Competing Ideologies

As a Deaf psychologist, I spend a lot of time reflecting upon how best to work with members of marginalized communities of all types.  Some of my clients are Deaf, some identify as trans*, and some are both.  And within both of those communities, similar tension exists around the issue of what it means to claim that particular cultural label. 

For many younger trans* individuals, gender is a fluid, socially constructed idea, not a biological one.  Those who identify as genderqueer or genderfluid often resist any form of binary gendered label.  Men can wear dresses and still be male.  Women can walk around in combat boots and red lipstick.  An individual can be male sometimes and female at other times or even a third gender that consists of a blend of both.  Indeed, turning traditional ideas about gender on end is one of the goals of the movement.  Under this philosophy, those who wish for a complete physical and social transformation are, in essence, supporting the status quo: a status quo that many gender non-conforming people find oppressive and hurtful.  Those who used to be oppressed have, post-transition, joined the enemy camp, so to speak.

On the other hand, many transgender individuals who have suffered silently for years are desperately happy to be able, finally, to walk down the street without fear.  Attracting unwanted attention may have previously resulted in discrimination, harassment, pain, or violence.  For those individuals, being able to access transition services in order to feel at home in their bodies and in the world has been a tremendous blessing.  And so the tension continues, between competing ways of viewing one’s own relationship to the social justice movement at large.

Similarly, within the Deaf community, there has long raged a debate about whether choosing a surgical intervention to improve one’s hearing is simply an accommodation to a world that does not sign, or if it represents victory of the oppressors.  Hearing people, by and large, view deafness as a sensory deficit to be remedied in any way possible.  Deaf culture views deafness as a unique way of existing within the world.  Deaf culture revolves around fluency in American Sign Language and an appreciation for Deaf art, history, and society.  For those who value Deaf culture the way that any other minority group values its own culture, choosing to get a cochlear implant as an adult is considered submitting to the oppressive tyranny of the majority.  Why cut one’s head open when there is nothing inherently wrong with being Deaf?

For other Deaf adults, a cochlear implant is simply a tool, much like a hearing aid.  It improves ones hearing, potentially, but it does not alter identity as a Deaf adult.  And so the tension continues to exist.  For both groups, the stakes feel high, for the opposing choice seeks to negate the one that each individual has made.  I wonder, however, if this is perhaps how movements advance.  All social justice movements thrive on tension and change.  Each subgroup forces the other to articulate their stance more clearly, to explain it to others, and to attempt, at least politically, to find common ground.

Contributed by Dr. Mel Whalen

Community Programs & Services – 2013 Accomplishments

“Success is to be measured not so much by the position that one has reached in life as by the obstacles which he has overcome.”

Booker T. Washington

It’s the beginning of a new season. As I reflect on our previous seasons, that combined to create our first year, I am amazed at what we accomplished. FY2013 was one of the most challenging times in my 25 year tenure with UMHS. We came to the table optimistic but determined to do our part to address the financial deficit within the health system; working together to create OUR plan.

Despite the challenges, we accomplished some amazing tasks that support our health system and our community, both internally and externally.

Accommodations Program

– We made 11,574 reservations for patients, families and visitors to UMHS via the Patient and Visitor Hotel Accommodations Program – that’s an average of 965 reservations per month! The onsite Med Inn Hotel averaged 100% occupancy for 12 months. And, we launched our partnership with the Ann Arbor Mennonite Guest Home – a six year project to bring additional lodging to our patients and their families.

Adolescent Health Initiative

– Lauren Ranalli, Director of the Regional Alliance for Healthy Schools (RAHS), was successfully hired as Director of the Adolescent Health Initiative and we received a grant from MDCH to hire a program manager. Physician Adolescent Champions have been identified and with medical director, Maggie Riley, MD (Family Medicine) we are firmly on our way to doing great work. Planning for the first state-wide conference on adolescent health in Michigan is, also, underway for April 2014. The conference will focus on translating knowledge on working with adolescents to practice.

Ann Arbor Meals on Wheels

– We marked 2 million meals served (since the late 1980’s) with a celebration and open house in January 2013 that recognized our staff, volunteers, donors and funders for support for nearly 40 years. Our annual volunteer-driven golf fundraising event, The Judy Fike Golf Outing to benefit Ann Arbor Meals on Wheels, raised over $25,000 this year which will be used to provide meals to area homebound seniors and others.

Comprehensive Gender Services Program

– The Gender Program saw the largest increase in new client enrollment for calendar year 2012 with 108 new clients (a 40% increase our previous high of 43 new patients in 2007) since the program’s inception in 1995. (Notably, that growth shows no sign of slowing, as the program has enrolled 158 new patients to date in 2013.) In addition, the program created two support groups: one for the parents and guardians of gender-variant children, and the second for spouses and partners of transgender adults. The program also increased its ties with the Disorders of Sexual Development clinic and maintains a strong connection to Family Medicine, Plastic Surgery, Urology and Reproductive Endocrinology in providing support for our clients. The first gender variant youth and sibling event will be held at CPS in October in direct response to the increasing needs of this special population. The UMHS-CGSP is the only university-based, multidisciplinary gender program in the United States.

Friends Gift Shops

– Provided over $200,000 in grants to support patients and family programs within the health system (this includes $150,000 in core awards given to support Child & Family Life, Social Work Guest Assistance Program (GAP), Trails Edge Vent Camp (for ventilator dependent children) and the Patient Education Advisory Committee). Some of the other awardees for FY2013 include the East Ann Arbor Surgical Center, Adult Medical Observation Unit, Transplant House, the Brandon NICU, the Depression Center and Canton Radiology.

Housing Bureau for Seniors

– Celebrated 30 years of serving area seniors and their families. The yearly conference, Senior Living Week that provides education and information about aging in place, resources to support housing transitions and contact with experts in the field of housing and aging support celebrated its 15th anniversary. One of the highlights of HBS, our HomeShare Program is the only official program of its kind in the state of Michigan and has proven demonstrably effective in the community as an alternative method for allowing seniors to remain in their home.

Interpreter Services

– Launch of two innovative new classes – Interpreting in Palliative Care and Interpreting in Mental Health, both new classes are the one of the firsts trainings of their kind offered nationally. In addition to these two new courses, we successfully offered professional trainings classes for Bridging the Gap, Medical Terminology and Body Systems and Foundations for Medical Interpreter (formerly Medical Interpreting – Basic Skills ASL). These course offerings make our program a standout for promoting medical interpreting as a profession. The next step on our journey is the accreditation of our training program.

Program for Multicultural Health

– Partnered with the brothers of Kappa Alpha Psi Fraternity, Inc. to present a successful African-American Men’s Health Symposium with significant contributions from Dr. Ken Jamerson, Frederick G L Huetwell Collegiate Professor of Cardiovascular Medicine and Professor of Internal Medicine (former medical director, Program for Multicultural Health), Brian Frey, UM School of Public Health Intern, Community Programs and Services, and Dr. Rohan Jeremiah, Paul D. Cornely Postdoctoral Scholar, UM School of Public Health. This symposium was Phase I of our partnership with Kappa Alpha Psi Fraternity, Inc. The symposium had barely closed before discussions began for Phase II — a Midwest regional symposium in 2014. The symposium also provided an opportunity to create an African-American Male Community Health Advocate group for the community. We are excited to train men how to educate other men on health issues (e.g. Hypertension, Diabetes, and Prostate Cancer) that are disproportionately experienced by African-American men.

– We enjoyed a successful summer teaching over 40 children (between the ages of 5 and 12) about nutrition. The children, summer camp participants at either the Parkridge Community Center in Ypsilanti, MI or Peace Neighborhood Center in Ann Arbor, MI learned about healthy eating, made health snacks, and participated in “taste-testing” vegetables and fruits not normally a part of their diet. (https://www.med.umich.edu/multicultural/‎)

Regional Alliance for Healthy Schools

– We experienced a period of transition within our program. Jennifer Salerno, the long-term director and visionary for RAHS left to pursue other endeavors. Lauren Ranalli, MPH, was hired to take her place at the helm. Lauren hit the ground running in March; working to successfully manage the challenges created by the merger of two school-districts. Economic challenges for both Ypsilanti Public Schools and Willow Run Community Schools districts drove a merger which had the potential to affect three (3) of our school-based health centers. Following the merger, we efficiently closed the Ypsilanti Middle School health center and moved those services to the Lincoln Middle School. This move expanded services in the school district and provided support for our Lincoln High School school-based health center. We were the award recipient of nearly $400,000 from HRSA to improve the Ypsilanti High School Health Center. The award will allow us to renovate our clinic space to provide more privacy and efficient flow for students visiting the school-based health center.

– Developing the next generation of “leaders and best,” staff and students attended “Advocacy Day” (students, accompanied by RAHS staff, visited Michigan State Legislators to garner support for school-based health centers) in Lansing and participated in Project VOICE on the UM Flint campus.

Volunteer Services

– Reorganized and streamlined volunteer training and orientation sessions successfully. Created a process to efficiently onboard non-student volunteers (retirees, stay-at-home parents, and others). Allowing equal access to community volunteers to support our patients, their families, faculty, and staff. But more importantly, we continue to average close to 2,000 volunteers providing support to our institution.

This is, by no means, an exhaustive list of our many accomplishments during FY13. I would still be writing!! Instead, this is just a sample of the excellent support we provide to the University of Michigan Health System and our patients, their families and friends and the community. We are a valuable resource. We will continue to flourish to provide quality and consistent energy and passion in support of the vision, mission and goals of the health system.

The best is, truly, yet to come!

“Success in any endeavor does not happen by accident. Rather, it’s the result of deliberate decisions, conscious effort, and immense persistence…all directed at specific goals.”

-Gary Ryan Blair

A Letter to Family & Friends from Parents of a Transgender Child

My name is Steve.  I am a 60 year old, long hair, tattooed outlaw biker (and successful business owner).  Besides being a recovering bigot, I’m also an unequivocal believer in the power of unconditional love.  My transgender child has gifted me the opportunity to transition to a better place.  The least I can do is help others find their way there, too.  This is the letter my wife and I sent to our family and friends to help them start that process….

When a child is born the universe is affected. We may not notice the change as its order of magnitude is comparatively small. However, it is there, nevertheless.

As parents, the effect is profound. Elation, joy, concern, and exhaustion often describe a new parent’s immediate outlook on their life. Most often, the inescapable responsibility to nurture and protect although overwhelming is offset by a commitment to unconditional love. We move forward devoted to an ideal that includes our vision of happiness for our child. We remain convinced that through our love and commitment this child will actualize their potential and will do so according to the ideal we formed for them at their birth. The years go by and are filled with memories that perhaps, modify our ideal but leave it mainly whole in our minds. Then, one day this child rejects our ideal for their own.

In some cases we may fight for our ideal particularly if we are convinced that our child’s change of direction is unhealthy or self-destructive. On the other hand, if our adult child has made a thoughtful decision that must replace our ideal with their own and their happiness is genuinely dependant upon the change we will now have to accept, then what choice is left to us? We are bound by our commitment to unconditional love. To be clear, some choices are not really choices at all. It is the way we handle the inevitability of the directions we are blessed with even before we are born or those that are subsequently presented to us that best defines us.

Lately, we have faced a confusion of emotions including sadness and anger. We have resented the upset of the position we assumed our lives to be. We have had to deal with an extraordinary change to the ideal life outcome we set our hearts on for our son and eldest child.

More importantly than anything else we have recently experienced, we have validated the unconditional love we committed ourselves to before he was born. That has sustained us as we recover from the shock of something we never saw coming.

During his internship in Germany over the summer, he had time to contemplate who he really is. He told us that he has struggled with that question for most of his life but never had the vocabulary to address it. With time on his hands, he researched for answers in the solitude of his apartment overseas. In September, as the first semester of his graduating year at University of Michigan began, he told us he is transgender. Our son believes in his heart that he is actually female in spirit. For those that are unfamiliar with the term transgender please understand…there is a lot to learn. We will address some of that later and will refer you to some materials that proved helpful to us.

As parents, and particularly as the loving parents of a close knit family, we immediately expressed our unequivocal support. There were lots of tears that were initially impossible to define. We felt profound sadness but struggled to understand exactly what it meant or where it came from. We were startled, shocked and deeply confused. We struck out to find help right away so we could be certain that the outcome of this would be as positive as possible.

After our initial shock came a combination of anger, sadness and guilt. We began a retrospective analysis of our parenting to see if there was some clue we had missed or something we could have done differently that would have effected another outcome. It is impossible to imagine the guilt we felt when our boy told us he had struggled with this for so many years…alone and concerned that he was some sort of monster. He told us he worked hard each and every day to be a perfect son so God would forgive him and lift away this burden. He kept this secret to himself for most of the time we have known him. He has endured so much emotional pain alone and without ever acting out or tipping his hand to anyone. We were absolutely stunned when we realized the gravity of his isolation. Statistically, more than 30 percent of transgender children successfully commit suicide.

God blessed our child with an extraordinary intellect and emotional stability that allowed him to prevail against the pressure of unknown and indefinable forces that haunted him for so long. For those of you who know him well, you will recall that he was a 4.0+ GPA student who graduated high school at the top of his class. He was president of the National Honors Society and competed for the varsity ski team in addition to playing violin for the orchestra. He recently graduated magna cum laude at University of Michigan’s Aerospace Engineering program and has been accepted into their accelerated Master’s Aerospace Engineering program. He has never been in trouble for any reason. We have never received a phone call from an authority of any kind. He has never tried drugs, alcohol or smoked cigarettes. He has always been the “perfect son”. He later admitted avoiding situations that would have possibly or inadvertently exposed his secret. That would have included drinking. It explains why he would be so quiet…withdrawn…so often. While we noticed that behavior, it had become so normal that we learned to accept it.

Webster defines “transgender” thusly, : of, relating to, or being a person (as a transsexual or transvestite) who identifies with or expresses a gender identity that differs from the one which corresponds to the person’s sex at birth

Our son was born with male genitalia but his “spirit” is female. His condition is one of gender identity. Fundamentally, he does not identify with the sex he was born with. People who have this condition often start out cross-dressing and assuming the identity of the sex they more comfortably relate to. Sometimes, depending on the individual and their commitment to their gender identity, they will ultimately transition to their preferred gender with gender reassignment surgery. In any case, it is important to note that the individual is compelled to have these feelings and to act upon them, accordingly. In other words, they cannot help it. There is no “cure” or therapy or prayer or medical treatment. There is only the person that has always been and now needs the understanding and support of their friends and loved ones. In this case, he is still who he has always been…a loving, intelligent and compassionate person who would generously give you the shirt off his back. He deserves our love and support.

Going forward, we will be changing pronouns here at home. That will likely be a challenge at first. We have been requested to refer to “her” as Kaitlyn. That was the name we picked out before he was born just in case our first born was a girl. We loved the name we gave our son but we love our Kaitlyn just as much. Please help with this. We understand that this may be difficult for you, too. We’re here to help you in any way we can. We would be happy to recommend some books that we read that have been very helpful to us and substantially improved our understanding of this subject. Specifically, “She’s Not There” by Jennifer Finney Boylan was very insightful and was also entertaining. We experienced chuckles and tears as we read it.

As our friends and family we must expect your help and support. If you feel that isn’t possible, we understand. Please just let us know and we will adjust our understanding of our relationship with you. Otherwise, we welcome the opportunity to hear about your feelings and we look forward to sharing our new daughter and her hopes, dreams, and accomplishments.

The Sound of One Hand Clapping

I am reminded of this ancient Zen koan when speaking to a person who doesn’t fit neatly into our binary ‘gender’ boxes.  And I try to keep it at the forefront of all that I do to serve the needs of gender variant people and their families.

As you’ll recall, the sound of one hand clapping is silence.  That is, the absence of sound.  Why the absence?  Because there is no resistance, no other hand to create a barrier against which the sound is created.

Gender variance is like this.

The ‘sound’ of feeling something other than ‘masculine’ or ‘feminine’ is only created because outsiders create a barrier.  That is, a child just feels how they feel.  We label it as appropriate, or not, depending upon how neatly the child’s feelings fit into our expectations, i.e. whether the child’s behaviors hit the ‘barrier’ of what we expect to see.

Confused yet?

Indulge me for a minute here, and consider a 3-year-old child.

The child feels feminine, loves activities we associate with little girls, colors we associate with female, the frilliness that Madison Avenue has taught us is ‘girly’.  This is one happy little kid, waking up each morning with energy and enthusiasm and readiness for whatever the day will bring—and for a 3-year-old, just being alive is a very exciting adventure.  Few 3-year-olds worry, or are anxious or depressed (thank goodness).

Enter Stage Right: Adult

The adult looks at this happy child, judges the child to be male or female (female, in this case), and treats the child accordingly.  Unless, of course, the adult is one who is intimately connected with the child, like a parent, or a doctor.  Then the adult might note the child’s physical body, and be concerned if there are body parts we associate with masculinity.

Once the dichotomy is noticed, it is usually not ‘unnoticed’ and the child begins to be treated differently.  In some families, the child continues to grow up happy and content and comfortable. In other families, the child is taken for evaluation to a doctor or psychotherapist to figure out what is ‘wrong’.

Incongruent Are Us

We might say the child is ‘gender incongruent’. Incongruence, as defined by Collins, is ‘the quality of being surprising because out-of-place; oddness’. But remember our story so far—the child isn’t surprised, nor feels odd.  The child just has feelings. Any incongruence is caused by adults who are uneasy with the mismatch between how the child feels and what expectations adults have for the child based upon the child’s body parts.

Wow, This Sounds Familiar

Who among us—having grown to a height out of range as ‘expected’ for our sex—hasn’t been asked many times “Do you play basketball?”  If I had collected spare change every time I’d been asked that growing up I might have been able to retire by now.

Remember the really bad old days, when your athletic ability was expected to correlate with your race? Or your cooking and cleaning ability was expected to correlate with your reproductive organs?  Sure, it sounds wrong and even silly now.  And may it ever be so.

What I’m suggesting is that the ