here with us,

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for your commitment and
for the many contributions

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you make to clinical social
work education at Smith.

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We look forward to the year ahead

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with every expectation for much success.

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Before we move to the Day-Garrett Award,

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I want to thank Carolyn du Bois,

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Katelin Lewis-Kulin,

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the SSW staff,

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and everyone else who contributed

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to the wonderful work
and job that was done

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in organizing the conference.

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So let's give Carolyn and
Katelin and staff a hand.

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(applause)

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I'd like to also add the thanks

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for the workshop leaders and students.

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I know that there's a lot going
on with continuing education

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and the experience of really looking at

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how we support our students

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in their field placement settings.

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So I'd like to give the workshop leaders

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and all the students who
participated a hand as well.

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(applause)

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The Day-Garrett Award
was established in 1978

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as a award of distinction
to be awarded annually

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to one person or several persons

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who have been outstanding contributors

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to professional social work,

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and who have been significant members

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of the Smith College community
educational experience.

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The award is given to those individuals

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who in the judgement of the
committee have personified

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in their lives and service
to their community,

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the high purpose of professional service

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for which the school has
been renowned for 95 years.

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The recipients are chosen
by an award committee,

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a faculty, field
representatives, and trustees.

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The Day-Garrett Award honors

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the extraordinary service and achievement

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of Florence Day and Annette Garrett.

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Florence Day was director

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of the School for Social
Work for 14 years,

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from 1942 to 1956.

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Under her directorship,

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the tradition of Monday
night lectures began,

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and a program of advanced
study was initiated in 1949.

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Students remember her
fondly as a nurturer,

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a wise person, one who really listened.

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Annette Garrett was associate
director of the school

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from 1935 to 1957, 22 years.

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She was an exceptional teacher,

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whose books became classics,
which still endure.

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Her book on interviewing
is in its fourth edition

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and has been translated
into 20 foreign languages.

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To present this year's award,

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I am pleased to introduce to you

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Smith College Provost, Marilyn Schuster.

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(applause)

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- First I want to welcome
everyone this evening and tell you

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that our new president, she's
been on the job for 19 days,

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Kathy McCartney is very sorry

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she can't be here this evening.

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She's out raising money for the college.

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And also, I was told very
strictly not to go off script,

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but I can't resist adding
a sort of belated toast

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to the praise of Carolyn,

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that we heard earlier in the evening.

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And to just say that
one of the many things

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that I've appreciated about
her leadership at the school

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is that the School for Social Work

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and the college have
grown closer together.

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We now have more programming together.

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And that the shared values

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of the school and the college

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are certainly something that
we've shared for a long time,

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but that have deepened
during her leadership.

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So now for the first of
the Day-Garrett Awards.

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For distinguished service to
the School for Social Work

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and the social work profession,
Dr. James Herbert Williams.

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As a graduate of the Smith
College School for Social Work,

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oh, yes.
(audience laughs)

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(applause)

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You didn't know it was
a hot seat, did you?

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As a graduate of the Smith
College School for Social Work

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and an esteemed social work professional,

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with 30 plus years of experience

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as a scholar, educator, and leader

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in the field of clinical social work,

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you are a source of great
pride for our school.

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You were one of the first
members of your family

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to attend college, graduating
with a BA in sociology

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from Grambling State University in 1972.

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You went on to earn your MSW here

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at the Smith College School
for Social Work in 1975.

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An MPA from the University
of Colorado in 1989.

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And in 1994 you became the only member

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of your family to earn a PhD

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when you completed your doctoral studies

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in social welfare at the
University of Washington, Seattle.

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You are Dean of the Graduate
School of Social Work

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at the University of Denver.

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And the first recipient of the
Milton Morris Endowed Chair.

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You are the current president
of the board of directors

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for the National Association
of Deans and Directors

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of Schools of Social Work.

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And this year, you received
the University of Washington

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2013 School of Social Work
Distinguished Alumni Award.

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Your international
commitment includes work

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on the United Nations-GSSW sponsored

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conflict-resolution initiative in Kenya,

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helping the members of various
tribes to learn to peacefully

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address issues arising from
their changing context.

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You have served on two commissions

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for the Council on Social Work Education,

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and as a member of the Society
for Social Work and Research,

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Board of Directors.

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Prior to you appointment to
the position of dean in 2007,

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you were the Foundation
Professor of Youth and Diversity

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at the School of Social Work

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in the College of Public Programs

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at Arizona State University.

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Your funded research
includes grants from the

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National Institutes of Child
Health and Human Development,

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The National Institute of Mental Health,

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the Danforth Foundation,

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the National Institute of Diabetes

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and Digestive and Kidney Disease,

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and the Departments of Justice, Education,

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and Health and Human Services.

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Your scholarship has been published

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in prominent health and
social science journals.

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Your research scholarship
and community engagement

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have focused on health promotion
and disease prevention,

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health disparities,
economic sustainability,

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human security, conflict resolution,

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delinquency and violence,
mental health services

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for African American
children in urban schools,

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disproportionate minority confinement

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of African American youth in
the criminal justice system,

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community strategies for
positive youth development,

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and social issues of the
African American community,

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as well as K to 12 academic performance,

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youth violence, delinquency prevention,

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adolescent substance abuse,
race and gender differences,

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and mental heath service needs

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and utilization patterns in urban schools.

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Dr. Williams, your life's
work has been shaped

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by a family legacy that values hard work

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and embodies resilience.

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Your contributions as a leader
in research and scholarship

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have enriched not only the
social work profession,

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but the world at large.

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You are a blessing to this
school and to our profession.

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It is with great pleasure that we bestow

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upon you the Day-Garrett Award.

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(applause)

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- Thank you.

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Whoa.

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(audience laughs)

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It's always very weird and a little odd

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to sit there and have
someone talk about you.

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It's almost like a out of
body of experience of like,

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boy, whoever that person
was they did a lot.

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(audience laughs)

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Thank you to the committee,
to the selection committee.

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I'm very honored and very touched.

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I arrived on this campus in 1973

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as a 22-year-old kid directly
out of undergraduate school.

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And my eyes was opened tremendously

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from all the wonderful knowledge

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that I learned while I was here.

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I've truly tried to tell
people that education

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is your ticket to and opens
your eyes to the world.

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I've had an opportunity
after being educated here.

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It opened doors and opened
my eyes to the world.

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And it's coming from a
very humble beginnings,

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and always still thinking of myself

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in a very humble place, even today.

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It really is an honor.

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I really cherish my experience
that I had here at Smith,

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and the education I got here at Smith.

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And some of the people.

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I think back today and I
still think of the names

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of Helen Pinkus and the
people that followed her,

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that was very instrumental, and who,

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shaping my ideas around sorta social work

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and the work that I'm doing.

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I'm very humbled and very honored.

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Thank you, Carolyn.

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Thank you to the committee

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for this wonderful, wonderful honor.

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I will cherish it always.

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Thank you very, very much.

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(applause)

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- Dr. Betty Morningstar.

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(applause)

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Scholar, educator, activist,

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philanthropist, and practitioner.

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You have been a leading advocate

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in the field of clinical
social work and a quiet force

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in the lives of people on every corner

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of the globe for 30 years and counting.

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You are a stalwart supporter

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of social and economic justice,

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and unimpeded access to services for all.

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You earned a bachelor's
degree in psychology

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from Smith College in 1971

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and continued your education

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in the Smith College
School for Social Work,

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earning you MSW in 1977 and PhD in 1989.

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Your have worked as a psychotherapist

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in private practice in
Brookline and Newton since 1983.

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You have taught at both

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the Simmons College
School for Social Work,

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and the Smith College
School for Social Work.

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And in addition to your
social work degrees,

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you earned an MA in religion

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from Andover Newton Theological School.

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And you are a core faculty member

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for the Advanced Certificate program

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in Contemplative Clinical Practices,

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here at the Smith College
School for Social Work.

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You have contributed to
the social work profession

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in so many ways, including
but not limited to,

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your contributions as
a longstanding member

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and leader in the Academy
of Certified Social Workers.

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You have worked to promote,
develop, and protect

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the practice of social
work and social workers.

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You're an exemplary leader,
currently serving as

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President of the
Massachusetts Chapter of NASW,

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and the Chair of the Social
Work Reinvestment Task Force,

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and previously having served as the first

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Vice President of the
Massachusetts Chapter,

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the Chair of the Awards Committee

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00:14:05.315 --> 00:14:07.788
of the Massachusetts Chapter,

263
00:14:07.788 --> 00:14:09.903
as well as a member of
the nominating committee

264
00:14:09.903 --> 00:14:13.098
of the National Office of NASW.

265
00:14:13.098 --> 00:14:15.074
In these many leadership roles,

266
00:14:15.074 --> 00:14:18.417
you have not only upheld,
but also advanced,

267
00:14:18.417 --> 00:14:23.013
the strong social justice
and advocacy mission of NASW.

268
00:14:24.001 --> 00:14:26.907
Your work with NASW enhances
the professional growth

269
00:14:26.907 --> 00:14:29.125
and development of its members,

270
00:14:29.125 --> 00:14:33.026
helps to create and maintain
professional standards,

271
00:14:33.026 --> 00:14:36.787
and advance sound social policies.

272
00:14:36.787 --> 00:14:39.538
Additionally, your
professional contributions

273
00:14:39.538 --> 00:14:44.101
include numerous publications
and presentations including

274
00:14:44.101 --> 00:14:49.101
Lesbian Parents: Understanding
Developmental Pathways 1999.

275
00:14:49.104 --> 00:14:50.184
And J. Laird,

276
00:14:50.184 --> 00:14:53.659
Lesbians and Lesbian Families:
Multiple Reflections.

277
00:14:55.745 --> 00:14:58.493
Stories that Transform:
Narrative Approaches

278
00:14:58.493 --> 00:15:02.312
to Spiritually Oriented
Clinical Practice, in 2010,

279
00:15:02.312 --> 00:15:07.195
in Volume 80 of the Smith
College Studies in Social Work.

280
00:15:07.931 --> 00:15:10.473
You have presented on topics such as,

281
00:15:10.473 --> 00:15:13.550
the impact of violence
and of the nuclear threat

282
00:15:13.550 --> 00:15:15.907
on psycho-social development,

283
00:15:15.907 --> 00:15:18.948
and adolescent and adult
sexual identity development

284
00:15:18.948 --> 00:15:21.224
throughout Massachusetts and nationally

285
00:15:21.224 --> 00:15:24.578
at NASW conferences and symposia.

286
00:15:25.647 --> 00:15:29.053
You have served as chaplaincy intern

287
00:15:29.053 --> 00:15:33.673
at Hebrew Rehabilitation
Hospital and SPARK Center,

288
00:15:33.673 --> 00:15:35.670
the Children's Medical
and Mental Health Center

289
00:15:35.670 --> 00:15:38.004
of Boston Medical Center.

290
00:15:38.004 --> 00:15:40.012
And you have been actively involved

291
00:15:40.012 --> 00:15:42.427
with Keshet, a national organization

292
00:15:42.427 --> 00:15:46.571
that works for the full
inclusion of LGBT Jews

293
00:15:46.571 --> 00:15:48.951
in all aspects of Jewish life,

294
00:15:48.951 --> 00:15:50.913
serving on the advisory committee

295
00:15:50.913 --> 00:15:53.130
and the development committee.

296
00:15:53.130 --> 00:15:55.092
You also serve on the advisory board

297
00:15:55.092 --> 00:15:57.692
of Creative Alternatives of New York,

298
00:15:57.692 --> 00:15:59.573
a drama therapy organization

299
00:15:59.573 --> 00:16:03.090
that serves clients who are
dealing with complex trauma.

300
00:16:03.090 --> 00:16:04.229
And you are a member

301
00:16:04.229 --> 00:16:07.246
of President's Council at Smith College.

302
00:16:08.361 --> 00:16:11.198
A second generation Lion of Judah,

303
00:16:11.198 --> 00:16:14.738
you have carried on the
philanthropic work of your family.

304
00:16:14.738 --> 00:16:16.654
Your generous financial support

305
00:16:16.654 --> 00:16:19.336
of the Smith College
School for Social Work

306
00:16:19.336 --> 00:16:21.577
advances the mission of the school

307
00:16:21.577 --> 00:16:24.316
and helps support its position

308
00:16:24.316 --> 00:16:27.857
as a leader in academic
and clinical excellence.

309
00:16:27.857 --> 00:16:31.177
Dr. Betty Morningstar,
you've contributed greatly

310
00:16:31.177 --> 00:16:33.093
to the lives of many through your life

311
00:16:33.093 --> 00:16:36.575
of service, activism, and advocacy.

312
00:16:36.575 --> 00:16:38.897
In recognition of your
service and dedication

313
00:16:38.897 --> 00:16:41.672
to the School for Social
Work and the profession,

314
00:16:41.672 --> 00:16:45.271
we are proud to present you
with a Day-Garrett Award.

315
00:16:45.271 --> 00:16:50.060
(applause)

316
00:17:02.707 --> 00:17:03.775
- Wow.

317
00:17:03.775 --> 00:17:05.934
For starters, I'm a little overwhelmed.

318
00:17:05.934 --> 00:17:10.316
But, thank you, Marilyn and Carolyn,

319
00:17:10.316 --> 00:17:14.356
and Caroline and all of the faculty

320
00:17:14.356 --> 00:17:16.777
and committee members that,

321
00:17:18.292 --> 00:17:21.223
that's not mine, I hope. (laughs)

322
00:17:22.669 --> 00:17:27.263
I really am so pleased and honored

323
00:17:27.263 --> 00:17:31.384
and grateful to be receiving this award

324
00:17:31.384 --> 00:17:33.904
from the School for Social Work.

325
00:17:33.904 --> 00:17:36.550
As you, I guess probably have gathered,

326
00:17:36.550 --> 00:17:38.280
I really kind of grew up here.

327
00:17:38.280 --> 00:17:42.169
I was an adolescent when I
first sat in this very room

328
00:17:42.169 --> 00:17:44.618
for lectures as an undergraduate.

329
00:17:46.368 --> 00:17:49.603
So it's my home away from home.

330
00:17:49.603 --> 00:17:54.061
And I really feel

331
00:17:54.061 --> 00:17:56.604
a strong connection to the school,

332
00:17:56.604 --> 00:17:58.240
to the School for Social Work.

333
00:17:58.240 --> 00:17:59.703
It, as you also heard,

334
00:17:59.703 --> 00:18:01.886
I'm second generation Smith,

335
00:18:01.886 --> 00:18:03.678
so I really kind of started coming here

336
00:18:03.678 --> 00:18:05.176
when I was a little kid.

337
00:18:05.176 --> 00:18:09.076
And so, I'm just so
grateful for all of the

338
00:18:09.076 --> 00:18:13.151
wonderful learning and support,

339
00:18:13.151 --> 00:18:17.992
and incredible intellectual stimulation

340
00:18:17.992 --> 00:18:21.276
from both the college and
graduate school years.

341
00:18:22.160 --> 00:18:23.626
I like to think of my time

342
00:18:23.626 --> 00:18:26.018
in the masters and doctoral programs

343
00:18:26.018 --> 00:18:29.825
as a kind of funny holding environment.

344
00:18:29.825 --> 00:18:31.857
Some of you might know that phrase

345
00:18:31.857 --> 00:18:34.538
from their social work education.

346
00:18:35.576 --> 00:18:37.922
At the same time, the gentle push

347
00:18:37.922 --> 00:18:40.024
to get out there and actually do the work,

348
00:18:40.024 --> 00:18:42.763
so I've had all of that here.

349
00:18:42.763 --> 00:18:46.803
And I am incredibly grateful

350
00:18:46.803 --> 00:18:48.881
for the many opportunities I've had

351
00:18:48.881 --> 00:18:51.958
to serve in the social work community.

352
00:18:51.958 --> 00:18:54.744
All of which got started here

353
00:18:54.744 --> 00:18:57.425
at this school, in this room,

354
00:18:57.425 --> 00:18:59.120
that brings back many memories.

355
00:18:59.120 --> 00:19:02.603
I won't even begin to
tell you any of them,

356
00:19:02.603 --> 00:19:04.296
or we'd be here all night.

357
00:19:05.365 --> 00:19:08.261
So just, thank you.

358
00:19:08.261 --> 00:19:09.944
That's the only thing I can figure out

359
00:19:09.944 --> 00:19:12.904
about how to say how thankful I am.

360
00:19:12.904 --> 00:19:16.746
And I do want to just
thank my families members,

361
00:19:16.746 --> 00:19:20.323
my entourage who has
joined me here tonight.

362
00:19:20.323 --> 00:19:22.742
My wife, Jeanette Kruger.

363
00:19:22.742 --> 00:19:24.809
My son, Will Morningstar.

364
00:19:24.809 --> 00:19:27.525
My sister-in-law, Faith Morningstar.

365
00:19:27.525 --> 00:19:29.649
And my dear friend, Harriet Fink.

366
00:19:29.649 --> 00:19:33.492
And having said that,

367
00:19:33.492 --> 00:19:37.288
enjoy the lecture and
thank you for being here.

368
00:19:37.288 --> 00:19:41.943
(applause)

369
00:19:48.345 --> 00:19:52.013
- And now I will turn the
lectern over to Carolyn du Bois,

370
00:19:52.013 --> 00:19:55.280
or du-Bwah, as we say in my former life,

371
00:19:56.143 --> 00:19:59.503
to introduce Dr. J. Michael Bostwick.

372
00:20:10.727 --> 00:20:12.219
- All right, greetings all.

373
00:20:13.107 --> 00:20:14.327
And thank you once again.

374
00:20:14.327 --> 00:20:16.823
Let me just add my
thanks to the field crew

375
00:20:16.823 --> 00:20:19.760
and to our field faculty supervisors

376
00:20:19.760 --> 00:20:23.742
and directors of training
who are here this evening.

377
00:20:23.742 --> 00:20:25.820
It is my pleasure this evening

378
00:20:25.820 --> 00:20:29.523
to introduce to you Dr.
J. Michael Bostwick,

379
00:20:29.523 --> 00:20:32.088
who will be presenting the
Day-Garrett Award lecture,

380
00:20:32.088 --> 00:20:37.088
which is entitled: Sex,
Gender, Intersexuality

381
00:20:37.382 --> 00:20:39.683
in the Olympics and the Real World.

382
00:20:40.613 --> 00:20:42.347
Let me tell you a bit about Dr. Bostwick.

383
00:20:42.347 --> 00:20:44.831
The resume was 44 pages long.

384
00:20:44.831 --> 00:20:45.566
(audience chatters)

385
00:20:45.566 --> 00:20:48.793
And there was no fluff in it at all.

386
00:20:48.793 --> 00:20:51.185
Dr. Bostwick received
his bachelor's degree

387
00:20:51.185 --> 00:20:54.110
in art history from Yale University.

388
00:20:54.110 --> 00:20:56.165
Then got another bachelor's degree

389
00:20:56.165 --> 00:20:59.427
in zoology from the University of Hawaii.

390
00:20:59.427 --> 00:21:00.785
Then went on to med school.

391
00:21:00.785 --> 00:21:04.489
Completed a medical degree
at Brown University.

392
00:21:04.489 --> 00:21:05.870
And then went on to complete

393
00:21:05.870 --> 00:21:08.703
what is really quite an
extraordinarily, I think,

394
00:21:08.703 --> 00:21:11.871
impressive course of
training which included

395
00:21:11.871 --> 00:21:15.366
an internship and junior
residency in pediatrics

396
00:21:15.366 --> 00:21:17.502
at Mass General Hospital.

397
00:21:17.502 --> 00:21:21.206
A psychiatry residency at
Cambridge Hospital where he then

398
00:21:21.206 --> 00:21:24.908
was named Chief Resident
of Outpatient Psychiatry.

399
00:21:24.908 --> 00:21:27.648
Then completed a fellowship
in consulting psychiatry

400
00:21:27.648 --> 00:21:29.592
at Brigham and Women's Hospital.

401
00:21:29.592 --> 00:21:30.788
And in his spare time went on

402
00:21:30.788 --> 00:21:32.471
and completed psychoanalytic training

403
00:21:32.471 --> 00:21:35.385
at the Boston Psychoanalytic Society.

404
00:21:35.385 --> 00:21:37.510
It's really quite remarkable.

