Book Review

Reviewed by Linda Darling

(The Gender Centre advise that this article may not be current and as such certain content, including but not limited to persons, contact details and dates may not apply. Where legal authority or medical related matters are cited, responsibility lies with the reader to obtain the most current relevant legal authority and/or medical publication.)

"Transsexualism In Society" (1995) Author: Frank Lewins.

Transsexualism In Society

by Frank Lewins
Published by Palgrave MacMillan, October 9 1995 I.S.B.N. 978-0732930448

Frank Lewins has written a very good P.R. publicity brochure for the Monash Medical Centre in Melbourne which does Gender Reassignment Surgery: which is a pity because he set out to write a book called Transsexualism in Society.

What does the author understand by "transsexualism"? He says on page 4:

"I am using an operational definition of transsexual. In other words, I am defining transsexual in terms of it's concrete manifestations, that is, anyone who has made or appears to have made, the transition to living permanently in the gender other than the one originally assigned to them".

And who might these people be? On page 5 he mentions 50 people whom he interviewed and comprised the basis of his study:

"Almost all interviews were with transsexuals associated with the Gender Dysphoria Clinic at the Monash Medical Centre in Melbourne. Six transsexuals were interviewed in Canberra and Sydney".

Yet on page 90 for example, he says:

"I received several letters and phone calls, ... from people who told me of their frustrated, long-term desire to live as women. Most of these people were transsexuals, now living as women. Two were not. They were living as men but had always wanted to be women and live as women".

This is just one example of his "operational definition" of transsexualism" given at the beginning of the book runs into problems of definition, appropriateness and clarity. He seems oblivious to the problem and says on page 4:

"throughout this book I use transsexual as a term of convenience to identify those people who have made this study possible".

The problem is, that when he departs from the medical model of transsexualism which is what he has at Monash, and brings in other people later in the book they are not comparable in terms of the medical model, but are still confusingly subsumed under the label transsexual. Also, but focusing on the "official" Monash, self-selected, institutionally formed group, Lewins is practically saying "look - the study I'm making is what transsexuality is and transsexuality is what I'm studying." This lack of appropriate language (queer language?) and concepts is to dog him all the way through. He says on page 137:

"transsexuals are a manifestations of a range of psychological identities"

But are all these identities medical model transsexuals? And if they are not, then is the medical model and the name transsexual, and the process of becoming a woman that he describes appropriate to them?

The other main problem with this work is that in it's attempt to impose a particular form of inductive sociological method on it's subjects it creates the object of it's own study. On page 1 he says the book:

"focuses on patterns of thinking and behaviour among transsexuals rather than on any individuals characteristics, hence the use of transsexualism rather than transsexual".

This leads to abstraction, nice neat models of behaviour and diagrams to illustrate Lewins' "radical" idea that "becoming a woman (what's that Frank?) is a process rather than a decision". Well fancy that!

For example, on page 71 he says:

"Figure 4.1 is not trying to convey the nature of any individuals experience but rather the patterned nature of transsexual's experiences as a whole".

Which Lewins knows of course. On page 70 he says:

"The six stages in the process of becoming a woman are:

• abiding anxiety;
• discovery;
• purging and delay;
• acceptance;
• surgical reassignment; and
• invisibility."

In this type of writing the abstract models and diagrams are real "heroes". The author has triumphed over the individual subject and seen the "truth" of a wider process. Individual case studies serve to validate the theory. The idea that he has shamelessly made his material fit preconceived theories never seems to have occurred to him - not even when he notes those people at Monash who cannot become "invisible" and cannot "do" gender sufficiently well to be given the go ahead for surgery and are therefore left in stage 1 of abiding anxiety through no fault of their own in a system that held out the hope of removing their anxiety.

In Lewins' world, the process of becoming a woman that he talks of carries the individual along a necessary and inevitable path. Problems of identity, breakdowns, drug abuse, alcoholism, rape, second thoughts, surgical mistakes, these are not part of the process, although interestingly enough, poverty is. This is due to the fact that if a person doesn't have the money then they do not advance so fast through the Monash surgical procedure.

The complexity of individual lives - the behaviour and thinking they create cannot easily be quantified and fitted into neat categories. This leads to a situation familiar to students of sociology, where it is possible to make conclusions, expressed as statements, based on information, and yet these statements while in some sense "true" have little use value in the real world. For example "in the future it will rain" so what? It is only when I say "it will rain on Friday morning" that a predictive statement can be tested by experience and it's truth determined by observation. Similarly, general statements or categories that have no predictive or explanatory power belong not to the realm of science but to that of opinion or ideology and they should be clearly marked as such. Simply qualifying statements all the time is not a way round this.

In the "how amazing!" category I'd put the following on page 92:

"... not only among the people I interviewed but also based on the files of post-operative transsexuals, their reason for contacting the clinic was for surgical reassignment. There was no evidence of anyone presenting with inexplicable anxiety, that is, asking the question "Doctor, why am I feeling this way and what can you do?"

Who gave permission for him to look at confidential medical files and why? What sampling methods did he use?

He continues by referring to "their general level of self-understanding and what they expected from the clinic". Confused people? Not on Lewins watch. And guess what - on page 106?

"... after living a minimum of two years as women, transsexuals generally have no second thoughts about the finality of surgery."

The process and model is all. On what basis did he reach this conclusion?

The authors desire to know the truth of his subjects in the patterns he ascribes to them and his power to select, edit, group, abstract and simplify complex material and even more complex issues, creates a form that allows the "expert" to stride above them, know their truth. As an example of sociology and method it seems to leave a great deal to be desired. It should be re-titled Transsexualism in Monash Medical Centre with some opinions and anecdotes added. Any conclusions cannot be extrapolated from such a small self-selecting group to the wider society especially when the existence and definition of transsexualism is in contention outside the sociology department.

I'm left with the feeling that this is lazy arrogant sociology. Too accepting of official views, too willing to take people at their word, too willing to turn the obvious into a diagram. By the end of the book he has practically appointed himself cultural arbiter for what "society" will accept (what society? where, when, why, how, the groups and dynamics at work?) Facts, statistics, geographical spread, or even evidence that he got out much into the target community are conspicuous by their absence. The idea that health workers would use this book as a resource, as suggested on the back of the book, seems highly unlikely and if it was, it should be a cause for concern. Frank Lewins' previous publications are all on the subject of migrant policy and settlement with one (alarmingly!) on Bioethics for Health Professionals.

Lewins' book does serve to point the way beyond the opinion/rhetoric/ideology problem if it is recognised that what is required is a well funded, wide ranging, in depth, large number of respondents survey done with the intention of gathering information about a largely unknown community or communities - those who self-identify with the trany community. The survey would cover aspects of health, lifestyle and sexuality asked of respondents where there are no major factors (such as being denied access to surgery) to inhibit their responses. The questions would be set by many individuals and interested agencies and the final results would be released in their raw form for individuals and organisations to use and incorporate in their own research. The fact that this hasn't happened by 1996 is an academic disgrace.

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