405
00:21:37.510 --> 00:21:40.424
Since 1996, Dr. Bostwick has served

406
00:21:40.424 --> 00:21:43.163
on the faculty of the
Department of Psychiatry

407
00:21:43.163 --> 00:21:46.182
at the University of Texas in San Antonio.

408
00:21:46.182 --> 00:21:47.330
And at the same time,

409
00:21:47.330 --> 00:21:50.209
as consulting professor of psychiatry

410
00:21:50.209 --> 00:21:52.845
at the Mayo Clinic in
Rochester, Minnesota,

411
00:21:52.845 --> 00:21:55.446
where he then became director
of the medical school

412
00:21:55.446 --> 00:21:58.661
of the education program in
psychiatry and now serves as the

413
00:21:58.661 --> 00:22:02.775
Assistant Dean of the Mayo
Clinic School of Medicine.

414
00:22:03.665 --> 00:22:06.668
Also, somehow in all of
this, he has 15 years service

415
00:22:06.668 --> 00:22:09.664
in active and reserve
duty in the Air Force,

416
00:22:09.664 --> 00:22:11.962
where he holds the rank
of Lieutenant Colonel.

417
00:22:13.387 --> 00:22:15.675
And maintains numerous academic

418
00:22:15.675 --> 00:22:17.683
and professional affiliations,

419
00:22:17.683 --> 00:22:21.515
including membership in the
American Board of Psychiatry,

420
00:22:21.515 --> 00:22:24.411
the Academy of Suicidality,

421
00:22:24.411 --> 00:22:27.045
the Academy of Psychosomatic Medicine.

422
00:22:27.045 --> 00:22:29.889
He is board certified in psychiatry,

423
00:22:29.889 --> 00:22:32.570
geriatric psychiatry,
addiction psychiatry,

424
00:22:32.570 --> 00:22:34.544
psychosomatic psychiatry and is a

425
00:22:34.544 --> 00:22:38.608
Diplomate of the National
Board of Medical Examiners.

426
00:22:38.608 --> 00:22:40.376
He's a prolific writer.

427
00:22:40.376 --> 00:22:43.685
He's an author of 91
articles, I counted them.

428
00:22:43.685 --> 00:22:48.352
A book on psychosomatic
medicine and 25 book chapters.

429
00:22:48.352 --> 00:22:50.419
He's a reviewer, an editor,

430
00:22:50.419 --> 00:22:53.983
or a editorial board member
of numerous journals.

431
00:22:53.983 --> 00:22:56.944
Clearly a gifted, and
oftentimes recognized,

432
00:22:56.944 --> 00:23:00.600
with honors for his teaching work,

433
00:23:00.600 --> 00:23:04.605
his mentorship and his
consultation to psychiatrists.

434
00:23:04.605 --> 00:23:06.637
And he's a highly sought after speaker,

435
00:23:06.637 --> 00:23:09.098
both internationally and nationally.

436
00:23:09.098 --> 00:23:11.605
He's presented across the world on topics

437
00:23:11.605 --> 00:23:16.540
which have included
suicidality, sex and gender,

438
00:23:16.540 --> 00:23:21.540
depression, empathy,
hopelessness and despair,

439
00:23:21.559 --> 00:23:23.271
and schizophrenia.

440
00:23:23.271 --> 00:23:25.384
With topics, and I just have to give you

441
00:23:25.384 --> 00:23:28.123
some of the highlights
because I was amused.

442
00:23:28.123 --> 00:23:31.791
Some of the topics of these
presentations go as follows:

443
00:23:31.791 --> 00:23:33.603
Trampled By a Zebra.

444
00:23:33.603 --> 00:23:36.551
Which has to do with rare diagnoses.

445
00:23:36.551 --> 00:23:39.105
Hiccups Were Not A State of Mind.

446
00:23:39.105 --> 00:23:41.346
Bugs Are Not Us.

447
00:23:41.346 --> 00:23:43.551
My Brain Is Catching Up To My Brain.

448
00:23:43.551 --> 00:23:44.701
And my personal favorite,

449
00:23:44.701 --> 00:23:49.701
which I imagine earns you
the love of your colleagues,

450
00:23:49.750 --> 00:23:53.516
Physicianhood As Potential
Personality Disorder.

451
00:23:53.516 --> 00:23:55.815
(audience laughs)

452
00:23:55.815 --> 00:23:58.392
He's an extraordinarily gifted teacher,

453
00:23:58.392 --> 00:24:00.435
writer, researcher, and clinician.

454
00:24:00.435 --> 00:24:02.931
Please join me in welcoming
Dr. J. Michael Bostwick.

455
00:24:02.931 --> 00:24:07.569
(applause)

456
00:24:13.942 --> 00:24:15.544
- Let's see.

457
00:24:15.544 --> 00:24:18.307
If I'm so accomplished,
why am I so anxious?

458
00:24:18.307 --> 00:24:19.700
(audience laughs)

459
00:24:19.700 --> 00:24:22.949
Er, the first thing is they hid the mouse.

460
00:24:23.756 --> 00:24:24.615
Okay.

461
00:24:24.615 --> 00:24:27.798
I think I'm anxious because
the topic is anxiety provoking.

462
00:24:29.537 --> 00:24:31.647
I find this such, anything related

463
00:24:31.647 --> 00:24:35.000
to sexuality and gender and sex,

464
00:24:35.000 --> 00:24:36.962
to be just full of opportunities

465
00:24:36.962 --> 00:24:39.921
to trip, to screw up, to offend.

466
00:24:40.714 --> 00:24:42.945
I hope to be intriguing and entertaining

467
00:24:42.945 --> 00:24:46.265
and provocative and
not offensive (laughs),

468
00:24:46.265 --> 00:24:47.598
but it's a challenge because people

469
00:24:47.598 --> 00:24:50.941
have very strong feelings
about these topics.

470
00:24:50.941 --> 00:24:54.388
In any case, I have a disclaimer.

471
00:24:55.276 --> 00:24:57.523
Number one, I'm a Euro-American.

472
00:24:57.523 --> 00:24:59.014
Now let me explain that.

473
00:24:59.014 --> 00:25:01.417
Caucasians, I actually know
a couple of Caucasians.

474
00:25:01.417 --> 00:25:02.577
One is from Armenia,

475
00:25:02.577 --> 00:25:07.160
and the other is from Uzbekistan.

476
00:25:07.160 --> 00:25:08.691
And these are Caucasian peoples,

477
00:25:08.691 --> 00:25:10.223
they are not European peoples,

478
00:25:10.223 --> 00:25:11.284
and they have made it very clear to me

479
00:25:11.284 --> 00:25:13.492
that I am not them.

480
00:25:13.492 --> 00:25:15.420
So I'm a Euro-American.

481
00:25:15.420 --> 00:25:18.044
I'm also male which is a dangerous thing

482
00:25:18.044 --> 00:25:20.272
to be sometimes at Smith College,

483
00:25:20.272 --> 00:25:22.315
as well as other places.
(laughter)

484
00:25:22.315 --> 00:25:23.731
Although I have to warn you

485
00:25:23.731 --> 00:25:26.021
that you may only be
perceiving me as a male.

486
00:25:26.021 --> 00:25:29.852
Underneath this appearance
I could be something else.

487
00:25:29.852 --> 00:25:31.128
And thirdly I'm a psychiatrist,

488
00:25:31.128 --> 00:25:34.534
which is by definition a
very, very scary thing.

489
00:25:35.944 --> 00:25:38.066
Actually, I'm not a trained analyst,

490
00:25:38.066 --> 00:25:39.251
but I have been analyzed,

491
00:25:39.251 --> 00:25:42.734
so I've been terrified by an
analyst, but I am not one.

492
00:25:42.734 --> 00:25:44.451
(audience laughs)

493
00:25:44.451 --> 00:25:45.450
So with those disclaimers,

494
00:25:45.450 --> 00:25:49.613
we'll proceed to my own experience.

495
00:25:49.613 --> 00:25:52.444
This is a bracelet that I wear.

496
00:25:52.444 --> 00:25:54.903
That I've worn since I was 17.

497
00:25:54.903 --> 00:25:57.574
And much to my surprise,

498
00:25:57.574 --> 00:25:59.581
I learned when I was a college student,

499
00:25:59.581 --> 00:26:02.064
from one of my classmates, that I was gay.

500
00:26:02.064 --> 00:26:05.222
Which was very interesting
to be told that I was gay.

501
00:26:05.222 --> 00:26:06.710
I thought that was something that I got

502
00:26:06.710 --> 00:26:09.634
to tell other people that I was or wasn't,

503
00:26:09.634 --> 00:26:10.914
but I learned that it was simply

504
00:26:10.914 --> 00:26:14.442
because I wore this signifier
of gayness, a bracelet.

505
00:26:14.442 --> 00:26:15.534
Did you all know that?

506
00:26:15.534 --> 00:26:16.194
(audience chatter)

507
00:26:16.194 --> 00:26:17.122
That's changed a little bit,

508
00:26:17.122 --> 00:26:19.305
but in the 1970s in New Haven,

509
00:26:19.305 --> 00:26:20.776
wearing a bracelet
meant that you were gay.

510
00:26:20.776 --> 00:26:23.761
Apparently I was the last to know.

511
00:26:25.304 --> 00:26:26.305
All right.

512
00:26:27.223 --> 00:26:29.971
So let's get started,
if we haven't already.

513
00:26:31.005 --> 00:26:34.041
On this topic intersexuality
and sexuality and gender,

514
00:26:34.041 --> 00:26:37.296
I actually got my start
in the U.S. Air Force.

515
00:26:37.296 --> 00:26:40.624
Now I went to Brown Medical
School and I had no money.

516
00:26:41.774 --> 00:26:42.493
Unfortunately this was the year

517
00:26:42.493 --> 00:26:44.954
that Ronald Reagan had killed the

518
00:26:44.954 --> 00:26:47.765
National Public Health Service Corps,

519
00:26:47.765 --> 00:26:48.786
because I would have done that.

520
00:26:48.786 --> 00:26:49.713
But I ended up in the Air Force,

521
00:26:49.713 --> 00:26:51.501
which was especially ironic because

522
00:26:51.501 --> 00:26:53.081
I was raised in an Air Force family,

523
00:26:53.081 --> 00:26:56.101
and I have a very difficult
relationship with my father.

524
00:26:56.101 --> 00:26:57.749
But there I was in the Air Force.

525
00:26:57.749 --> 00:27:00.628
And if you want to learn
about marginalized people

526
00:27:00.628 --> 00:27:03.229
and people who are challenged
by the culture they're in,

527
00:27:03.229 --> 00:27:05.689
a great place to do it
is in an organization

528
00:27:05.689 --> 00:27:09.173
that has strong boundaries
and challenges people

529
00:27:09.173 --> 00:27:12.657
who are not meeting their expectations.

530
00:27:12.657 --> 00:27:16.696
So this was a patient
who I first met as a man.

531
00:27:16.696 --> 00:27:18.760
And I was given the task of proving

532
00:27:18.760 --> 00:27:21.594
that this person was crazy.

533
00:27:21.594 --> 00:27:25.683
Because they, 19 years into
their career in the Air Force,

534
00:27:25.683 --> 00:27:29.699
had been discovered to be working

535
00:27:31.119 --> 00:27:33.397
at the base as a man, going home,

536
00:27:33.397 --> 00:27:36.184
and becoming a woman and becoming

537
00:27:36.184 --> 00:27:39.645
the vice president of their
child's PTA as a woman.

538
00:27:39.645 --> 00:27:44.289
And that boundary transgression
was so unacceptable

539
00:27:44.289 --> 00:27:48.633
that another military person
called their commander

540
00:27:48.633 --> 00:27:51.300
and they ended up being
sent to mental health

541
00:27:51.300 --> 00:27:53.692
to be proven that they were crazy.

542
00:27:53.692 --> 00:27:55.688
Well, I tried really hard, (laughs)

543
00:27:55.688 --> 00:27:58.151
but this person was not
crazy in the slightest.

544
00:27:58.151 --> 00:27:59.984
And in fact, I believed may have managed

545
00:27:59.984 --> 00:28:01.655
to be the first person who was allowed

546
00:28:01.655 --> 00:28:04.140
to retire as a transgendered person

547
00:28:04.140 --> 00:28:06.275
from the military with full benefits.

548
00:28:06.275 --> 00:28:07.723
And largely that was because

549
00:28:07.723 --> 00:28:09.310
they had the goods on the military

550
00:28:09.310 --> 00:28:11.378
and threatened to go
to the New York Times.

551
00:28:11.378 --> 00:28:13.026
Which has happened on
numerous other occasions

552
00:28:13.026 --> 00:28:14.698
involving people in the military

553
00:28:14.698 --> 00:28:17.158
around issues of sexuality and gender.

554
00:28:17.158 --> 00:28:19.178
In any case, that's where I got my start.

555
00:28:19.178 --> 00:28:21.478
And what I know is not
the result of my training

556
00:28:21.478 --> 00:28:23.789
because there was none
of that in my training

557
00:28:23.789 --> 00:28:25.545
in Boston in the '70s.

558
00:28:26.777 --> 00:28:28.595
It's what I've learned
along the way taking care

559
00:28:28.595 --> 00:28:30.731
of several dozen folks
who were trying to sort

560
00:28:30.731 --> 00:28:34.027
these issues out for themselves.

561
00:28:34.027 --> 00:28:36.095
Now, Caster Semenya.

562
00:28:36.095 --> 00:28:38.401
How many of you know who this person is?

563
00:28:38.401 --> 00:28:39.397
Okay.

564
00:28:39.397 --> 00:28:41.349
I'll tell you more about the story later,

565
00:28:41.349 --> 00:28:44.443
but suffice it to say that Caster Semenya

566
00:28:46.029 --> 00:28:48.144
can really challenge our assumptions

567
00:28:48.144 --> 00:28:51.397
or our ideas about what

568
00:28:51.397 --> 00:28:53.534
a woman or a man should look like.

569
00:28:53.534 --> 00:28:56.298
And the story, I'll go
into it in detail later,

570
00:28:56.298 --> 00:28:59.409
but basically this is a person

571
00:28:59.409 --> 00:29:02.961
who is likely intersexual,
although no one knows for sure,

572
00:29:02.961 --> 00:29:05.827
except for a very select committee

573
00:29:05.827 --> 00:29:09.798
that decided whether or not
she could compete as a woman.

574
00:29:10.859 --> 00:29:12.404
So the objectives of my talk are to give

575
00:29:12.404 --> 00:29:15.822
definitions of sex, gender
identify, and gender behavior.

576
00:29:15.822 --> 00:29:18.562
To explore the differential
of intersexual diagnoses,

577
00:29:18.562 --> 00:29:20.325
of which there are many.

578
00:29:20.325 --> 00:29:24.158
So it means really that
individuals with these diagnoses

579
00:29:24.158 --> 00:29:27.313
have very different experiences
and very different lives

580
00:29:27.313 --> 00:29:30.149
that we need to take into consideration.

581
00:29:30.149 --> 00:29:32.817
How many of you have read
Middlesex by Eugenides?

582
00:29:32.817 --> 00:29:34.169
Okay, so you know something about a person

583
00:29:34.169 --> 00:29:37.025
who thinks they're a girl
and they turn into a boy

584
00:29:37.025 --> 00:29:40.833
or something when they reach adolescence.

585
00:29:40.833 --> 00:29:41.860
I'm gonna introduce the concept

586
00:29:41.860 --> 00:29:43.715
of fetal brain masculinization.

587
00:29:43.715 --> 00:29:47.600
Now, I was warned to not be a (stammers),

588
00:29:47.600 --> 00:29:48.721
there's a term, I don't
have it quite right,

589
00:29:48.721 --> 00:29:49.677
biologist isn't the term,

590
00:29:49.677 --> 00:29:51.489
but I was warned to be careful about

591
00:29:51.489 --> 00:29:53.594
being too reductionist about biology,

592
00:29:53.594 --> 00:29:55.337
but I think it's very freeing actually

593
00:29:55.337 --> 00:29:56.695
to have people finally looking at brains

594
00:29:56.695 --> 00:29:58.666
and seeing that there are, in fact,

595
00:29:58.666 --> 00:30:01.945
neuroanatomical and
neurobiological correlates

596
00:30:03.037 --> 00:30:07.059
to sexuality, to gender, to
gender expression, et cetera.

597
00:30:07.059 --> 00:30:07.779
And then I'm gonna talk about

598
00:30:07.779 --> 00:30:09.945
a case in the news, Caster Semenya.

599
00:30:09.945 --> 00:30:12.228
And finally, show some video
clips of my own patient,

600
00:30:12.228 --> 00:30:14.200
and tell you a little about her

601
00:30:14.200 --> 00:30:15.920
and how she came to see me

602
00:30:15.920 --> 00:30:18.645
and how as a psychiatrist it
was the first and only time

603
00:30:18.645 --> 00:30:21.158
I've ever ordered
chromosomes on a patient.

604
00:30:21.158 --> 00:30:22.294
Not something you typically do

605
00:30:22.294 --> 00:30:24.385
in a traditional psychoanalytic training,

606
00:30:24.385 --> 00:30:24.966
"Tell me about your mother,

607
00:30:24.966 --> 00:30:26.693
"and can I check your
chromosomes?" (laughs)

608
00:30:26.693 --> 00:30:29.457
Not what you usually do.

609
00:30:29.457 --> 00:30:31.355
And then we'll have a discussion.

610
00:30:32.521 --> 00:30:33.550
How do we define sex?

611
00:30:33.550 --> 00:30:35.966
It's really, really challenging.

612
00:30:35.966 --> 00:30:38.890
There are objective,
scientific approaches.

613
00:30:38.890 --> 00:30:43.257
But there are contributions from anatomy.

614
00:30:43.257 --> 00:30:45.438
Contributions from physiology,

615
00:30:45.438 --> 00:30:50.082
and genetics, endocrinology, psychology.

616
00:30:50.082 --> 00:30:51.850
There's no absolute definition.

617
00:30:51.850 --> 00:30:54.029
And one of the things
that kind of intrigues me

618
00:30:54.029 --> 00:30:57.561
is that even the scientific
literature seems to think

619
00:30:57.561 --> 00:30:59.673
that if you show up and say
you're a man or a woman,

620
00:30:59.673 --> 00:31:01.761
and you'll be studied as a man or a woman.

621
00:31:01.761 --> 00:31:03.830
Now I would contend that since we don't

622
00:31:03.830 --> 00:31:05.641
routinely check chromosomes on people,

623
00:31:05.641 --> 00:31:08.122
and we don't routinely study

624
00:31:09.473 --> 00:31:11.502
much of that what they
tell themselves to be,

625
00:31:11.502 --> 00:31:14.034
our literature on men and
women is probably flawed

626
00:31:14.034 --> 00:31:17.053
because it includes
all kinds of surprises.

627
00:31:17.053 --> 00:31:19.602
And that'll be my patient
when I tell you about her.

628
00:31:20.790 --> 00:31:23.372
Gender is a subjective thing.

629
00:31:23.372 --> 00:31:25.111
It's fluid, it's a personal thing.

630
00:31:25.111 --> 00:31:27.677
It's also an interpersonal thing.

631
00:31:27.677 --> 00:31:29.458
No matter how you express your gender,

632
00:31:29.458 --> 00:31:31.526
you have to confront
everybody else around you

633
00:31:31.526 --> 00:31:32.918
who is interpreting your gender,

634
00:31:32.918 --> 00:31:35.009
expressing their own gender
and challenging your gender,

635
00:31:35.009 --> 00:31:36.169
or agreeing with your gender.

636
00:31:36.169 --> 00:31:39.861
It's quite a fluid place.

637
00:31:39.861 --> 00:31:42.577
It's a bio, psycho, socio,
cultural construction.

638
00:31:42.577 --> 00:31:44.805
It has elements of all of these things.

639
00:31:44.805 --> 00:31:46.479
And they all come together
and collide together

640
00:31:46.479 --> 00:31:50.382
in ways that can be quite challenging.

641
00:31:50.382 --> 00:31:52.794
There is a core gender identity, usually.

642
00:31:52.794 --> 00:31:54.746
People know what their
core gender identity is.

643
00:31:54.746 --> 00:31:56.882
And typically it's either male or female,

644
00:31:56.882 --> 00:31:59.422
although there are folks who
are somewhere in between.

645
00:32:00.274 --> 00:32:02.028
It's this personal sense of maleness,

646
00:32:02.028 --> 00:32:04.048
femaleness or in betweenness.

647
00:32:04.048 --> 00:32:06.855
And regardless of how you present yourself

648
00:32:06.855 --> 00:32:10.108
or how you behave, very often you know

649
00:32:10.108 --> 00:32:12.732
who you are at core in this way.

650
00:32:12.732 --> 00:32:13.892
And you may get into trouble

651
00:32:13.892 --> 00:32:15.515
when people who are
talking to you about that

652
00:32:15.515 --> 00:32:17.863
don't agree with your
own sense of who you are,

653
00:32:17.863 --> 00:32:19.240
which is really kind of offensive actually

654
00:32:19.240 --> 00:32:21.869
to be told that you're
not who you think you are

655
00:32:21.869 --> 00:32:24.174
because somebody else knows better.

656
00:32:24.174 --> 00:32:27.481
There's been a lot of bad work
done based on that premise.

657
00:32:28.518 --> 00:32:31.295
For most people it's well
established by age three.

658
00:32:31.295 --> 00:32:33.939
A child of three, no matter
how they're behaving or acting,

659
00:32:33.939 --> 00:32:35.379
can typically tell you whether they think

660
00:32:35.379 --> 00:32:38.026
of themselves as a boy or a girl.

661
00:32:38.026 --> 00:32:40.865
And then the gender behavior issue

662
00:32:40.865 --> 00:32:43.048
is really a separate issue,

663
00:32:43.048 --> 00:32:47.436
and one that needs to be taken
into consideration as well.

664
00:32:47.436 --> 00:32:51.940
Now, in many cultures, ours included,

665
00:32:51.940 --> 00:32:53.263
there are ways that we expect

666
00:32:53.263 --> 00:32:55.679
boys and girls to typically act,

667
00:32:55.679 --> 00:33:00.115
ways that they should
act we impose upon them.

668
00:33:00.115 --> 00:33:03.040
One of my favorites is a cartoon.

669
00:33:03.040 --> 00:33:05.829
This is a cartoon by the author of Maus.

670
00:33:05.829 --> 00:33:10.829
You know, the cartoon strip
about the concentration camps.

671
00:33:11.153 --> 00:33:13.859
And he had a child,

672
00:33:13.859 --> 00:33:17.163
and was trying very hard to raise his girl

673
00:33:17.163 --> 00:33:21.295
in a liberal, gender-free way.

674
00:33:21.295 --> 00:33:24.706
So he did a comic strip
where he showed her

675
00:33:24.706 --> 00:33:28.958
with a fire truck that she
had wrapped up in a blanket

676
00:33:28.958 --> 00:33:31.370
and was rocking like this, like a baby.

677
00:33:31.370 --> 00:33:32.098
(audience laughs)

678
00:33:32.098 --> 00:33:36.909
Now, talk about a child asserting her

679
00:33:36.909 --> 00:33:40.824
rather stereotypic gender
role with a fire truck.

680
00:33:40.824 --> 00:33:42.680
But again, gender behavior
is culturally based,

681
00:33:42.680 --> 00:33:43.932
and historically specific.

682
00:33:43.932 --> 00:33:45.311
One of the fun things to do is to look

683
00:33:45.311 --> 00:33:47.214
at the role of pink and blue.

684
00:33:47.214 --> 00:33:49.746
Which has varied even in
the last hundred years,

685
00:33:49.746 --> 00:33:51.114
between which was a masculine color

686
00:33:51.114 --> 00:33:53.726
and which was a feminine color.

687
00:33:53.726 --> 00:33:54.839
Right now, it's blue and pink,

688
00:33:54.839 --> 00:33:57.092
but a hundred years
ago it was the reverse.

689
00:33:57.092 --> 00:33:58.252
So you can see how these things

690
00:33:58.252 --> 00:34:00.800
are fluid and change as well.

691
00:34:00.800 --> 00:34:02.694
Which can be quite confusing.

692
00:34:02.694 --> 00:34:06.130
Gender roles are taught by
demonstration and expectation.

693
00:34:06.130 --> 00:34:09.286
But again, the reality is
that what you're being taught

694
00:34:09.286 --> 00:34:11.166
may confront or rub up against

695
00:34:11.166 --> 00:34:13.210
who you feel yourself to be.

696
00:34:13.210 --> 00:34:15.393
And depending upon who is teaching you,

697
00:34:15.393 --> 00:34:16.669
and who is demonstrating for you,

698
00:34:16.669 --> 00:34:18.621
they may not take that very well.

699
00:34:18.621 --> 00:34:21.637
So it's a challenging, challenging area.

700
00:34:22.729 --> 00:34:24.151
Gender is a social construction.

701
00:34:24.151 --> 00:34:26.286
And it's so pervasive that in our society

702
00:34:26.286 --> 00:34:28.630
we've gone to assume
it's bred into our genes.

703
00:34:28.630 --> 00:34:31.046
Just the very fact that
it's a pervasive belief,

704
00:34:31.046 --> 00:34:33.194
means it must be in the genes, right?

705
00:34:34.134 --> 00:34:35.892
Do you all agree with? I hope not.

706
00:34:35.892 --> 00:34:37.820
No, these days we like to say

707
00:34:37.820 --> 00:34:40.492
that things that seem obvious are genetic.

708
00:34:40.492 --> 00:34:42.163
Most people find it hard to believe

709
00:34:42.163 --> 00:34:43.927
that gender is constantly created

710
00:34:43.927 --> 00:34:46.459
and recreated out of human
interaction, out of social life,

711
00:34:46.459 --> 00:34:49.595
and it's the texture and
order of that social life.

712
00:34:49.595 --> 00:34:52.819
Yet, like culture, gender's
a human production,

713
00:34:52.819 --> 00:34:55.962
and we're all always doing gender.

714
00:34:55.962 --> 00:34:59.093
And even if you're radical about gender,

715
00:34:59.093 --> 00:35:01.533
you're still doing radical about gender.

716
00:35:01.533 --> 00:35:04.352
You have to do it because otherwise

717
00:35:05.206 --> 00:35:07.357
you're going to go through
the world being done,

718
00:35:07.357 --> 00:35:08.750
I would say. (laughs)

719
00:35:08.750 --> 00:35:09.992
That sounds fun and strange, doesn't it?

720
00:35:09.992 --> 00:35:12.070
But, so keeping terms straight.

721
00:35:12.070 --> 00:35:14.642
Sex is what science says you are.

722
00:35:15.436 --> 00:35:18.130
If you can buy that, we'll go with that.

723
00:35:18.130 --> 00:35:21.731
Gender is who you believe you
are and how you express it.

724
00:35:22.913 --> 00:35:25.324
Sexual orientation is whom you desire.

725
00:35:25.324 --> 00:35:28.167
And again, it's a third separate category.

726
00:35:28.167 --> 00:35:29.666
You cannot assume, for example,

727
00:35:29.666 --> 00:35:31.244
that because I have a bracelet

728
00:35:31.244 --> 00:35:32.823
my mother gave me when I was 17

729
00:35:32.823 --> 00:35:34.764
that I am therefore gay.

730
00:35:34.764 --> 00:35:37.033
Maybe I am gay, maybe I'm not.

731
00:35:37.033 --> 00:35:39.806
But I have a bracelet
and that's apparently,

732
00:35:39.806 --> 00:35:42.940
it goes in the second category
rather than the third.

733
00:35:42.940 --> 00:35:45.375
Although they could be
related, but they might not be.

734
00:35:46.423 --> 00:35:49.192
Sexual orientation is independent of sex.

735
00:35:51.974 --> 00:35:54.226
And we do know that gender
atypical boys and girls

736
00:35:54.226 --> 00:35:56.989
are more likely to have
same sex attractions,

737
00:35:56.989 --> 00:35:59.868
but not necessarily.

738
00:35:59.868 --> 00:36:01.493
So again, it's all about a world

739
00:36:01.493 --> 00:36:03.885
where you can't make assumptions.

740
00:36:03.885 --> 00:36:06.648
The assumptive world does not apply here.

741
00:36:06.648 --> 00:36:09.956
Now the John Joan case is one that

742
00:36:09.956 --> 00:36:12.596
I think is an extremely powerful

743
00:36:12.596 --> 00:36:15.212
and important case to talk about.

744
00:36:15.212 --> 00:36:18.231
Are you all familiar with
this case to some extent?

745
00:36:18.231 --> 00:36:19.810
John Colapinto wrote about.

746
00:36:19.810 --> 00:36:21.231
These were a pair of Canadian twins

747
00:36:21.231 --> 00:36:22.706
that were born into a Mennonite family

748
00:36:22.706 --> 00:36:26.444
in rural Canada in the 1960s.

749
00:36:26.444 --> 00:36:29.473
And these were identical twin boys.

750
00:36:29.473 --> 00:36:32.643
And at six months the boys had phimosis,

751
00:36:32.643 --> 00:36:36.706
meaning a constriction of the
foreskin of their penises.

752
00:36:36.706 --> 00:36:40.306
They went to have
circumcision and one of them,

753
00:36:40.306 --> 00:36:42.442
in an unfortunate, very
unfortunate accident,

754
00:36:42.442 --> 00:36:44.473
had his penis burned off.

755
00:36:45.344 --> 00:36:47.670
And this is a real problem if you're a boy

756
00:36:47.670 --> 00:36:49.586
or a man to have your penis burned off.

757
00:36:49.586 --> 00:36:51.392
I think you would agree.

758
00:36:53.127 --> 00:36:57.576
According to the very
prevalent notion of the time,

759
00:36:57.576 --> 00:37:00.968
expounded by John Money at
Johns Hopkins University,

760
00:37:01.878 --> 00:37:04.969
nature didn't matter,
nurture was everything.

761
00:37:04.969 --> 00:37:07.349
So if you simply took a
child at a very young age,

762
00:37:07.349 --> 00:37:09.032
and you raised them in the gender

763
00:37:09.032 --> 00:37:13.084
that you wanted them to be,
they would become that thing.

764
00:37:13.084 --> 00:37:15.104
Now what made this case
much more complicated

765
00:37:15.104 --> 00:37:18.277
is that John Money didn't
really study John and Joan,

766
00:37:18.277 --> 00:37:19.775
they were proving his theory.

767
00:37:19.775 --> 00:37:20.661
And they were the perfect proof

768
00:37:20.661 --> 00:37:22.774
because they were identical twins.

769
00:37:22.774 --> 00:37:26.365
And so he reported that it
was going very, very well

770
00:37:27.590 --> 00:37:29.498
with this twinship that he had created

771
00:37:29.498 --> 00:37:32.319
of a boy and girl, identical twins.

772
00:37:32.319 --> 00:37:34.856
In reality it was going terribly.

773
00:37:37.520 --> 00:37:40.805
Joan was extremely unhappy with this plan.

774
00:37:40.805 --> 00:37:42.001
Was fighting it from the moment

775
00:37:42.001 --> 00:37:46.807
that she was put in this role.

776
00:37:46.807 --> 00:37:49.686
Was in some ways
stereotypically more masculine

777
00:37:49.686 --> 00:37:52.159
than her identical twin brother,

778
00:37:52.159 --> 00:37:54.876
and was ripping off the girl
clothing that was put on her,

779
00:37:54.876 --> 00:37:57.155
refusing to do the girl
thing she was asked to do.

780
00:37:57.155 --> 00:37:58.216
When her parents were instructed

781
00:37:58.216 --> 00:38:01.861
that at every moment they
should treat her as a girl,

782
00:38:01.861 --> 00:38:04.322
that if they did not, they would ruin her

783
00:38:04.322 --> 00:38:07.236
and ruin her chances of a proper identity.

784
00:38:07.236 --> 00:38:10.022
Now this was the optimal gender approach,

785
00:38:10.022 --> 00:38:12.262
and it was prevalent and is still,

786
00:38:12.262 --> 00:38:14.282
there's still remnants of it around.

787
00:38:14.282 --> 00:38:16.244
I still encounter people, colleagues,

788
00:38:16.244 --> 00:38:17.966
who believe that this is true.

789
00:38:18.890 --> 00:38:23.890
And the story ends up with Joan,

790
00:38:24.234 --> 00:38:25.886
who by then is now 14,

791
00:38:25.886 --> 00:38:29.067
has been taking estrogens for two years

792
00:38:29.067 --> 00:38:31.784
and has had enough breast development

793
00:38:31.784 --> 00:38:35.010
that he has to undergo a
mastectomy as a teenager

794
00:38:35.010 --> 00:38:38.538
to revert to being the
boy that he always was.

795
00:38:39.375 --> 00:38:41.179
Okay, you got that story straight?

796
00:38:41.179 --> 00:38:45.155
And so this is a picture on
the right of Joan become John.

797
00:38:46.151 --> 00:38:50.466
And another picture here
of Joan become John.

798
00:38:50.466 --> 00:38:52.927
Now the story is actually
really, really tragic

799
00:38:52.927 --> 00:38:54.772
because it actually probably destroyed

800
00:38:54.772 --> 00:38:57.117
the lives of both twins.

801
00:38:57.117 --> 00:38:59.332
In his mid 30s,

802
00:39:01.183 --> 00:39:03.854
the boy-boy twin killed himself.

803
00:39:03.854 --> 00:39:04.934
And two years later,

804
00:39:04.934 --> 00:39:07.533
the girl-boy twin killed himself as well.

805
00:39:08.462 --> 00:39:12.179
So it's really an incredibly tragic story.

806
00:39:13.065 --> 00:39:15.959
Now again, this is the work of Reiner,

807
00:39:15.959 --> 00:39:19.064
who has some, you think
my resume is strange,

808
00:39:19.064 --> 00:39:21.003
this person is trained
as a child psychiatrist

809
00:39:21.003 --> 00:39:23.428
and a urologist.

810
00:39:23.428 --> 00:39:24.078
Sound like a bad joke,

811
00:39:24.078 --> 00:39:27.143
what do a urologist and a child
psychiatrist have in common?

812
00:39:27.143 --> 00:39:27.728
(audience laughs)

813
00:39:27.728 --> 00:39:31.854
In any case, he was a product of the money

814
00:39:31.854 --> 00:39:35.049
at Johns Hopkins universe
but didn't buy it.

815
00:39:35.049 --> 00:39:38.091
And he studied 16 chromosomal males

816
00:39:38.091 --> 00:39:39.861
who had colloquial exstrophy,

817
00:39:39.861 --> 00:39:42.415
meaning that they were
born with testicles,

818
00:39:42.415 --> 00:39:46.559
but without any, their
abdominal wall was not there.

819
00:39:46.559 --> 00:39:49.020
So they're missing their
private parts basically

820
00:39:49.020 --> 00:39:50.622
and had to have something done

821
00:39:50.622 --> 00:39:53.478
to deal with the fact
that they were basically

822
00:39:53.478 --> 00:39:57.022
wide open in their belly
like a bad horror movie.

823
00:39:57.022 --> 00:40:00.240
And according to the mores at the time,

824
00:40:00.240 --> 00:40:02.282
they were all raised as girls.

825
00:40:02.282 --> 00:40:04.516
The surgeries were done and
they were turned into girls.

826
00:40:04.516 --> 00:40:07.999
Except for two, his parents
refused to go along with that.

827
00:40:07.999 --> 00:40:10.008
So they had the reparative surgeries,

828
00:40:10.008 --> 00:40:12.411
but raised the two of the 14 as boys.

829
00:40:12.411 --> 00:40:15.673
Now Reiner followed these
boys up many years later

830
00:40:15.673 --> 00:40:17.936
in a New England Journal article.

831
00:40:17.936 --> 00:40:21.036
And again, reminding you,
normal internal testes,

832
00:40:21.036 --> 00:40:25.169
disrupted external
genitalia, normal brains.

833
00:40:25.169 --> 00:40:27.077
Don't forget, normal brains.

834
00:40:27.077 --> 00:40:28.331
I once had a schizophrenic patient

835
00:40:28.331 --> 00:40:30.467
who kept attacking his penis

836
00:40:30.467 --> 00:40:33.230
because he said he wanted
to destroy his lust.

837
00:40:33.230 --> 00:40:34.437
I did not tell him that he should be

838
00:40:34.437 --> 00:40:36.678
shooting himself in the head,

839
00:40:36.678 --> 00:40:38.698
because he had shot and cut
himself in the genitals.

840
00:40:38.698 --> 00:40:41.670
But the brain is important,
it's very important.

841
00:40:41.670 --> 00:40:44.967
16 of the 16 people demonstrated

842
00:40:44.967 --> 00:40:46.353
male-typical gender behaviors,

843
00:40:46.353 --> 00:40:49.580
even though they'd been
raised, 14 of them as girls.

844
00:40:49.580 --> 00:40:51.879
Two of the 16 were raised as boys.

845
00:40:51.879 --> 00:40:56.359
14 of the 16 were surgically
altered to look like girls.

846
00:40:57.556 --> 00:41:00.694
Eight of the 14 became
males in adolescence.

847
00:41:00.694 --> 00:41:03.144
Lived as males, identified as males.

848
00:41:04.285 --> 00:41:07.096
Six of the eight had sexual
reassignment surgery so that

849
00:41:07.096 --> 00:41:11.844
they could be physically
manifesting their masculinity.

850
00:41:12.750 --> 00:41:16.370
Five of 14 continued to live as females.

851
00:41:16.370 --> 00:41:18.746
Three of the five had an unclear sense

852
00:41:18.746 --> 00:41:20.116
of themselves or gender identity,

853
00:41:20.116 --> 00:41:22.496
but were tending to think
of themselves as male,

854
00:41:22.496 --> 00:41:25.178
and one refused to talk about it.

855
00:41:25.178 --> 00:41:27.059
Now I'm surprised that
more than one didn't refuse

856
00:41:27.059 --> 00:41:28.301
to talk about it because I think

857
00:41:28.301 --> 00:41:30.715
I'd be pretty pissed and
wouldn't want to talk about it.

858
00:41:30.715 --> 00:41:31.900
But the point of this study,

859
00:41:31.900 --> 00:41:34.685
which I think is really, really important,

860
00:41:34.685 --> 00:41:36.195
New England Journal 2004,

861
00:41:36.195 --> 00:41:39.029
is it really, really, I think,

862
00:41:39.029 --> 00:41:41.636
shot down the optimal gender doctrine.

863
00:41:41.636 --> 00:41:44.655
In a way that makes that doctrine

864
00:41:44.655 --> 00:41:47.131
of John Money just
completely unacceptable.

865
00:41:47.131 --> 00:41:49.453
And Reiner's continued to go on to work

866
00:41:49.453 --> 00:41:52.193
with populations, in this case,

867
00:41:53.077 --> 00:41:55.924
well, I'm not sure quite
what to call these folks,

868
00:41:55.924 --> 00:41:57.515
but they speak to, he has things to say

869
00:41:57.515 --> 00:42:00.220
about transgendered folks,
about intersex folks,

870
00:42:00.220 --> 00:42:03.018
and about people who have
these congenital anomalies

871
00:42:03.018 --> 00:42:05.038
that don't, do not in fact,

872
00:42:05.038 --> 00:42:07.173
tell you what you should do with them.

873
00:42:08.195 --> 00:42:10.290
So they're unpredictable identifications.

874
00:42:10.290 --> 00:42:11.265
That was Reiner's point.

875
00:42:11.265 --> 00:42:14.339
That routine male assignment
of genetic males to female sex

876
00:42:14.339 --> 00:42:16.232
because they don't have a penis

877
00:42:16.232 --> 00:42:19.540
can result in unpredictable
identifications later.

878
00:42:19.540 --> 00:42:21.281
Clinical interventions in such children

879
00:42:21.281 --> 00:42:24.659
should be re-examined, the
light of these findings.

880
00:42:24.659 --> 00:42:26.679
That is don't do anything.

881
00:42:26.679 --> 00:42:29.650
Let the child grow and
tell you who they are.

882
00:42:30.511 --> 00:42:32.390
You can do that surgery stuff later.

883
00:42:33.223 --> 00:42:35.072
It also brings up the
notion that sex hormones

884
00:42:35.072 --> 00:42:38.369
do organize the prenatal brain.

885
00:42:38.369 --> 00:42:40.250
So future sex reassignment decisions

886
00:42:40.250 --> 00:42:42.211
should be made with maximum sophistication

887
00:42:42.211 --> 00:42:43.616
in regard to the implications,

888
00:42:43.616 --> 00:42:46.333
psychosocial and psychosexual
brain development,

889
00:42:46.333 --> 00:42:49.234
as it is influenced by the
intrauterine hormonal milieu.

890
00:42:49.234 --> 00:42:50.976
Now I want to say here

891
00:42:50.976 --> 00:42:53.008
that we come up against the limitations

892
00:42:53.008 --> 00:42:57.245
of what we know with
how the brain is sexed.

893
00:42:57.245 --> 00:42:59.312
So we don't have a explanation

894
00:42:59.312 --> 00:43:02.492
for how transgender works in the brain,

895
00:43:02.492 --> 00:43:04.849
but we have the fact that it exists.

896
00:43:04.849 --> 00:43:06.428
And the notion that somehow we know

897
00:43:06.428 --> 00:43:07.963
and can make decisions for people

898
00:43:07.963 --> 00:43:09.774
based on what we know, we don't know.

899
00:43:09.774 --> 00:43:11.400
We don't know.

900
00:43:11.400 --> 00:43:13.280
Reiner is making observations based on

901
00:43:13.280 --> 00:43:14.963
what he saw with these 16 people

902
00:43:14.963 --> 00:43:18.056
who are raised in the wrong gender.

903
00:43:19.398 --> 00:43:21.253
There's also good evidence.

904
00:43:21.253 --> 00:43:23.553
This is from Sheri Berenbaum,
who's a psychologist

905
00:43:23.553 --> 00:43:27.093
who has studied, again, masculinization,

906
00:43:27.093 --> 00:43:29.369
which by definition includes
feminization of the brain.

907
00:43:29.369 --> 00:43:32.154
The point is that the brain is genderized.

908
00:43:32.154 --> 00:43:33.525
Is that right? Sounds like blenderized.

909
00:43:33.525 --> 00:43:35.513
But in any case, that something happens

910
00:43:35.513 --> 00:43:38.892
in utero to lead to something.

911
00:43:38.892 --> 00:43:40.098
And that there is good evidence

912
00:43:40.098 --> 00:43:42.374
that exposure to high levels of androgens

913
00:43:42.374 --> 00:43:44.197
during prenatal development can result

914
00:43:44.197 --> 00:43:46.112
in masculinization of activity,

915
00:43:46.112 --> 00:43:47.250
and of occupational interest,

916
00:43:47.250 --> 00:43:50.268
sexual orientation, and
some spatial abilities.

917
00:43:50.268 --> 00:43:54.196
Smaller effect on pre-gender
identity, but still there.

918
00:43:54.196 --> 00:43:56.603
Now again, this would mean potentially

919
00:43:56.603 --> 00:43:59.582
that someone who had a core
gender identity as a female

920
00:43:59.582 --> 00:44:01.737
could nonetheless be much more interested

921
00:44:01.737 --> 00:44:04.070
in masculine activities and perhaps choose

922
00:44:04.070 --> 00:44:07.129
a same sex partner, more likely.

923
00:44:08.098 --> 00:44:09.259
The brain knows.

924
00:44:09.259 --> 00:44:11.418
Reiner again, saying, "Clinical
decisions should not be

925
00:44:11.418 --> 00:44:14.216
"based on anatomy or
correctness of sexual function,

926
00:44:14.216 --> 00:44:17.478
"but on what the brain wants to do."

927
00:44:17.478 --> 00:44:20.187
You know, people manage to
work out their sexual function.

928
00:44:20.187 --> 00:44:21.244
They don't need to have the focus

929
00:44:21.244 --> 00:44:24.343
be simply on building them
an organ that will work.

930
00:44:24.343 --> 00:44:26.143
Which again, is sort
of the Money approach.

931
00:44:26.143 --> 00:44:28.905
And by and large, the organ
that will work is a vagina

932
00:44:28.905 --> 00:44:31.204
because it's too hard to build a penis.

933
00:44:31.204 --> 00:44:34.479
That's the reality of
surgery, make 'em into girls.

934
00:44:34.479 --> 00:44:36.247
Which I think is offensive to women,

935
00:44:36.247 --> 00:44:38.726
as well as offensive on lots of levels.

936
00:44:38.726 --> 00:44:41.884
But anyway, back to the brain
being the critical organ.

937
00:44:41.884 --> 00:44:44.761
And the one that we actually
don't understand terribly well.

938
00:44:45.924 --> 00:44:47.724
There's a clinical threshold.

939
00:44:47.724 --> 00:44:49.576
And these are from the Harry Benjamin's

940
00:44:49.576 --> 00:44:51.978
Standards of Care from 2001.

941
00:44:51.978 --> 00:44:54.556
There are updated standards
that came out in 2011.

942
00:44:54.556 --> 00:44:56.298
I tried to read them for pithy quotes

943
00:44:56.298 --> 00:44:58.213
and they simply aren't there. (laughs)

944
00:44:58.213 --> 00:44:59.455
From what I could tell.

945
00:44:59.455 --> 00:45:02.752
They're very prescriptive
without being very philosophical.

946
00:45:02.752 --> 00:45:05.515
So the notion here was that

947
00:45:05.515 --> 00:45:06.676
a clinical threshold is passed

948
00:45:06.676 --> 00:45:08.498
when concerns,
uncertainties, and questions

949
00:45:08.498 --> 00:45:11.273
about gender identify
persist in development,

950
00:45:11.273 --> 00:45:13.189
become so important as to affect

951
00:45:13.189 --> 00:45:15.916
how a person functions in their life.

952
00:45:15.916 --> 00:45:18.351
I think we could probably
all agree with that.

953
00:45:19.249 --> 00:45:22.002
And such struggles start
in the preschool years

954
00:45:22.002 --> 00:45:23.558
and can go on through old age

955
00:45:23.558 --> 00:45:26.042
with many, many different forms.

956
00:45:26.042 --> 00:45:27.633
They come about because people

957
00:45:27.633 --> 00:45:30.050
are unhappy with their anatomy,

958
00:45:30.050 --> 00:45:31.601
or what their body looks like.

959
00:45:31.601 --> 00:45:32.727
If they feel themselves to be a woman

960
00:45:32.727 --> 00:45:35.124
and they have all these male parts, yuk.

961
00:45:35.124 --> 00:45:36.980
As what happened with a patient of mine

962
00:45:36.980 --> 00:45:40.451
who was a genetic female

963
00:45:40.451 --> 00:45:43.272
but very much felt himself to be a man.

964
00:45:43.272 --> 00:45:45.477
Was totally disgusted with menstruation

965
00:45:45.477 --> 00:45:47.951
and with those breasts,
and it was very bad.

966
00:45:47.951 --> 00:45:49.459
And in fact, I'm quite proud of myself

967
00:45:49.459 --> 00:45:51.097
because this person was rejected

968
00:45:51.097 --> 00:45:53.859
for a mastectomy by a
large insurance company,

969
00:45:53.859 --> 00:45:56.773
and I appealed it as
a congenital disorder,

970
00:45:56.773 --> 00:45:59.363
and they got the surgery done.

971
00:45:59.363 --> 00:46:00.458
And it hasn't happened again,

972
00:46:00.458 --> 00:46:02.118
but that one time it seemed pretty cool

973
00:46:02.118 --> 00:46:03.426
that we could do that.

974
00:46:04.467 --> 00:46:07.041
So now I'm going to play
the first of the clip

975
00:46:07.041 --> 00:46:08.876
from a patient of mine.

976
00:46:08.876 --> 00:46:12.521
And this was a woman
who was referred to me

977
00:46:12.521 --> 00:46:16.209
with concerns about whether or not

978
00:46:16.209 --> 00:46:18.731
she was actually really a man, okay?

979
00:46:18.731 --> 00:46:20.646
So we'll have three different short clips,

980
00:46:20.646 --> 00:46:23.153
and then some things in between.

981
00:46:23.153 --> 00:46:24.818
And if it works, it will run.

982
00:46:24.818 --> 00:46:26.356
Tell me a little of your story.

983
00:46:26.356 --> 00:46:27.880
How did you come to see me?

984
00:46:27.880 --> 00:46:29.772
What was going on?

985
00:46:29.772 --> 00:46:33.146
- Well, I had been going
to my endocrinologist

986
00:46:33.146 --> 00:46:35.944
and just expressed to him that I was

987
00:46:35.944 --> 00:46:40.483
having problems resolving
issues of sexuality.

988
00:46:40.483 --> 00:46:44.046
And he suggested that
I should talk to you.

989
00:46:44.046 --> 00:46:46.543
And through a series of referrals anyway,

990
00:46:46.543 --> 00:46:47.981
I got to you.

991
00:46:49.341 --> 00:46:50.204
- [John] Was there a piece in there

992
00:46:50.204 --> 00:46:52.666
also about gender issues?

993
00:46:52.666 --> 00:46:54.790
- Well, at the, I did explain to him

994
00:46:54.790 --> 00:46:57.981
that when I was born

995
00:46:57.981 --> 00:47:00.716
that I had had surgery

996
00:47:00.716 --> 00:47:03.977
because of some ambiguous genitalia.

997
00:47:03.977 --> 00:47:08.586
And that I felt that that was an issue,

998
00:47:08.586 --> 00:47:11.818
and I was just dealing with confusion

999
00:47:11.818 --> 00:47:13.676
as to whether I was a lesbian,

1000
00:47:13.676 --> 00:47:16.182
whether I was straight
because I had been married.

1001
00:47:17.845 --> 00:47:20.227
I had conflicting issues with a church

1002
00:47:20.227 --> 00:47:22.305
I'm currently going to.

1003
00:47:22.305 --> 00:47:25.044
And basically just confused.

1004
00:47:26.779 --> 00:47:28.114
- [John] What was the
connection in your mind

1005
00:47:28.114 --> 00:47:32.683
between your confusion and
the ambiguous genitalia?

1006
00:47:34.116 --> 00:47:39.110
- Well, I think a lot of it was

1007
00:47:40.440 --> 00:47:42.675
because of my involvement in the church,

1008
00:47:44.869 --> 00:47:49.460
I felt that I was expected
to think and behave

1009
00:47:49.460 --> 00:47:51.619
in a way very consistent with

1010
00:47:52.493 --> 00:47:55.305
what would be for lack of
a better term, a woman.

1011
00:47:55.305 --> 00:47:59.461
And I don't always
think and feel that way.

1012
00:47:59.461 --> 00:48:01.562
And that caused great confusion for me,

1013
00:48:01.562 --> 00:48:04.179
and 'cause I didn't know
what to do with that.

1014
00:48:05.764 --> 00:48:08.086
- [John] When you say
you don't think and feel

1015
00:48:08.086 --> 00:48:10.310
like a woman, what do you mean?

1016
00:48:12.161 --> 00:48:14.226
- It's hard to describe.

1017
00:48:15.864 --> 00:48:17.969
I think a lot of it is in the way

1018
00:48:19.083 --> 00:48:21.209
I interact with other people.

1019
00:48:22.908 --> 00:48:24.110
With either gender.

1020
00:48:24.885 --> 00:48:26.815
A lot of times I feel more comfortable

1021
00:48:27.705 --> 00:48:32.705
hanging around with guys
than I do with women.

1022
00:48:34.579 --> 00:48:35.600
I don't have a lot of interest

1023
00:48:35.600 --> 00:48:39.640
in what I refer to as girly activities.

1024
00:48:39.640 --> 00:48:41.477
But it's been a problem because

1025
00:48:42.419 --> 00:48:44.868
as I present myself as female,

1026
00:48:46.220 --> 00:48:49.579
I can't cross into just
either world easily.

1027
00:48:49.579 --> 00:48:52.331
It's not like I'm accepted
hanging out with the guys

1028
00:48:52.331 --> 00:48:54.718
because they view me as a woman.

1029
00:48:56.754 --> 00:48:59.992
So it's just sometimes quite difficult.

1030
00:49:00.948 --> 00:49:03.620
- [John] So you don't want
to hang out with the girls

1031
00:49:03.620 --> 00:49:06.778
because you don't feel
comfortable with them as a girl.

1032
00:49:06.778 --> 00:49:07.672
- Correct.

1033
00:49:07.672 --> 00:49:08.952
- [John] And you don't
want to hang out with--

1034
00:49:08.952 --> 00:49:10.171
- Doing the nails and the hair

1035
00:49:10.171 --> 00:49:11.935
on a Saturday night with your girls.

1036
00:49:11.935 --> 00:49:15.685
No, that's just not, that's just not me.

1037
00:49:15.685 --> 00:49:16.904
- [John] And you're not
permitted to hang out

1038
00:49:16.904 --> 00:49:21.029
with the guys because
they think of you as,

1039
00:49:21.029 --> 00:49:22.620
- They think of me as a woman.

1040
00:49:22.620 --> 00:49:23.269
- [John] As a woman.

1041
00:49:23.269 --> 00:49:26.107
- So obviously they wouldn't
include me in that group.

1042
00:49:26.989 --> 00:49:31.122
So it's, it's, tends to be difficult.

1043
00:49:32.393 --> 00:49:34.906
- [John] What do you think of yourself as?

1044
00:49:36.096 --> 00:49:39.682
- Well, I'm not unhappy to have,

1045
00:49:40.879 --> 00:49:42.856
I'm not unhappy being a woman.

1046
00:49:42.856 --> 00:49:46.879
It's not like I have a
desire to become a man.

1047
00:49:49.055 --> 00:49:50.889
I think of myself,

1048
00:49:53.135 --> 00:49:56.142
at least in the way my mind operates,

1049
00:49:56.142 --> 00:49:58.139
as more masculine.

1050
00:49:58.139 --> 00:49:59.799
In the way I deal with other people,

1051
00:49:59.799 --> 00:50:02.340
in the way I deal with situations.

1052
00:50:03.874 --> 00:50:07.372
I tend to be at least,

1053
00:50:07.372 --> 00:50:09.473
if a personality profiles that we do

1054
00:50:09.473 --> 00:50:10.889
through work and stuff,

1055
00:50:10.889 --> 00:50:13.496
I'm a driver and implementer.

1056
00:50:15.196 --> 00:50:17.270
I just feel,

1057
00:50:19.423 --> 00:50:23.353
I feel I think like a guy in a lotta ways.

1058
00:50:24.275 --> 00:50:26.370
- [John] And if anatomy weren't an issue,

1059
00:50:27.839 --> 00:50:31.078
and what would you be at core?

1060
00:50:31.078 --> 00:50:33.181
- I'd be a male at core.

1061
00:50:33.181 --> 00:50:34.817
No question about it.

1062
00:50:37.887 --> 00:50:40.406
- I think it's interesting
how many stereotypes

1063
00:50:40.406 --> 00:50:44.080
she puts out there trying
to figure out who she is.

1064
00:50:44.922 --> 00:50:49.105
So intersexuality is what I
wanted to talk about some.

1065
00:50:49.105 --> 00:50:50.593
And it's when there's a disagreement

1066
00:50:50.593 --> 00:50:54.427
between the phenotypic
and the gonadal sex.

1067
00:50:54.427 --> 00:50:58.017
So what the body looks like
versus what the gonads are,

1068
00:50:59.085 --> 00:51:03.740
are not adding up to what
generally is called normal.

1069
00:51:05.290 --> 00:51:07.054
For a male pseudohermaphrodite,

1070
00:51:07.054 --> 00:51:10.442
there's testicular tissue,
but female external genitalia.

1071
00:51:11.524 --> 00:51:13.211
And for a female pseudohermaphrodite,

1072
00:51:13.211 --> 00:51:16.258
there's ovarian tissue, but
male external genitalia.

1073
00:51:16.258 --> 00:51:17.918
Now I can already tell you,

1074
00:51:17.918 --> 00:51:19.961
there'll be lots of diagnoses coming.

1075
00:51:19.961 --> 00:51:21.319
I'll try not to belabor any of them,

1076
00:51:21.319 --> 00:51:23.096
but there are many, many
different conditions

1077
00:51:23.096 --> 00:51:26.331
that fall into intersexuality.

1078
00:51:26.334 --> 00:51:27.605
A hermaphrodite is someone who

1079
00:51:27.605 --> 00:51:30.948
has both testicular and ovarian tissue.

1080
00:51:30.948 --> 00:51:32.492
So it's actually a tissue diagnosis,

1081
00:51:32.492 --> 00:51:34.721
not a descriptive diagnosis.

1082
00:51:35.972 --> 00:51:38.971
And by the way, in her
story she talks about

1083
00:51:40.322 --> 00:51:42.736
how testicular tissue was removed.

1084
00:51:42.736 --> 00:51:45.500
She learned that only 50 years later

1085
00:51:45.500 --> 00:51:48.223
when we were actually
able to get the lab report

1086
00:51:48.223 --> 00:51:50.017
that she'd never seen

1087
00:51:50.017 --> 00:51:52.215
from the naval hospital
where she was born.

1088
00:51:52.215 --> 00:51:55.315
So with hermaphrodites, again
it's a tissue diagnosis,

1089
00:51:55.315 --> 00:51:56.870
so you can look male, you can look female,

1090
00:51:56.870 --> 00:51:59.030
or you can have an ambiguous phenotype.

1091
00:51:59.030 --> 00:52:00.596
That's not the way we usually think of it.

1092
00:52:00.596 --> 00:52:03.614
But that is actually the definition.

1093
00:52:03.614 --> 00:52:05.076
And the whole point of intersexuality

1094
00:52:05.076 --> 00:52:07.364
is its diversity, not pathology.

1095
00:52:08.474 --> 00:52:10.922
Again, back to that
sociocultural construction.

1096
00:52:10.922 --> 00:52:13.301
The level of pathology, the
level of medical involvement,

1097
00:52:13.301 --> 00:52:14.939
the level of psychological involvement

1098
00:52:14.939 --> 00:52:16.378
or social involvement that's needed

1099
00:52:16.378 --> 00:52:18.699
to help folks who are different,

1100
00:52:18.699 --> 00:52:21.991
is a diversity issue I think,
not a pathological one.

1101
00:52:22.879 --> 00:52:25.201
Male pseudohermaphroditism is complete

1102
00:52:25.201 --> 00:52:27.499
or partial androgen sensitivity.

1103
00:52:27.499 --> 00:52:29.450
And this is a condition in which

1104
00:52:29.450 --> 00:52:31.322
the individual has normal testes

1105
00:52:31.322 --> 00:52:33.518
and normal testosterone production,

1106
00:52:33.518 --> 00:52:36.803
but the testosterone doesn't do much.

1107
00:52:36.803 --> 00:52:38.034
In other words, you have to have receptors

1108
00:52:38.034 --> 00:52:39.927
that already receive that testosterone

1109
00:52:39.927 --> 00:52:42.853
produced by the testes in order to have

1110
00:52:42.853 --> 00:52:45.360
the things develop and evolve

1111
00:52:47.526 --> 00:52:49.252
that are testosterone related.

1112
00:52:49.252 --> 00:52:52.469
Interestingly, what actually
masculinizes the brain

1113
00:52:52.469 --> 00:52:55.242
is estrogen, a breakdown
product of testosterone,

1114
00:52:55.242 --> 00:52:57.786
which I just think is kind of fascinating.

1115
00:52:57.786 --> 00:53:01.024
But with a complete androgen
insensitivity syndrome,

1116
00:53:01.024 --> 00:53:04.124
these are actually women
who often look like

1117
00:53:04.124 --> 00:53:06.711
stereotypically fabulous women

1118
00:53:06.711 --> 00:53:09.062
because they have Barbie figures.

1119
00:53:09.062 --> 00:53:10.130
They have narrow male hips,

1120
00:53:10.130 --> 00:53:11.221
they have long, long legs.

1121
00:53:11.221 --> 00:53:12.881
They have proportions that are male,

1122
00:53:12.881 --> 00:53:16.886
but they don't have any of the male parts.

1123
00:53:16.886 --> 00:53:20.269
But there are also folks who
have partial receptor responses

1124
00:53:20.269 --> 00:53:21.373
so they have bits and pieces

1125
00:53:21.373 --> 00:53:24.205
of the male masculinization going on.

1126
00:53:25.250 --> 00:53:27.171
There can be no brain masculinization,

1127
00:53:27.171 --> 00:53:29.748
probably with a complete
androgen insensitivity situation.

1128
00:53:29.748 --> 00:53:32.073
And there can be partial
brain masculinization.

1129
00:53:32.073 --> 00:53:33.769
There can be a female gender identity

1130
00:53:33.769 --> 00:53:36.832
or a male gender identity,
or something in between.

1131
00:53:37.995 --> 00:53:40.227
The phenotype, the body may be female,

1132
00:53:40.227 --> 00:53:41.562
or it may be ambiguous.

1133
00:53:41.562 --> 00:53:44.500
Again, because there's a
range of receptor responses,

1134
00:53:44.500 --> 00:53:48.304
and there are probably many
versions of this condition.

1135
00:53:48.304 --> 00:53:52.077
5-alpha-reductase deficiency
is a diagnosis from Middlesex.

1136
00:53:52.077 --> 00:53:55.108
So this is a condition where
there are normal testes

1137
00:53:55.108 --> 00:53:57.313
and normal testosterone production.

1138
00:53:57.313 --> 00:53:59.008
There's normal brain masculinization

1139
00:53:59.008 --> 00:54:01.237
and normal male gender identity,

1140
00:54:01.237 --> 00:54:04.453
but the body is not really responding

1141
00:54:04.453 --> 00:54:06.612
because of this failure
to convert testosterone

1142
00:54:06.612 --> 00:54:09.271
to dihydrotestosterone, the
body doesn't masculinize

1143
00:54:09.271 --> 00:54:11.987
until puberty when there's
so much testosterone

1144
00:54:11.987 --> 00:54:14.889
that finally the body masculinizes.

1145
00:54:14.889 --> 00:54:15.992
And there are cultures because

1146
00:54:15.992 --> 00:54:18.509
this is an autosomal receptive condition,

1147
00:54:20.169 --> 00:54:22.285
a condition in which this
is just sort of known.

1148
00:54:22.285 --> 00:54:23.585
In several populations around the world,

1149
00:54:23.585 --> 00:54:25.803
where they're just
people who turn into men

1150
00:54:25.803 --> 00:54:27.719
when they get to puberty and that's okay

1151
00:54:27.719 --> 00:54:28.578
because we've seen this before,

1152
00:54:28.578 --> 00:54:31.317
we know what it is, we understand it.

1153
00:54:31.317 --> 00:54:33.581
The point about Middlesex is that

1154
00:54:33.581 --> 00:54:35.055
they've left that part of the world,

1155
00:54:35.055 --> 00:54:37.803
and they're in the U.S.
where nobody really gets it.

1156
00:54:38.914 --> 00:54:42.507
Male pseudohermaphroditism occurs

1157
00:54:42.507 --> 00:54:44.758
with a testicular dysgenesis,

1158
00:54:44.758 --> 00:54:48.932
one or both of the testes
are inadequately developed.

1159
00:54:49.959 --> 00:54:52.617
Incomplete fetal masculinization,

1160
00:54:52.617 --> 00:54:54.243
not because you have an ovary,

1161
00:54:54.243 --> 00:54:57.563
but because you have a testis
that isn't working very well.

1162
00:54:57.563 --> 00:54:59.565
You can have mixed gonadal dysgenesis

1163
00:54:59.565 --> 00:55:02.583
where you have more than
one cell line going on.

1164
00:55:02.583 --> 00:55:04.963
That is you can have a
XY line and an XX line,

1165
00:55:04.963 --> 00:55:06.681
or an XY line and an X.

1166
00:55:06.681 --> 00:55:09.089
You can have a mosaic basically

1167
00:55:09.089 --> 00:55:11.816
which leads to various things in between.

1168
00:55:11.816 --> 00:55:12.850
And in fact, the patient here

1169
00:55:12.850 --> 00:55:15.207
is a mosaic as she'll tell you.

1170
00:55:15.207 --> 00:55:18.015
The most common mosaic is actually 46, XY,

1171
00:55:18.015 --> 00:55:20.373
which is male, correct?

1172
00:55:20.373 --> 00:55:22.415
You know what 45, X is?

1173
00:55:22.415 --> 00:55:23.993
It's Turner syndrome.

1174
00:55:23.993 --> 00:55:28.766
And Turner syndrome are women
who are typically very short.

1175
00:55:28.766 --> 00:55:30.750
Often have some other characteristics,

1176
00:55:30.750 --> 00:55:32.725
including a broad shield chest.

1177
00:55:32.725 --> 00:55:35.871
Certain characteristics
that are quite obvious.

1178
00:55:35.871 --> 00:55:37.809
And in fact if you look at this patient,

1179
00:55:37.809 --> 00:55:39.086
she looks a little bit that way,

1180
00:55:39.086 --> 00:55:41.106
and she's barely five feet tall.

1181
00:55:41.106 --> 00:55:42.267
And one of the comments she made was,

1182
00:55:42.267 --> 00:55:44.705
"I make a terrible guy
because I'm so short."

1183
00:55:45.691 --> 00:55:47.775
In any case, this mosaicism is common.

1184
00:55:47.775 --> 00:55:49.729
And again, it can manifest as someone

1185
00:55:49.729 --> 00:55:52.419
who is male, female, or in between.

1186
00:55:54.922 --> 00:55:56.511
If you look at fetal
ultrasounds and you see

1187
00:55:56.511 --> 00:55:59.332
that the genitalia are
developing abnormally,

1188
00:55:59.332 --> 00:56:00.946
you may find a lot of this.

1189
00:56:00.946 --> 00:56:02.908
If you take a bunch of
kids that are just born

1190
00:56:02.908 --> 00:56:03.767
and you check their chromosomes,

1191
00:56:03.767 --> 00:56:04.788
you may find a lot of this,

1192
00:56:04.788 --> 00:56:07.585
but they look completely
normal phenotypically.

1193
00:56:08.735 --> 00:56:09.576
So you can have an incomplete

1194
00:56:09.576 --> 00:56:12.393
to full fetal masculinization.

1195
00:56:12.393 --> 00:56:14.046
So congenital adrenal hyperplasia

1196
00:56:14.046 --> 00:56:16.820
is another example of
pseudohermaphroditism.

1197
00:56:16.820 --> 00:56:18.190
And this is where the andrenals

1198
00:56:18.190 --> 00:56:20.686
are producing too much
masculinizing hormone.

1199
00:56:20.686 --> 00:56:23.263
So not even the sex glands,
but the adrenal glands.

1200
00:56:23.263 --> 00:56:25.039
And you end up with a female.

1201
00:56:25.039 --> 00:56:26.502
Typically a female gender identity,

1202
00:56:26.502 --> 00:56:28.627
but maybe a fused labia,

1203
00:56:28.627 --> 00:56:31.749
maybe a masculine habitus,

1204
00:56:31.749 --> 00:56:34.326
maybe a very large clitoris.

1205
00:56:34.326 --> 00:56:36.904
So on the way to a more
masculine expression.

1206
00:56:36.904 --> 00:56:39.644
Because remember, genitals
all come from the same place.

1207
00:56:39.644 --> 00:56:42.221
And they just develop
along different pathways.

1208
00:56:42.221 --> 00:56:45.460
Normal ovaries but too much
androgen coming from somewhere.

1209
00:56:45.460 --> 00:56:47.979
Which this could also
occur with the mother,

1210
00:56:47.979 --> 00:56:48.780
for whatever reason,

1211
00:56:48.780 --> 00:56:51.617
that's taking androgens
during the pregnancy.

1212
00:56:51.617 --> 00:56:54.658
Partial to full body
masculinization occurs.

1213
00:56:54.658 --> 00:56:58.198
This is actually probably
fairly common in athletes,

1214
00:56:58.198 --> 00:57:00.648
very good female athletes.

1215
00:57:00.648 --> 00:57:02.274
Female gender identity,

1216
00:57:02.274 --> 00:57:04.735
but maybe increased male typical behavior.

1217
00:57:04.735 --> 00:57:08.473
And maybe more likely to
choose a same sex partner.

1218
00:57:08.473 --> 00:57:10.829
Again, back to that idea
of brain masculinization.

1219
00:57:10.829 --> 00:57:13.267
In this case occurring
because of adrenal production,

1220
00:57:13.267 --> 00:57:18.267
or hormones that the mother
has taken during the pregnancy.

1221
00:57:18.270 --> 00:57:21.529
So this is a little, a
second clip of Cindy.

1222
00:57:21.529 --> 00:57:22.744
Who again, I should have told you,

1223
00:57:22.744 --> 00:57:25.610
at the time of this tape
was in her late 40s.

1224
00:57:25.610 --> 00:57:28.071
I met her when she was 48.

1225
00:57:28.071 --> 00:57:29.711
And how long have you known that?

1226
00:57:30.593 --> 00:57:32.889
- Well, when I was raised,

1227
00:57:33.994 --> 00:57:37.224
I had surgery at approximately
six months of age,

1228
00:57:37.224 --> 00:57:40.544
where they restructured my clitoris

1229
00:57:40.544 --> 00:57:42.959
because I had a hyper clitoris.

1230
00:57:42.959 --> 00:57:44.898
I did have a vagina.

1231
00:57:44.898 --> 00:57:46.743
And they also did surgery to remove

1232
00:57:46.743 --> 00:57:49.983
what they referred to
as testicular tissue,

1233
00:57:49.983 --> 00:57:52.502
although this was back in 1954.

1234
00:57:52.502 --> 00:57:55.822
And I don't know exactly what
tests they were able to do.

1235
00:57:55.822 --> 00:57:58.557
I haven't been able to get medical records

1236
00:57:58.557 --> 00:58:02.415
to find out exactly
everything that they did.

1237
00:58:03.356 --> 00:58:05.281
As I was growing up,

1238
00:58:05.281 --> 00:58:07.764
I have an abdominal scar.

1239
00:58:09.390 --> 00:58:13.133
My parents explained that
I had a hernia as a child.

1240
00:58:13.133 --> 00:58:14.340
And you know, 'cause I had asked

1241
00:58:14.340 --> 00:58:16.813
about this fairly large scar.

1242
00:58:16.813 --> 00:58:20.121
And they told me that I wouldn't be able

1243
00:58:20.121 --> 00:58:21.340
to have children though.

1244
00:58:21.340 --> 00:58:24.080
They did give me that
piece of information.

1245
00:58:24.080 --> 00:58:27.604
But I never really questioned it.

1246
00:58:29.501 --> 00:58:32.717
I know growing up, as I
look back in hindsight,

1247
00:58:32.717 --> 00:58:36.624
I had a lot of feelings towards

1248
00:58:37.365 --> 00:58:41.847
other women that were maybe
not sexual but more paternal.

1249
00:58:41.847 --> 00:58:44.087
I think one of my earliest memories is

1250
00:58:44.087 --> 00:58:45.797
when I was in third grade,

1251
00:58:47.048 --> 00:58:49.007
standing on a hill
overlooking the school yard

1252
00:58:49.007 --> 00:58:52.733
with two little girls and I
can even remember their name.

1253
00:58:52.733 --> 00:58:54.950
Nikki and Leanne, they
were in first grade.

1254
00:58:54.950 --> 00:58:57.087
And I had my arm around each
one of 'em on each side,

1255
00:58:57.087 --> 00:59:01.068
and I just felt so
protective and not maternal,

1256
00:59:01.068 --> 00:59:05.293
but more paternal of
these two little girls.

1257
00:59:06.885 --> 00:59:11.022
So I basically went through life believing

1258
00:59:11.022 --> 00:59:14.464
that I was normal as a female.

1259
00:59:16.118 --> 00:59:17.772
Had boyfriends.

1260
00:59:19.160 --> 00:59:21.952
Sex is, you know, high school.

1261
00:59:23.222 --> 00:59:26.439
I had my first lesbian experience

1262
00:59:26.439 --> 00:59:29.043
probably about a year or
so out of high school.

1263
00:59:29.043 --> 00:59:31.180
But then met a man and got married

1264
00:59:31.180 --> 00:59:33.849
and was married for 16 years.

1265
00:59:35.324 --> 00:59:38.736
He knew of my past
experiences and that was okay.

1266
00:59:39.741 --> 00:59:41.563
Sexually the relationship was fine.

1267
00:59:41.563 --> 00:59:43.142
I've never had a problem with that.

1268
00:59:43.142 --> 00:59:46.090
It's not like there was ever a problem

1269
00:59:47.396 --> 00:59:49.497
achieving orgasm or anything like that.

1270
00:59:49.497 --> 00:59:54.014
But I know that my fantasy life

1271
00:59:54.014 --> 00:59:57.229
was more geared toward thinking

1272
00:59:57.229 --> 00:59:58.657
of being with another woman

1273
00:59:58.657 --> 01:00:00.583
as opposed to with a man.

1274
01:00:01.676 --> 01:00:04.640
My parents told me
after I had been married

1275
01:00:04.640 --> 01:00:09.640
for several years about the
surgery I had as a child.

1276
01:00:09.772 --> 01:00:12.562
And their comment was,
"Well, you're a big girl now,

1277
01:00:12.562 --> 01:00:15.046
"I guess we can tell you this."

1278
01:00:15.046 --> 01:00:20.046
And so that was pretty
shocking for me at that point.

1279
01:00:20.599 --> 01:00:25.405
And I spent a lot of my life
after knowing that information,

1280
01:00:27.964 --> 01:00:31.308
what I refer to as my freak
issues, I felt like a freak,

1281
01:00:31.308 --> 01:00:34.755
that you know I didn't
know where to fit in.

1282
01:00:36.525 --> 01:00:40.472
I eventually divorced after
about 16 years of marriage.

1283
01:00:40.472 --> 01:00:43.003
And came out as a lesbian,

1284
01:00:43.003 --> 01:00:46.899
and had a couple of long-term
lesbian relationships.

1285
01:00:48.355 --> 01:00:50.403
And it wasn't until recently

1286
01:00:50.403 --> 01:00:52.532
that I had a chromosome analysis done

1287
01:00:52.532 --> 01:00:57.284
where it was discovered that I was XY

1288
01:00:57.284 --> 01:01:01.017
and also XO mosaic.

1289
01:01:02.823 --> 01:01:05.504
- [John] Tell me about how you came

1290
01:01:05.504 --> 01:01:07.002
to have a chromosome analysis

1291
01:01:07.002 --> 01:01:10.750
and what that was like for you.

1292
01:01:10.750 --> 01:01:13.048
- It was interesting because

1293
01:01:13.048 --> 01:01:15.717
after I had started therapy,

1294
01:01:16.813 --> 01:01:17.487
- [John] With me.

1295
01:01:17.487 --> 01:01:22.487
- with you and you had
suggested that we find out.

1296
01:01:23.679 --> 01:01:24.961
And you're the first person

1297
01:01:24.961 --> 01:01:26.702
who's ever even suggested that.

1298
01:01:26.702 --> 01:01:28.317
I thought that was kind of interesting.

1299
01:01:28.317 --> 01:01:29.872
And I remember waiting,

1300
01:01:29.872 --> 01:01:33.180
'cause it was almost two weeks
before I got the results,

1301
01:01:33.180 --> 01:01:36.199
trying to figure out what
results I really wanted to see.

1302
01:01:36.199 --> 01:01:37.731
Part of me wanted,

1303
01:01:37.731 --> 01:01:39.392
part of me wanted XY because

1304
01:01:39.392 --> 01:01:42.317
I felt that's just exactly
who I was. (laughs)

1305
01:01:42.317 --> 01:01:44.812
But part of me was really afraid of that.

1306
01:01:46.249 --> 01:01:48.145
I guess at that time I wasn't really

1307
01:01:49.007 --> 01:01:51.765
too conversant on issues of mosaics

1308
01:01:51.765 --> 01:01:55.468
and you know I really didn't have

1309
01:01:55.468 --> 01:01:58.094
as much information as I do now.

1310
01:02:00.065 --> 01:02:01.362
So it was really interesting,

1311
01:02:01.362 --> 01:02:03.962
and when I found out it was, that I was,

1312
01:02:03.962 --> 01:02:07.638
that I was XY and XO mosaic

1313
01:02:10.501 --> 01:02:13.377
I kinda, I went home,

1314
01:02:14.852 --> 01:02:16.772
and I thought about it.

1315
01:02:18.240 --> 01:02:21.583
In some sense it was even more
confusing to know about that

1316
01:02:21.583 --> 01:02:25.774
because you know presenting
myself as a female

1317
01:02:27.040 --> 01:02:29.088
but having chromosomes with XY,

1318
01:02:29.088 --> 01:02:32.570
it's like I think it almost
added to the confusion.

1319
01:02:32.570 --> 01:02:33.484
So it was a dichotomy.

1320
01:02:33.484 --> 01:02:36.386
Part of me was really expecting that,

1321
01:02:36.386 --> 01:02:38.163
but once I got that
information it was like,

1322
01:02:38.163 --> 01:02:39.869
well now what do I do?

1323
01:02:45.540 --> 01:02:46.840
- I think you can hear some of John Money

1324
01:02:46.840 --> 01:02:49.527
in the way this person was raised, right?

1325
01:02:49.527 --> 01:02:51.256
Learning in her 20s,

1326
01:02:51.256 --> 01:02:54.333
partway into a marriage about her history,

1327
01:02:54.333 --> 01:02:57.594
having it just be a
hernia until that point

1328
01:02:57.594 --> 01:03:01.258
to explain a lot of things that
were very confusing for her.

1329
01:03:02.992 --> 01:03:07.404
So in some, sex versus
gender, sex chromosomal.

1330
01:03:08.350 --> 01:03:11.391
Anatomic, that's about as
good as medicine can do.

1331
01:03:11.391 --> 01:03:15.028
Gender identity, intrapsychic gender.

1332
01:03:15.028 --> 01:03:16.666
You know who you are in other words.

1333
01:03:16.666 --> 01:03:19.581
Gender role, interpersonal
and sociocultural.

1334
01:03:19.581 --> 01:03:23.342
Sexual orientation, both
intrapsychic and interpersonal

1335
01:03:23.342 --> 01:03:25.142
because presumably if you have sex

1336
01:03:25.142 --> 01:03:28.054
with someone else it becomes
an interpersonal phenomenon.

1337
01:03:28.054 --> 01:03:30.353
(audience laughs)

1338
01:03:30.353 --> 01:03:32.285
We were having a conversation
earlier today about,

1339
01:03:32.285 --> 01:03:33.550
well I won't, anyway.

1340
01:03:33.550 --> 01:03:35.640
Caster Semenya (laughs)
(audience laughs)

1341
01:03:35.640 --> 01:03:37.380
in the news.

1342
01:03:39.266 --> 01:03:40.733
Female gender identity.

1343
01:03:40.733 --> 01:03:42.893
That was made very clear.

1344
01:03:42.893 --> 01:03:46.213
Male-typical childhood
behaviors also made very clear.

1345
01:03:46.213 --> 01:03:50.554
She grew up in I believe
a village in Soweto.

1346
01:03:50.554 --> 01:03:52.646
Not Soweta, in the part of Africa

1347
01:03:52.646 --> 01:03:56.605
which was an apartheid
place for African people.

1348
01:03:56.605 --> 01:03:58.794
And she grew up running barefoot

1349
01:03:59.731 --> 01:04:00.951
through her entire childhood

1350
01:04:00.951 --> 01:04:03.803
because the family couldn't afford shoes.

1351
01:04:03.803 --> 01:04:06.221
Had internal testes, we think.

1352
01:04:06.221 --> 01:04:08.159
We do not know.

1353
01:04:08.159 --> 01:04:10.539
Broad shoulders, narrow hips.

1354
01:04:10.539 --> 01:04:12.904
She has a muscular, flat chest.

1355
01:04:12.904 --> 01:04:14.168
Signifiers.

1356
01:04:15.005 --> 01:04:17.553
A baritone, gruff voice.

1357
01:04:17.553 --> 01:04:21.499
Now all of this came out in
these reports about this,

1358
01:04:21.499 --> 01:04:23.856
then in her late teens runner,

1359
01:04:23.856 --> 01:04:26.654
who had just won an international race

1360
01:04:26.654 --> 01:04:29.336
with the fastest time in the year.

1361
01:04:29.336 --> 01:04:33.852
800 meters, the fastest
time that year in the world.

1362
01:04:33.852 --> 01:04:37.671
And there are three questions
for you to think about then.

1363
01:04:37.671 --> 01:04:39.220
Is Caster a woman?

1364
01:04:40.514 --> 01:04:42.592
You don't have to vote, you
can just think about it.

1365
01:04:42.592 --> 01:04:43.451
Should she have been permitted to run

1366
01:04:43.451 --> 01:04:45.652
in the Olympics as a woman?

1367
01:04:46.841 --> 01:04:48.397
And should health insurance be expected

1368
01:04:48.397 --> 01:04:50.301
to cover treatments specific

1369
01:04:50.301 --> 01:04:52.577
to transgendered and intersex people?

1370
01:04:52.577 --> 01:04:54.120
And this last question is actually

1371
01:04:54.120 --> 01:04:55.514
more directed to the medical sttudents

1372
01:04:55.514 --> 01:04:57.440
and the residents that I teach.

1373
01:04:57.440 --> 01:04:59.031
Trying to raise some awareness about this

1374
01:04:59.031 --> 01:05:00.377
because as I've already told you,

1375
01:05:00.377 --> 01:05:03.315
I had to appeal a decision
for one of my patients

1376
01:05:03.315 --> 01:05:05.724
to get the treatment they needed.

1377
01:05:06.774 --> 01:05:09.816
So in the Olympics there's
been sex gender confusion.

1378
01:05:09.816 --> 01:05:12.509
Actually mostly only in the modern games.

1379
01:05:12.509 --> 01:05:14.715
It really wasn't a problem
in the ancient games

1380
01:05:14.715 --> 01:05:17.048
because there were no fig leaves.

1381
01:05:17.048 --> 01:05:17.918
(audience laughs)

1382
01:05:17.918 --> 01:05:19.340
And the way that you knew

1383
01:05:19.340 --> 01:05:21.743
that you were dealing with men,

1384
01:05:21.743 --> 01:05:24.586
primarily in the ancient games is because

1385
01:05:24.586 --> 01:05:27.407
they had their parts out
there for all to view.

1386
01:05:28.271 --> 01:05:29.763
Okay, I don't mean to be,

1387
01:05:29.763 --> 01:05:31.446
well, I do mean to be a
little funny about that.

1388
01:05:31.446 --> 01:05:33.814
But I permit you to laugh
on this serious topic.

1389
01:05:34.941 --> 01:05:36.573
Actually it's sort of funny.

1390
01:05:36.573 --> 01:05:38.874
In the Victoria and Albert Museum,

1391
01:05:38.874 --> 01:05:40.673
there is a picture of,

1392
01:05:40.673 --> 01:05:43.796
there's a statue not unlike David.

1393
01:05:43.796 --> 01:05:48.672
And that central fig leaf there,

1394
01:05:48.672 --> 01:05:51.110
was created in the Victorian era

1395
01:05:51.110 --> 01:05:52.851
so that when the queen came to the museum,

1396
01:05:52.851 --> 01:05:54.593
they could cover up the private parts

1397
01:05:54.593 --> 01:05:58.354
with a piece of plaster so
she would not be offended.

1398
01:05:58.354 --> 01:06:01.256
And then when the queen had
left they could remove it.

1399
01:06:01.256 --> 01:06:03.635
From what I've heard of
Victoria and Albert's sex life,

1400
01:06:03.635 --> 01:06:05.250
that was not necessary.

1401
01:06:05.250 --> 01:06:08.849
(audience laughs)

1402
01:06:08.849 --> 01:06:10.816
The modern games started in 1896.

1403
01:06:10.816 --> 01:06:12.836
Women entered the modern games in 1912.

1404
01:06:12.836 --> 01:06:14.797
And it's been a really
sad history ever since

1405
01:06:14.797 --> 01:06:17.862
of trying to establish who's
a woman and who's a man.

1406
01:06:17.862 --> 01:06:19.441
And the big concern was

1407
01:06:19.441 --> 01:06:22.517
that somehow men would fake
being women for advantage.

1408
01:06:22.517 --> 01:06:24.363
There's never been a case of a man

1409
01:06:24.363 --> 01:06:25.896
who faked being a woman for advantage

1410
01:06:25.896 --> 01:06:28.252
that has been actually proven.

1411
01:06:28.252 --> 01:06:30.840
There have been some
allegations, but no proof.

1412
01:06:31.920 --> 01:06:34.490
And the history really is very, very sad.

1413
01:06:34.490 --> 01:06:38.646
In the 1930s, you all know
who Stella and Helen are?

1414
01:06:38.646 --> 01:06:42.408
Stella and Helen were American runners.

1415
01:06:42.408 --> 01:06:46.668
And they both looked a little masculine.

1416
01:06:46.668 --> 01:06:50.429
So Helen accused Stella of being a man.

1417
01:06:50.429 --> 01:06:53.610
And at that time what happened then was

1418
01:06:53.610 --> 01:06:56.745
that you examined, and
this is still the case,

1419
01:06:56.745 --> 01:06:58.184
you have to make an accusation, and then,

1420
01:06:58.184 --> 01:07:00.146
so Stella got examined
and Stella was found

1421
01:07:00.146 --> 01:07:02.724
to in fact be a woman.

1422
01:07:02.724 --> 01:07:05.300
Well, Helen was not examined.

1423
01:07:05.300 --> 01:07:08.714
But several decades later
she died in the crossfire

1424
01:07:10.624 --> 01:07:13.079
of a bank robbery and at the autopsy

1425
01:07:13.079 --> 01:07:15.680
they found that she had
ambiguous genitalia.

1426
01:07:15.680 --> 01:07:17.479
So since I am talking to a bunch of people

1427
01:07:17.479 --> 01:07:20.300
who are therapists,
the power of projection

1428
01:07:20.300 --> 01:07:21.704
shows up quite profoundly I think

1429
01:07:21.704 --> 01:07:23.787
in the Stella versus Helen story.

1430
01:07:23.787 --> 01:07:26.887
In the 1960s women were
forced to parade nude

1431
01:07:26.887 --> 01:07:28.907
in front of judges, largely men,

1432
01:07:28.907 --> 01:07:31.089
to determine that they
had the proper parts.

1433
01:07:31.089 --> 01:07:32.587
That's sort of a modern version with women

1434
01:07:32.587 --> 01:07:34.792
of the ancient version with men

1435
01:07:34.792 --> 01:07:36.894
of if you had the right parts,

1436
01:07:36.894 --> 01:07:38.325
you were allowed to compete as a woman.

1437
01:07:38.325 --> 01:07:39.162
Or in the case of the women,

1438
01:07:39.162 --> 01:07:40.497
if you didn't have the wrong parts,

1439
01:07:40.497 --> 01:07:43.387
you were allowed to compete as a woman.

1440
01:07:43.387 --> 01:07:44.978
In the 1960s through 1990s,

1441
01:07:44.978 --> 01:07:46.638
there were a variety of lab tests.

1442
01:07:46.638 --> 01:07:47.683
And as I've already sort of hinted

1443
01:07:47.683 --> 01:07:48.937
to you with all these diagnoses,

1444
01:07:48.937 --> 01:07:51.634
lab tests are extraordinarily unreliable.

1445
01:07:51.634 --> 01:07:53.816
The sensitivity is low,
the specificity is low,

1446
01:07:53.816 --> 01:07:55.638
they're fairly worthless.

1447
01:07:55.638 --> 01:07:57.578
So we had Barr bodies,
they didn't work very well.

1448
01:07:57.578 --> 01:08:00.376
We had SRY genes, they
didn't work very well.

1449
01:08:00.376 --> 01:08:01.316
Because of this problem

1450
01:08:01.316 --> 01:08:02.918
that there were too many examples

1451
01:08:02.918 --> 01:08:04.613
of people who had missing Barr bodies,

1452
01:08:04.613 --> 01:08:06.400
or had Barr bodies that are whatever,

1453
01:08:06.400 --> 01:08:08.270
and they turned out to not have

1454
01:08:08.270 --> 01:08:10.696
the diagnosis they were supposed to have.

1455
01:08:10.696 --> 01:08:12.971
At this point, all this
has gone out the window

1456
01:08:12.971 --> 01:08:15.014
for a panel of experts.

1457
01:08:15.014 --> 01:08:18.056
And the panel of experts convenes
from multiple disciplines,

1458
01:08:18.056 --> 01:08:20.668
ranging from psychology to
anatomy to endocrinology,

1459
01:08:20.668 --> 01:08:22.838
and they all decide whether the person

1460
01:08:22.838 --> 01:08:27.157
who's been challenged is a man or a woman.

1461
01:08:27.157 --> 01:08:27.730
Do you like that?

1462
01:08:27.730 --> 01:08:29.228
Would you like to be on that panel?

1463
01:08:29.228 --> 01:08:30.191
(audience chatter)

1464
01:08:30.191 --> 01:08:32.083
Scares me.

1465
01:08:32.083 --> 01:08:33.598
So anatomy, physiology, genetics,

1466
01:08:33.598 --> 01:08:34.910
endocrinology, and psychology

1467
01:08:34.910 --> 01:08:36.570
are all represented on this panel

1468
01:08:36.570 --> 01:08:39.797
to decide that athlete's fate.

1469
01:08:39.797 --> 01:08:43.489
So, back to that question.

1470
01:08:43.489 --> 01:08:44.403
Are we looking at a man?

1471
01:08:44.403 --> 01:08:45.250
Are we looking at a woman?

1472
01:08:45.250 --> 01:08:47.965
Are we looking at a person
who's neither a man nor a woman?

1473
01:08:48.818 --> 01:08:50.669
Think about it.

1474
01:08:54.111 --> 01:08:56.230
Two more pictures of Caster.

1475
01:08:57.176 --> 01:09:00.380
Again, on the left,

1476
01:09:00.380 --> 01:09:03.161
that picture is from the time
when she won that world race.

1477
01:09:04.639 --> 01:09:08.697
And after she was accused of
being a man by her colleagues,

1478
01:09:08.697 --> 01:09:11.239
she went home to South Africa,

1479
01:09:11.239 --> 01:09:12.539
which was determined to prove to the world

1480
01:09:12.539 --> 01:09:14.177
that she was actually a woman.

1481
01:09:14.177 --> 01:09:15.791
So for the first time in her life,

1482
01:09:15.791 --> 01:09:17.033
she was dressed up in a dress,

1483
01:09:17.033 --> 01:09:18.054
makeup was put on her face,

1484
01:09:18.054 --> 01:09:19.157
and she was put in high heels,

1485
01:09:19.157 --> 01:09:20.875
which hurt her feet very much.

1486
01:09:20.875 --> 01:09:22.350
Put on the cover of a magazine

1487
01:09:22.350 --> 01:09:24.555
as sort of a glam person,

1488
01:09:24.555 --> 01:09:27.283
to sort of prove that
she really was a woman.

1489
01:09:28.500 --> 01:09:29.517
I don't know quite what to think of this,

1490
01:09:29.517 --> 01:09:31.932
except I think it's fairly appalling.

1491
01:09:31.932 --> 01:09:33.290
But it's right there with the gay Mormons

1492
01:09:33.290 --> 01:09:36.354
and the people with one
strap gowns at the bottom.

1493
01:09:37.191 --> 01:09:38.954
So what's your assessment?

1494
01:09:40.091 --> 01:09:41.026
What are you thinking?

1495
01:09:41.026 --> 01:09:42.431
Again, I won't take a poll,

1496
01:09:42.431 --> 01:09:46.516
but this was quite a
challenging situation.

1497
01:09:47.434 --> 01:09:48.889
Oh, my daughter added that.

1498
01:09:48.889 --> 01:09:50.328
(audience laughs)

1499
01:09:50.328 --> 01:09:53.347
My daughter is very clever
with things that I can't do.

1500
01:09:53.347 --> 01:09:54.543
Now I put this picture up here

1501
01:09:54.543 --> 01:09:56.203
because one of these women is the one

1502
01:09:56.203 --> 01:09:59.407
who accused Caster Semenya of being a man.

1503
01:09:59.407 --> 01:10:03.365
And to my eye, they all
look fairly gender atypical.

1504
01:10:03.365 --> 01:10:06.449
I mean, it's sorta the
kettle calling the pot black.

1505
01:10:06.449 --> 01:10:07.306
I think.

1506
01:10:07.306 --> 01:10:08.072
I don't know if you'd agree,

1507
01:10:08.072 --> 01:10:09.953
but I think that these women

1508
01:10:09.953 --> 01:10:12.797
have remarkable muscular definition.

1509
01:10:12.797 --> 01:10:16.145
Remarkably low measures of body fat.

1510
01:10:16.145 --> 01:10:19.186
And are remarkably slender.

1511
01:10:19.186 --> 01:10:23.145
Interesting that she was selected out.

1512
01:10:23.145 --> 01:10:24.166
You might also wonder, of course,

1513
01:10:24.166 --> 01:10:27.574
about the racial issues
involved with that.

1514
01:10:28.880 --> 01:10:31.220
So a woman among woman, or what?

1515
01:10:32.198 --> 01:10:33.930
Now again, I think in
the culture right now

1516
01:10:33.930 --> 01:10:35.509
there's really a great confusion

1517
01:10:35.509 --> 01:10:38.168
about what a man looks like
and what a woman looks like.

1518
01:10:38.168 --> 01:10:39.549
Maybe that's a good thing.

1519
01:10:39.549 --> 01:10:41.151
But you just pick up any,

1520
01:10:41.151 --> 01:10:42.533
you go to the airport and
pick up all these magazines,

1521
01:10:42.533 --> 01:10:43.914
and everybody's got six packs.

1522
01:10:43.914 --> 01:10:45.249
Men, women, whatever.

1523
01:10:45.249 --> 01:10:48.430
I guess the bikini means the
person on the right is a woman.

1524
01:10:48.430 --> 01:10:49.707
And the fact that the person on the left

1525
01:10:49.707 --> 01:10:51.796
doesn't have a bikini means they're a man.

1526
01:10:51.796 --> 01:10:53.132
(audience laughs)

1527
01:10:53.132 --> 01:10:56.702
If you have a better strategy,
let me know. (laughs)

1528
01:10:58.449 --> 01:11:00.956
This is LeAnn Rimes, the singer.

1529
01:11:00.956 --> 01:11:03.173
How working out saved her.

1530
01:11:03.173 --> 01:11:05.355
She's since gone on to
talk about her depression,

1531
01:11:05.355 --> 01:11:07.411
but here she had very impressive

1532
01:11:07.411 --> 01:11:10.644
muscular development as a woman.

1533
01:11:12.274 --> 01:11:15.059
So, which is the real Caster Semenya?

1534
01:11:16.152 --> 01:11:17.166
These two pictures are up there.

1535
01:11:17.166 --> 01:11:18.269
I think I've tried to make the case

1536
01:11:18.269 --> 01:11:21.240
that the person on the left
is the real Caster Semenya.

1537
01:11:21.240 --> 01:11:22.761
And the person on the right is an attempt

1538
01:11:22.761 --> 01:11:26.545
to pander to societal,
sociocultural stereotypes.

1539
01:11:27.432 --> 01:11:30.717
And maybe Caster Semenya
does like dressing that way,

1540
01:11:30.717 --> 01:11:32.737
but it is ironic that
she didn't have to do it

1541
01:11:32.737 --> 01:11:35.531
until she became a world figure.

1542
01:11:37.312 --> 01:11:38.647
South Africa was very much determined

1543
01:11:38.647 --> 01:11:42.200
to have her be allowed to run as a woman.

1544
01:11:42.200 --> 01:11:44.847
Now, by the way,

1545
01:11:45.926 --> 01:11:47.035
the end of the story was

1546
01:11:47.035 --> 01:11:48.719
that after I think
something like 10 months,

1547
01:11:48.719 --> 01:11:52.399
that panel of experts decided
she was in fact a woman.

1548
01:11:52.399 --> 01:11:54.500
They didn't tell anybody
why she was a woman.

1549
01:11:54.500 --> 01:11:56.715
Which is actually very
good for her privacy,

1550
01:11:56.715 --> 01:11:59.493
but which is not very
good for our education.

1551
01:11:59.493 --> 01:12:01.901
And she went on in the 2012 Olympics

1552
01:12:01.901 --> 01:12:05.116
to earn a silver medal
in the 800 meter race.

1553
01:12:05.116 --> 01:12:08.541
So one of those people who was a woman,

1554
01:12:08.541 --> 01:12:11.515
but not challenged, beat
her, for what that's worth.

1555
01:12:11.515 --> 01:12:14.812
And by the way, that time
that she had was remarkable,

1556
01:12:14.812 --> 01:12:17.691
but it was not by any means
the lowest ever for a woman.

1557
01:12:17.691 --> 01:12:19.235
So once again you've got to wonder

1558
01:12:19.235 --> 01:12:21.358
about why she was singled out.

1559
01:12:22.311 --> 01:12:25.314
So we have a final clip from my patient.

1560
01:12:26.352 --> 01:12:28.120
How could your parents
have done it differently

1561
01:12:28.120 --> 01:12:31.928
if they had told you
earlier that, about this,

1562
01:12:31.928 --> 01:12:35.277
what would that have freed
you up to be here to do?

1563
01:12:36.223 --> 01:12:39.625
- Well, I've done a lot of reading,

1564
01:12:39.625 --> 01:12:44.060
and I know that a lot
of people advocate now

1565
01:12:44.060 --> 01:12:48.868
to take children and if possible

1566
01:12:49.929 --> 01:12:53.721
let them interact with
other intersexed children,

1567
01:12:53.721 --> 01:12:56.497
or at least get them into

1568
01:12:56.497 --> 01:12:59.318
some kind of a counseling situation.

1569
01:12:59.318 --> 01:13:02.161
Obviously a young child can't necessarily

1570
01:13:02.161 --> 01:13:04.503
understand the issues of intersex,

1571
01:13:04.503 --> 01:13:09.427
but to help them at least feel
positive about who they are.

1572
01:13:11.944 --> 01:13:13.833
It would have been a really nice thing

1573
01:13:13.833 --> 01:13:16.337
if my parents would have done that.

1574
01:13:16.337 --> 01:13:20.934
As a child I was dragged
to the doctor frequently

1575
01:13:20.934 --> 01:13:24.208
for what I can only tell was deciding

1576
01:13:24.208 --> 01:13:27.134
how my bone growth rate was going.

1577
01:13:27.134 --> 01:13:28.527
But here I was a little child,

1578
01:13:28.527 --> 01:13:30.474
I'd be taken into these
huge conference rooms

1579
01:13:30.474 --> 01:13:33.178
with all these doctors
in their white coats,

1580
01:13:33.178 --> 01:13:34.931
and no one told me anything.

1581
01:13:34.931 --> 01:13:37.752
They'd just kinda look at
me and measure my wrist,

1582
01:13:37.752 --> 01:13:40.625
and then I'd be taken out again.

1583
01:13:40.625 --> 01:13:44.261
It was like, that was
really scary as a child.

1584
01:13:44.261 --> 01:13:46.698
And no explanation whatsoever.

1585
01:13:46.698 --> 01:13:51.488
And I never asked the questions either.

1586
01:13:54.836 --> 01:13:56.322
- [John] Well, how could
a person in your situation

1587
01:13:56.322 --> 01:13:57.877
know what questions to ask?

1588
01:13:58.919 --> 01:14:00.251
Is that even possible?

1589
01:14:00.251 --> 01:14:03.261
- I think that's a good point because

1590
01:14:04.465 --> 01:14:06.412
you have nothing to base it on.

1591
01:14:06.412 --> 01:14:08.154
You have nothing to base.

1592
01:14:08.154 --> 01:14:13.053
You know if, without
intervention of a professional,

1593
01:14:13.053 --> 01:14:17.877
I would not have known what
questions to ask at all.

1594
01:14:19.867 --> 01:14:22.671
- [John] So at this point,
what are the questions to ask?

1595
01:14:25.405 --> 01:14:27.617
- That's a good question. (laughs)

1596
01:14:31.441 --> 01:14:32.852
I guess

1597
01:14:37.048 --> 01:14:40.044
the questions that I have is basically

1598
01:14:40.044 --> 01:14:44.201
how to fit into the world that I live in.

1599
01:14:45.287 --> 01:14:46.969
The people I come in contact every day

1600
01:14:46.969 --> 01:14:49.679
know nothing about intersexuality.

1601
01:14:50.950 --> 01:14:53.558
If I were to come on
and say, "I'm intersex,"

1602
01:14:53.558 --> 01:14:55.625
they'd probably look at me like, what?

1603
01:14:55.625 --> 01:14:58.167
Or use the term hermaphrodite.

1604
01:14:58.167 --> 01:14:59.769
You know.

1605
01:14:59.769 --> 01:15:02.045
I think their interpretation
of hermaphrodite

1606
01:15:02.045 --> 01:15:05.469
is somebody that's got a
six inch penis and a vagina,

1607
01:15:05.469 --> 01:15:07.130
and can have sex with themselves.

1608
01:15:07.130 --> 01:15:08.244
(audience laughs)

1609
01:15:08.244 --> 01:15:09.663
You know, I don't think that they

1610
01:15:10.588 --> 01:15:15.285
understand exactly what
it means to be intersex.

1611
01:15:15.285 --> 01:15:19.754
To have part of you look one way,

1612
01:15:19.754 --> 01:15:24.226
and yet for me, my
brains works another way.

1613
01:15:25.188 --> 01:15:27.043
It's quite difficult.

1614
01:15:27.043 --> 01:15:29.243
- So I will intend it to end with the idea

1615
01:15:29.243 --> 01:15:33.417
that it, in fact, is quite
difficult, challenging.

1616
01:15:34.490 --> 01:15:36.591
So I'm not sure what's
supposed to happen now.

1617
01:15:36.591 --> 01:15:38.971
- [Voiceover] Take some
questions for a bit?

1618
01:15:38.971 --> 01:15:40.123
- Okay.

1619
01:15:41.041 --> 01:15:42.164
- [Voiceover] You could clap now.

1620
01:15:42.164 --> 01:15:46.953
(applause)

1621
01:15:53.158 --> 01:15:55.515
- You can see why he's
a Day-Garrett professor.

1622
01:15:55.515 --> 01:15:56.803
(audience laughs)

1623
01:15:56.803 --> 01:15:57.720
- [Voiceover] Thanks.

1624
01:15:57.720 --> 01:15:58.994
- You're welcome.

1625
01:15:58.994 --> 01:16:00.707
I welcome any questions.

1626
01:16:06.504 --> 01:16:11.026
(audience member mutters)

1627
01:16:22.374 --> 01:16:23.829
Well, actually that's a great question,

1628
01:16:23.829 --> 01:16:24.909
and I can give you an example

1629
01:16:24.909 --> 01:16:28.781
that is really quite challenging.

1630
01:16:31.069 --> 01:16:34.236
A person who has manic
depressive illness in his 20s,

1631
01:16:34.236 --> 01:16:38.509
who is Somalian, in my community,

1632
01:16:39.480 --> 01:16:40.723
speaks four languages because

1633
01:16:40.723 --> 01:16:45.723
of the multiple relocations
that went on in his childhood.

1634
01:16:46.951 --> 01:16:49.947
Ends up in the U.S. with
bad bipolar illness.

1635
01:16:49.947 --> 01:16:52.596
Three hospitalizations
in the last six months,

1636
01:16:52.596 --> 01:16:54.139
and I'm asked to comment

1637
01:16:54.139 --> 01:16:58.012
on whether this person is transgendered.

1638
01:16:59.038 --> 01:17:01.082
Now as I talk with him,

1639
01:17:01.082 --> 01:17:04.059
they are living in a community that,

1640
01:17:06.011 --> 01:17:07.858
a small town with a
small Muslim community,

1641
01:17:07.858 --> 01:17:11.433
with a very, very conservative mullah,

1642
01:17:11.433 --> 01:17:13.314
who has absolutely condemned

1643
01:17:13.314 --> 01:17:15.656
anything related to homosexuality.

1644
01:17:16.702 --> 01:17:19.806
So this person is being
abused in their community

1645
01:17:19.806 --> 01:17:23.242
by other men of the community
for being different.

1646
01:17:23.242 --> 01:17:26.167
They have found their
way as a cosmetologist,

1647
01:17:26.167 --> 01:17:29.024
and are allowed, up to a
point, to interact with women

1648
01:17:29.024 --> 01:17:30.927
doing their hair, doing
their makeup and such,

1649
01:17:30.927 --> 01:17:32.726
but at some point it becomes uncomfortable

1650
01:17:32.726 --> 01:17:35.281
because they're a man.

1651
01:17:35.281 --> 01:17:38.659
They come wanting, they've been suicidal

1652
01:17:38.659 --> 01:17:41.457
and psychotic three times
in the last six months,

1653
01:17:41.457 --> 01:17:46.077
to talk about having
surgery to become a woman.

1654
01:17:46.077 --> 01:17:49.061
Now complicating matters
further of course,

1655
01:17:49.061 --> 01:17:51.696
is in Iran right now
it's not okay to be gay,

1656
01:17:51.696 --> 01:17:54.842
but it is okay to be transsexual.

1657
01:17:54.842 --> 01:17:56.456
That is you can have an operation

1658
01:17:56.456 --> 01:17:58.359
if you're a gay man to become a woman

1659
01:17:58.359 --> 01:18:00.658
because that's believed to be a disease,

1660
01:18:00.658 --> 01:18:04.257
but homosexuality is believed to be a sin.

1661
01:18:04.257 --> 01:18:09.132
So there's an example of a
very complicated mix of things.

1662
01:18:09.132 --> 01:18:12.386
What I said was you have
to get your bipolar illness

1663
01:18:12.386 --> 01:18:13.907
under control because this person

1664
01:18:13.907 --> 01:18:16.031
was not compliant with care

1665
01:18:16.031 --> 01:18:18.504
before we can even
begin to deal with this.

1666
01:18:18.504 --> 01:18:21.309
And we have to be able to talk about

1667
01:18:21.309 --> 01:18:23.150
whether the issue here is that you are

1668
01:18:23.150 --> 01:18:24.810
completely unaccepted by your culture

1669
01:18:24.810 --> 01:18:27.155
and feel condemned by Allah,

1670
01:18:27.155 --> 01:18:29.897
or whether you really are in fact

1671
01:18:29.897 --> 01:18:33.693
someone who is a woman
born in a man's body.

1672
01:18:34.676 --> 01:18:37.055
So there's an example that I think

1673
01:18:37.055 --> 01:18:39.493
cuts across many of the
things we've talked about,

1674
01:18:39.493 --> 01:18:41.607
and illustrates how challenging it is

1675
01:18:41.607 --> 01:18:44.555
to come up with an answer.

1676
01:18:44.555 --> 01:18:47.446
Partly as well because depending on

1677
01:18:47.446 --> 01:18:49.372
which culture you're dealing with,

1678
01:18:49.372 --> 01:18:51.370
attitudes about masculinity and femininity

1679
01:18:51.370 --> 01:18:53.273
are more or less fluid.

1680
01:18:53.273 --> 01:18:55.752
And things can happen to you because

1681
01:18:56.651 --> 01:18:57.708
you're in the wrong culture.

1682
01:18:57.708 --> 01:19:02.169
In this case, in African, Islamic culture,

1683
01:19:03.540 --> 01:19:05.440
transplanted to the U.S.

1684
01:19:06.560 --> 01:19:08.436
I don't know if that's a,
that's like, kinda like,

1685
01:19:08.436 --> 01:19:11.051
it gives you an idea of
the complexity, yeah.

1686
01:19:13.172 --> 01:19:15.114
Other questions?

1687
01:19:17.649 --> 01:19:19.821
Have I stunned you all into silence?

1688
01:19:19.821 --> 01:19:21.498
(audience laughs)
Ma'am?

1689
01:19:21.498 --> 01:19:23.384
- [Voiceover] How is your
client in that video?

1690
01:19:23.384 --> 01:19:24.739
- My client now.

1691
01:19:25.748 --> 01:19:27.948
My client now interestingly ended up

1692
01:19:27.948 --> 01:19:32.034
in this very small,
fundamentalist Christian church,

1693
01:19:32.034 --> 01:19:35.030
in which the pastor said, "I
don't know what to do with you.

1694
01:19:35.030 --> 01:19:36.945
"The scripture does not advise us.

1695
01:19:36.945 --> 01:19:38.663
"You can either be a celibate for God,

1696
01:19:38.663 --> 01:19:40.823
"or you can marry a man."

1697
01:19:40.823 --> 01:19:42.785
Which wasn't a very good answer.

1698
01:19:44.101 --> 01:19:45.422
What my patient decided to do

1699
01:19:45.422 --> 01:19:49.263
was actually to take her
90-year-old mother in

1700
01:19:49.263 --> 01:19:52.062
and help her in her waning years.

1701
01:19:52.062 --> 01:19:54.500
And decided for now to be celibate.

1702
01:19:54.500 --> 01:19:57.402
But because of her Christian beliefs,

1703
01:19:57.402 --> 01:20:00.536
but also because she
at least now understood

1704
01:20:00.536 --> 01:20:04.402
why she felt so confused and
no longer feels confused.

1705
01:20:04.402 --> 01:20:06.677
That is she has now adopted an identity

1706
01:20:06.677 --> 01:20:10.821
as an intersexed person with
a mosaic set of chromosomes

1707
01:20:10.821 --> 01:20:14.256
that explain this sense of
discordancy inside of herself.

1708
01:20:15.370 --> 01:20:17.849
Again, not somebody I could
ever have found to be crazy,

1709
01:20:17.849 --> 01:20:20.565
although I did treat her with Sertraline

1710
01:20:20.565 --> 01:20:23.915
for her depression (laughs), which helped.

1711
01:20:26.370 --> 01:20:27.426
I want to emphasize too,

1712
01:20:27.426 --> 01:20:29.272
I've probably treated about 25 people,

1713
01:20:29.272 --> 01:20:32.767
which makes me some kind of
national expert at least.

1714
01:20:32.767 --> 01:20:33.927
It's a little bit astounding really,

1715
01:20:33.927 --> 01:20:35.704
but I think the challenge

1716
01:20:35.704 --> 01:20:37.886
with working with folks who present

1717
01:20:37.886 --> 01:20:40.846
with these sorts of issues is listening.

1718
01:20:40.846 --> 01:20:42.588
And trying to help with a narrative,

1719
01:20:42.588 --> 01:20:46.383
and a story, and a solution
that will work for them.

1720
01:20:47.652 --> 01:20:48.730
I don't have an answer to each

1721
01:20:48.730 --> 01:20:51.006
one of these questions at all.

1722
01:20:51.006 --> 01:20:53.629
It's varying, with younger
kids now it's much easier

1723
01:20:53.629 --> 01:20:58.065
because they're not so self-hating.

1724
01:20:58.065 --> 01:21:00.786
Although I did just see
a patient this week,

1725
01:21:02.176 --> 01:21:04.218
a married man with a child

1726
01:21:04.218 --> 01:21:05.901
who has made the transition on the

1727
01:21:05.901 --> 01:21:07.980
4th of July of this year.

1728
01:21:07.980 --> 01:21:09.919
And nothing happened.

1729
01:21:09.919 --> 01:21:11.834
Nobody got upset, nobody got excited.

1730
01:21:11.834 --> 01:21:13.261
They just accepted this person

1731
01:21:13.261 --> 01:21:16.082
as the woman that he is, she is.

1732
01:21:16.082 --> 01:21:17.534
And so she came to see me

1733
01:21:17.534 --> 01:21:20.041
to talk about how much she hates herself

1734
01:21:20.041 --> 01:21:22.491
for being the way that she is.

1735
01:21:22.491 --> 01:21:24.256
So (laughs) you know, the issues change.

1736
01:21:24.256 --> 01:21:25.834
And what she said was, "I've been so busy

1737
01:21:25.834 --> 01:21:28.574
"making the transition
that I didn't have to face

1738
01:21:28.574 --> 01:21:29.990
"the part of me that really hates

1739
01:21:29.990 --> 01:21:31.651
"what I'm putting my family through,

1740
01:21:31.651 --> 01:21:34.158
"and hates that I'm not normal."

1741
01:21:34.158 --> 01:21:35.957
So the work is moving on now to,

1742
01:21:35.957 --> 01:21:37.397
I'm actually gonna put this person

1743
01:21:37.397 --> 01:21:39.417
into a group, a mixed group.

1744
01:21:39.417 --> 01:21:40.798
I've treated several people now

1745
01:21:40.798 --> 01:21:42.040
in Rochester, Minnesota,

1746
01:21:42.040 --> 01:21:45.646
where we do not have a
transgendered community of any size.

1747
01:21:47.569 --> 01:21:48.678
By putting them into my regular group,

1748
01:21:48.678 --> 01:21:51.765
where people actually
tell them they're okay.

1749
01:21:51.765 --> 01:21:53.959
And so then that seems to really help.

1750
01:21:55.040 --> 01:21:57.001
People you wouldn't expect, by the way.

1751
01:21:59.054 --> 01:22:00.300
- [Voiceover] Could you
explain a little bit more

1752
01:22:00.300 --> 01:22:03.295
about moving forward, how different

1753
01:22:03.295 --> 01:22:06.394
ethnic organizations are going to be doing

1754
01:22:06.394 --> 01:22:08.832
groups with people and certain,

1755
01:22:08.832 --> 01:22:10.597
Caster Semenya (mutters),

1756
01:22:10.597 --> 01:22:12.303
only time this is going to happen

1757
01:22:12.303 --> 01:22:15.275
with the Olympic Committee (mutters)

1758
01:22:15.275 --> 01:22:17.663
inclusion for (mutters).

1759
01:22:17.663 --> 01:22:20.426
- Well, it's a great question.

1760
01:22:20.426 --> 01:22:21.343
My understanding of where we are

1761
01:22:21.343 --> 01:22:22.968
is with that panel of experts

1762
01:22:22.968 --> 01:22:25.487
who will consider each case individually.

1763
01:22:25.487 --> 01:22:27.705
The standard, there have been Olympics

1764
01:22:27.705 --> 01:22:30.108
in which they've tested
everybody, all the women,

1765
01:22:30.108 --> 01:22:32.546
and found any number of people,

1766
01:22:32.546 --> 01:22:35.447
a dozen or more who had
chromosomal abnormalities,

1767
01:22:35.447 --> 01:22:37.526
but nobody suspected them.

1768
01:22:37.526 --> 01:22:39.977
There was a famous runner in the 1980s,

1769
01:22:41.491 --> 01:22:43.230
Jo-La Perez who turned out,

1770
01:22:43.230 --> 01:22:45.134
when she was accused to be a complete

1771
01:22:45.134 --> 01:22:47.315
androgen insensitivity, XY chromosomes.

1772
01:22:47.315 --> 01:22:50.334
It ruined her life, it
ruined her marriage.

1773
01:22:50.334 --> 01:22:51.646
It ruined everything.

1774
01:22:51.646 --> 01:22:53.666
At this point it's about
you accuse somebody,

1775
01:22:53.666 --> 01:22:57.010
and they get investigated.

1776
01:22:57.010 --> 01:22:58.275
It's not a great standard.

1777
01:22:58.275 --> 01:23:00.190
Obviously it's not a great standard.

1778
01:23:00.190 --> 01:23:01.491
In the case of Caster Semenya,

1779
01:23:01.491 --> 01:23:04.091
they did come up with
I think a good answer.

1780
01:23:04.091 --> 01:23:05.275
But there's a whole lot of fussing

1781
01:23:05.275 --> 01:23:07.249
and bothering about your
testosterone levels.

1782
01:23:07.249 --> 01:23:09.187
And what that means,
and as I've pointed out,

1783
01:23:09.187 --> 01:23:11.253
you can have a testosterone
level of a million,

1784
01:23:11.253 --> 01:23:12.508
but the receptors don't respond.

1785
01:23:12.508 --> 01:23:14.365
That doesn't do anything.

1786
01:23:14.365 --> 01:23:16.914
So we don't really have a
good standard, we don't.

1787
01:23:18.354 --> 01:23:20.688
And really, it really is a witch hunt.

1788
01:23:20.688 --> 01:23:22.384
You point out that somebody looks strange,

1789
01:23:22.384 --> 01:23:23.962
and then they get investigated.

1790
01:23:23.962 --> 01:23:26.540
And maybe they get taken
off the circuit for a while,

1791
01:23:26.540 --> 01:23:30.989
while a bunch of experts secretly
sort out what's going on.

1792
01:23:30.989 --> 01:23:33.605
And that's why I made the
comment that I think for her,

1793
01:23:33.605 --> 01:23:35.010
it would be nice to know what they decided

1794
01:23:35.010 --> 01:23:37.483
because it would help
to set some precedent.

1795
01:23:37.483 --> 01:23:40.248
But for her privacy they didn't do that.

1796
01:23:40.248 --> 01:23:42.752
So we really don't know what
she has, or what she is,

1797
01:23:42.752 --> 01:23:45.328
or what they came up
with for an explanation

1798
01:23:45.328 --> 01:23:49.082
for this very gender
atypical presentation.

1799
01:23:50.203 --> 01:23:52.126
So the answer really is
that there is no standard

1800
01:23:52.126 --> 01:23:54.610
right now other than
this panel of experts.

1801
01:23:54.610 --> 01:23:56.908
And I can tell you the
state of the science is such

1802
01:23:56.908 --> 01:24:00.229
that there really isn't
an obvious conclusion

1803
01:24:00.229 --> 01:24:02.457
that I think we could draw.

1804
01:24:04.570 --> 01:24:07.268
One other thing I probably, uh-huh, sure?

1805
01:24:07.268 --> 01:24:08.371
- [Voiceover] Can I ask with regard to

1806
01:24:08.371 --> 01:24:11.721
like your earlier point about a child

1807
01:24:11.721 --> 01:24:16.422
making the decision
about identity (mutters).

1808
01:24:16.422 --> 01:24:19.901
Is there actually a clinical
medical guideline involved?

1809
01:24:20.852 --> 01:24:22.965
- Well, I think there is
increasingly consensus

1810
01:24:22.965 --> 01:24:25.031
that you should not do
anything irrevocable

1811
01:24:25.031 --> 01:24:29.722
with a child until basically
they're, almost an adult.

1812
01:24:29.722 --> 01:24:31.978
There are many examples
of gender atypical boys,

1813
01:24:31.978 --> 01:24:36.412
for example, who may go so
far as to present as girls,

1814
01:24:36.412 --> 01:24:39.593
but then in adult
adolescence cast that off

1815
01:24:39.593 --> 01:24:41.922
and decide to present as men.

1816
01:24:44.175 --> 01:24:45.077
I think where we are right now

1817
01:24:45.077 --> 01:24:48.560
is let the child express
themself as they are,

1818
01:24:48.560 --> 01:24:51.555
but see if that identity
that they've adopted

1819
01:24:51.555 --> 01:24:54.723
is in fact going to be a
permanent identity or not.

1820
01:24:55.758 --> 01:24:57.011
There's a woman named Dianne Berg

1821
01:24:57.011 --> 01:24:58.355
at the University of Minnesota,

1822
01:24:58.355 --> 01:25:01.663
which has a very important
human sexuality center,

1823
01:25:01.663 --> 01:25:05.553
who works almost exclusively with children

1824
01:25:05.553 --> 01:25:06.876
who are gender atypical.

1825
01:25:06.876 --> 01:25:10.254
And again, trying to minimize the damage,

1826
01:25:10.254 --> 01:25:12.459
which this person spoke about.

1827
01:25:12.459 --> 01:25:13.958
That nobody told her anything.

1828
01:25:13.958 --> 01:25:15.235
Nobody exposed her to anything.

1829
01:25:15.235 --> 01:25:17.161
Nobody discussed anything.

1830
01:25:17.161 --> 01:25:18.799
But to not do anything irrevocable

1831
01:25:18.799 --> 01:25:21.736
until the child is ready
essentially as an adult

1832
01:25:21.736 --> 01:25:25.915
with capacity to make that
decision for themselves.

1833
01:25:25.915 --> 01:25:28.318
And again, if you read the popular press,

1834
01:25:28.318 --> 01:25:30.291
there was an article in
People magazine two weeks ago

1835
01:25:30.291 --> 01:25:34.359
about a 12 year old who is
well on her way to surgery.

1836
01:25:35.288 --> 01:25:36.852
But there are other examples

1837
01:25:38.016 --> 01:25:40.670
of children who present as
girls for a long period of time

1838
01:25:40.670 --> 01:25:43.349
and then decide, I mean
perhaps to be a gay man,

1839
01:25:43.349 --> 01:25:46.641
or to be just a man, but often a gay man.

1840
01:25:46.641 --> 01:25:49.183
A book by, written 25 years ago,

1841
01:25:49.183 --> 01:25:50.982
called The Sissy Boy Syndrome,

1842
01:25:50.982 --> 01:25:52.956
speaks to some of this
from a different era,

1843
01:25:52.956 --> 01:25:55.852
by Richard Green, might
be worth looking at.

1844
01:25:55.852 --> 01:25:57.326
But I think right now let's do no harm

1845
01:25:57.326 --> 01:26:00.449
by not doing anything like

1846
01:26:00.449 --> 01:26:04.264
fashioning genitals that
you want this child to have.

1847
01:26:04.264 --> 01:26:07.198
And focusing much more on their
interpersonal development,

1848
01:26:07.198 --> 01:26:10.146
on their brain, than on their parts.

1849
01:26:10.146 --> 01:26:11.342
You know, it seems to be a particular

1850
01:26:11.342 --> 01:26:15.382
American preoccupation with
having the right parts.

1851
01:26:15.382 --> 01:26:16.512
The bigger the better if you're a man,

1852
01:26:16.512 --> 01:26:19.867
and I don't know, you
know I'm going with that.

1853
01:26:19.867 --> 01:26:20.795
(audience laughs)

1854
01:26:20.795 --> 01:26:21.654
And in fact, ironically,

1855
01:26:21.654 --> 01:26:23.755
just because I think
this story is amusing,

1856
01:26:23.755 --> 01:26:25.265
the person I showed you
at the very beginning,

1857
01:26:25.265 --> 01:26:27.633
my very first patient, did go to Canada

1858
01:26:27.633 --> 01:26:31.952
and did have gender reassignment surgery.

1859
01:26:31.952 --> 01:26:34.610
And come back and said, "Yes,
it went very, very well.

1860
01:26:34.610 --> 01:26:36.027
"They had a lot of tissue to work with

1861
01:26:36.027 --> 01:26:38.318
"because I was really big as a man."

1862
01:26:38.318 --> 01:26:39.433
Which I thought was very funny

1863
01:26:39.433 --> 01:26:41.093
because here was a woman (laughs)

1864
01:26:41.093 --> 01:26:43.612
coming and bragging like a guy might.

1865
01:26:43.612 --> 01:26:45.771
You know, some of that
gender bending was going on.

1866
01:26:45.771 --> 01:26:46.379
(audience laughs)

1867
01:26:46.379 --> 01:26:48.143
And in fact, apparently it
was a very successful surgery

1868
01:26:48.143 --> 01:26:49.456
for the very fact that there was

1869
01:26:49.456 --> 01:26:51.150
a lot of tissue to work with.

1870
01:26:52.241 --> 01:26:54.278
(laughter)

1871
01:26:54.278 --> 01:26:56.855
And I hope it's okay to enjoy what I do

1872
01:26:56.855 --> 01:26:59.653
because the stories are
so amazing. (laughs)

1873
01:26:59.653 --> 01:27:01.591
I mean I try to hear them with humility

1874
01:27:01.591 --> 01:27:05.356
and with interest and that
seems to work pretty well.

1875
01:27:06.293 --> 01:27:07.210
Um-hmm?

1876
01:27:08.376 --> 01:27:10.431
- [Voiceover] Thank you.

1877
01:27:10.431 --> 01:27:12.439
I feel that you've moved on the one end

1878
01:27:12.439 --> 01:27:14.111
to the questions that are coming

1879
01:27:14.111 --> 01:27:17.038
(mutters) what Caster is (mutters)

1880
01:27:17.038 --> 01:27:20.532
and I (mutters).

1881
01:27:20.532 --> 01:27:21.663
I don't know what (mutters).

1882
01:27:21.663 --> 01:27:24.806
If she prefers or what program you prefer,

1883
01:27:24.806 --> 01:27:26.919
but you know, for me
the answer is very clear

1884
01:27:26.919 --> 01:27:31.218
that she is whatever (muttters),

1885
01:27:31.218 --> 01:27:33.407
and I think that that's really (mutters).

1886
01:27:33.407 --> 01:27:34.173
That's something that I thought

1887
01:27:34.173 --> 01:27:36.054
maybe I wanted you to say in response

1888
01:27:36.054 --> 01:27:38.829
(mutters) and with that,

1889
01:27:38.829 --> 01:27:42.973
I'm wondering, given that you've prevented

1890
01:27:42.973 --> 01:27:46.409
some bias (mutters) you're coming from has

1891
01:27:46.409 --> 01:27:48.870
in your own area and a male psychiatrist

1892
01:27:48.870 --> 01:27:51.912
and how you would answer those

1893
01:27:51.912 --> 01:27:55.905
particular identity (mutters).

1894
01:27:55.905 --> 01:27:58.616
That while sort of the scientific world

1895
01:27:58.616 --> 01:28:03.155
as you presented doesn't
have a good answer,

1896
01:28:03.155 --> 01:28:04.865
or a (mutters) answer,

1897
01:28:04.865 --> 01:28:06.502
where we also know that

1898
01:28:06.502 --> 01:28:08.105
the implications of (mutters)

1899
01:28:08.105 --> 01:28:10.639
and you'll get answers
within your (mutters)

1900
01:28:10.639 --> 01:28:14.567
and have (mutters)

1901
01:28:14.567 --> 01:28:15.654
who are gender variant

1902
01:28:15.654 --> 01:28:17.256
and who have (mutters)

1903
01:28:17.256 --> 01:28:19.415
expressing their identity and hearing it,

1904
01:28:19.415 --> 01:28:23.095
and so I'd ask if you could talk about

1905
01:28:23.095 --> 01:28:24.558
in understanding that this is

1906
01:28:24.558 --> 01:28:28.377
a sociocultural and socially
constructed phenomenon,

1907
01:28:28.377 --> 01:28:31.441
how do you in concrete
steps in your practice

1908
01:28:31.441 --> 01:28:34.181
work towards humanizing the individuals

1909
01:28:34.181 --> 01:28:35.121
that you are working with,

1910
01:28:35.121 --> 01:28:38.233
and whatever way that
they have to (mutters)

1911
01:28:38.233 --> 01:28:41.163
And so if there are some suggestions

1912
01:28:41.163 --> 01:28:44.936
for (mutters) and do you
ask all of your clients

1913
01:28:44.936 --> 01:28:48.199
(mutters), you know, what pronoun

1914
01:28:48.199 --> 01:28:50.487
are you supposed to use?

1915
01:28:53.188 --> 01:28:54.433
- I do.

1916
01:28:55.525 --> 01:28:57.564
Maybe I shouldn't say that quite...

1917
01:28:59.151 --> 01:29:01.138
I try to listen for gender variance,

1918
01:29:01.138 --> 01:29:03.901
and then to react or respond to it.

1919
01:29:03.901 --> 01:29:06.339
I try to, I let people know that they have

1920
01:29:06.339 --> 01:29:08.660
to help me understand
because I really don't

1921
01:29:08.660 --> 01:29:11.072
know who they are until we talk about it,

1922
01:29:11.072 --> 01:29:15.286
and try to co-construct an understanding.

1923
01:29:15.286 --> 01:29:16.794
Now with Caster Semenya,

1924
01:29:16.794 --> 01:29:19.012
the New York Times ran
an article very early

1925
01:29:19.012 --> 01:29:21.288
where her people back home,

1926
01:29:21.288 --> 01:29:24.724
her family, her aunties, they
all knew that she was a girl.

1927
01:29:24.724 --> 01:29:25.966
They also knew that she was a girl

1928
01:29:25.966 --> 01:29:27.406
who played with the boys.

1929
01:29:27.406 --> 01:29:29.008
They knew that, that was what they knew.

1930
01:29:29.008 --> 01:29:32.432
And there wasn't a problem
from their perspective.

1931
01:29:32.432 --> 01:29:34.847
So in essence, what it
really boils down to

1932
01:29:34.847 --> 01:29:37.970
is what are we really about having

1933
01:29:37.970 --> 01:29:40.512
testosterone people in one camp,

1934
01:29:40.512 --> 01:29:41.928
and are we gonna put people

1935
01:29:41.928 --> 01:29:45.144
in a camp based on their
testosterone level?

1936
01:29:45.144 --> 01:29:47.771
I mean, it gets pretty, pretty crazy.

1937
01:29:48.747 --> 01:29:50.679
I already told you that
my experience has been

1938
01:29:50.679 --> 01:29:54.777
that no one person that I've
worked with is like any other.

1939
01:29:54.777 --> 01:29:56.576
And I put that out there.

1940
01:29:56.576 --> 01:29:57.792
And the choices they make

1941
01:29:57.792 --> 01:30:00.887
are not like any other either.

1942
01:30:00.887 --> 01:30:03.348
And what always seems to come up

1943
01:30:03.348 --> 01:30:04.833
in one way or another is the way

1944
01:30:04.833 --> 01:30:06.412
that they feel estranged from the culture

1945
01:30:06.412 --> 01:30:08.305
that they're a part of.

1946
01:30:08.305 --> 01:30:12.084
And can we find a way for
them to feel connected?

1947
01:30:13.785 --> 01:30:15.835
You know, I put the fact that

1948
01:30:15.835 --> 01:30:20.082
I'm a white, or a Euro-American
male psychiatrist out there,

1949
01:30:20.082 --> 01:30:23.262
because those are problematic
signifiers as well.

1950
01:30:23.262 --> 01:30:26.420
Could I possibly understand the challenges

1951
01:30:26.420 --> 01:30:28.138
of folks who come to me with these issues

1952
01:30:28.138 --> 01:30:30.460
because of what I look like?

1953
01:30:30.460 --> 01:30:32.944
But I already alluded to
the reality that you really

1954
01:30:32.944 --> 01:30:36.792
don't know what's underneath
my pink shirt, you know?

1955
01:30:38.679 --> 01:30:41.094
So I think we have to
face our own limitations

1956
01:30:41.094 --> 01:30:45.428
as people who are doing gender.

1957
01:30:45.428 --> 01:30:47.937
And we have to try to expand our minds.

1958
01:30:47.937 --> 01:30:49.701
And often frankly, to expand the minds

1959
01:30:49.701 --> 01:30:51.884
of our patients or our clients.

1960
01:30:51.884 --> 01:30:53.358
Because at least with the person

1961
01:30:53.358 --> 01:30:56.408
I just told you about who
has made the transition

1962
01:30:56.408 --> 01:30:59.610
and is now discovering how
much she hates herself,

1963
01:31:01.188 --> 01:31:04.008
that's the culture internalized.

1964
01:31:05.749 --> 01:31:07.136
So, you know, I'm not giving you

1965
01:31:07.136 --> 01:31:10.405
a very clear answer because
I don't think I have one.

1966
01:31:10.405 --> 01:31:12.702
What I've learned from
being willing frankly,

1967
01:31:12.702 --> 01:31:14.389
to see these folks and in my community

1968
01:31:14.389 --> 01:31:16.270
people refer these folks my direction

1969
01:31:16.270 --> 01:31:18.883
because they don't
necessarily want to see them,

1970
01:31:18.883 --> 01:31:22.923
is to be open and to
do my best to be open.

1971
01:31:22.923 --> 01:31:25.746
And occasionally I'm
confronted with my own biases,

1972
01:31:25.746 --> 01:31:27.573
maybe explicitly by the
person that I'm with,

1973
01:31:27.573 --> 01:31:29.423
and we have to work that out.

1974
01:31:29.423 --> 01:31:31.582
But having had psychoanalytic training

1975
01:31:31.582 --> 01:31:33.950
and being psychoanalyzed myself,

1976
01:31:33.950 --> 01:31:35.947
that's the nature of the work.

1977
01:31:35.947 --> 01:31:37.143
You create an alliance hopefully

1978
01:31:37.143 --> 01:31:39.650
in which you can sort these things out.

1979
01:31:39.650 --> 01:31:41.449
And certainly if I'm encountering somebody

1980
01:31:41.449 --> 01:31:45.281
whose sexuality, whose gender expression

1981
01:31:45.281 --> 01:31:46.928
is different from my own,

1982
01:31:46.928 --> 01:31:48.380
there are going to be many opportunities

1983
01:31:48.380 --> 01:31:50.829
for empathic failures
that we're gonna have

1984
01:31:50.829 --> 01:31:52.930
to work on and try to sort out.

1985
01:31:53.875 --> 01:31:56.038
I don't know if that is a helpful answer,

1986
01:31:56.038 --> 01:31:59.764
or if I'm dodging some part of
the question you were asking.

1987
01:32:01.637 --> 01:32:03.135
Is there more to it?

1988
01:32:04.220 --> 01:32:06.129
- [Voiceover] Well, I suppose
that's what I'm asking.

1989
01:32:06.129 --> 01:32:08.270
That sort of is there more to,

1990
01:32:09.456 --> 01:32:11.955
yes there are the potential
for empathic failures

1991
01:32:11.955 --> 01:32:14.985
and sort of the (mutters),

1992
01:32:14.985 --> 01:32:16.900
but also, you know,

1993
01:32:18.015 --> 01:32:21.053
what are your forms when
it comes to assessment?

1994
01:32:21.053 --> 01:32:24.024
How do you balance, work to maybe--

1995
01:32:24.024 --> 01:32:24.644
- Well.

1996
01:32:24.644 --> 01:32:25.764
- [Voiceover] Get to the place

1997
01:32:25.764 --> 01:32:29.583
that perhaps (mutters).

1998
01:32:29.583 --> 01:32:32.165
You might have a difference
in your areas too and--

1999
01:32:32.165 --> 01:32:34.568
- Well, and I work in an organization

2000
01:32:35.616 --> 01:32:38.637
with 2,000 physicians
and 40,000 employees.

2001
01:32:38.637 --> 01:32:42.048
We did this year have an LGBTI,

2002
01:32:43.071 --> 01:32:45.775
I may be leaving out some signifiers,

2003
01:32:46.706 --> 01:32:49.456
task force to work on
exactly those things.

2004
01:32:49.456 --> 01:32:51.511
So right now we're working
on adjusting our forms.

2005
01:32:51.511 --> 01:32:53.635
We're working on changing our bathrooms.

2006
01:32:53.635 --> 01:32:55.516
We're working on identifying,

2007
01:32:55.516 --> 01:32:57.606
actually my belief,

2008
01:32:57.606 --> 01:32:59.834
you can take this any way you want,

2009
01:32:59.834 --> 01:33:01.588
but I believe that we
need to identify people

2010
01:33:01.588 --> 01:33:03.375
who are willing to do this work.

2011
01:33:03.375 --> 01:33:05.790
Not assume that everyone
will do this work.

2012
01:33:05.790 --> 01:33:07.892
Because there's nothing
more offensive than having

2013
01:33:07.892 --> 01:33:11.734
someone who's trying to
be cool working with you.

2014
01:33:11.734 --> 01:33:13.974
So what we're working to do

2015
01:33:13.974 --> 01:33:16.551
is identify a panel of providers

2016
01:33:16.551 --> 01:33:20.794
who are comfortable engaging
in a clinical encounter

2017
01:33:20.794 --> 01:33:23.973
with a person who identifies
as gender variant.

2018
01:33:23.973 --> 01:33:27.241
And then at least setting it up so that

2019
01:33:28.211 --> 01:33:30.253
the providers are interested
in seeing the patients,

2020
01:33:30.253 --> 01:33:32.458
and the patients feel
that at least the provider

2021
01:33:32.458 --> 01:33:35.117
wants to see them, does that make sense?

2022
01:33:35.117 --> 01:33:38.774
I'll tell you an anecdote
which absolutely enraged me.

2023
01:33:38.774 --> 01:33:41.017
I had a patient who wanted to start,

2024
01:33:42.176 --> 01:33:43.252
let me get this right,

2025
01:33:43.252 --> 01:33:46.316
a male to female transgendered person

2026
01:33:46.316 --> 01:33:50.531
who wanted to start
estrogens, female hormones.

2027
01:33:50.531 --> 01:33:53.026
I called up the endocrinologist on call

2028
01:33:53.026 --> 01:33:54.431
and I said, "What should I do?"

2029
01:33:54.431 --> 01:33:55.290
And he said, "Oh, it's really simple.

2030
01:33:55.290 --> 01:33:56.172
"It's really, really easy."

2031
01:33:56.172 --> 01:33:57.589
What you do is you do
this and you do that,

2032
01:33:57.589 --> 01:33:59.086
and then you order this
test and you do that,

2033
01:33:59.086 --> 01:34:00.816
and anybody can do it.

2034
01:34:00.816 --> 01:34:04.345
And I said, "Well, how about I
send this person to see you?"

2035
01:34:04.345 --> 01:34:05.669
And they said, "Oh, no, no, no.

2036
01:34:05.669 --> 01:34:07.990
"I'm not a specialist in that."

2037
01:34:07.990 --> 01:34:09.926
Literally, literally.

2038
01:34:10.730 --> 01:34:14.254
Now I wanted to, I don't
know what I wanted.

2039
01:34:14.254 --> 01:34:17.295
I wanted to do something to his gender.

2040
01:34:17.295 --> 01:34:19.281
But anyway.
(audience laughs)

2041
01:34:20.741 --> 01:34:24.749
That's an example of the kind
of challenge that we face.

2042
01:34:24.749 --> 01:34:27.051
Luckily another member of his department,

2043
01:34:28.005 --> 01:34:31.700
another endocrinologist is
being funded by that department

2044
01:34:31.700 --> 01:34:33.920
to go get training in centers

2045
01:34:33.920 --> 01:34:36.219
where people are doing this work.

2046
01:34:38.079 --> 01:34:39.727
So that we will have someone identified

2047
01:34:39.727 --> 01:34:40.772
who wants to work with folks

2048
01:34:40.772 --> 01:34:42.779
and who knows something
about what they're doing.

2049
01:34:43.934 --> 01:34:44.700
'Cause there are two parts.

2050
01:34:44.700 --> 01:34:46.186
It's one to be open to it,

2051
01:34:46.186 --> 01:34:48.426
but there's another to actually
know what you're doing.

2052
01:34:48.426 --> 01:34:49.587
And those two things are not necessarily

2053
01:34:49.587 --> 01:34:51.886
the same things either, right?

2054
01:34:51.886 --> 01:34:52.664
There are a lot of well-meaning people

2055
01:34:52.664 --> 01:34:55.204
who do terrible things to
their clients and patients.

2056
01:34:56.379 --> 01:34:58.054
And there's part of that
story here too I think

2057
01:34:58.054 --> 01:35:00.596
when we hear about this pastor.

2058
01:35:00.596 --> 01:35:01.722
Who really doesn't have a very good answer

2059
01:35:01.722 --> 01:35:05.292
for this member of his flock.

2060
01:35:06.299 --> 01:35:09.353
So to make a short, the summary is this,

2061
01:35:09.353 --> 01:35:11.153
we have a committee, we're
trying to change the way

2062
01:35:11.153 --> 01:35:14.600
that we offer access to
people with gender variance.

2063
01:35:14.600 --> 01:35:17.793
And are hoping to identify
a panel of providers.

2064
01:35:17.793 --> 01:35:19.732
I already have an underground panel.

2065
01:35:19.732 --> 01:35:22.210
I know who they are, they know who I am.

2066
01:35:22.210 --> 01:35:24.220
But to make it explicit so that there is,

2067
01:35:24.220 --> 01:35:26.077
when someone calls on
the phone for a clinic

2068
01:35:26.077 --> 01:35:27.737
at this institution they will be directed

2069
01:35:27.737 --> 01:35:29.315
to people who want to work with them.

2070
01:35:30.210 --> 01:35:31.579
What happens then is when you refer them

2071
01:35:31.579 --> 01:35:33.238
to a sub-specialist as invariably

2072
01:35:33.238 --> 01:35:35.461
at a place like Mayo Clinic you will,

2073
01:35:35.461 --> 01:35:38.537
they have the advocacy of the
person making the referral.

2074
01:35:38.537 --> 01:35:40.544
Because a heart's a heart, you know?

2075
01:35:41.419 --> 01:35:42.852
So that's kind of where it is.

2076
01:35:42.852 --> 01:35:44.477
It's a work in progress at our place.

2077
01:35:44.477 --> 01:35:46.068
We just had this committee
in the last year.

2078
01:35:46.068 --> 01:35:48.656
Just got the endorsement of
our clinical practice committee

2079
01:35:48.656 --> 01:35:50.027
to come up with a better model

2080
01:35:50.027 --> 01:35:52.010
within the past six months.

2081
01:35:53.811 --> 01:35:54.442
- [Voiceover] Thank you.

2082
01:35:54.442 --> 01:35:55.225
- Thanks.

2083
01:35:55.225 --> 01:35:55.549
- [Voiceover] Thank you.

2084
01:35:55.549 --> 01:35:56.772
- Okay, thank you.

2085
01:35:56.772 --> 01:36:01.772
(applause)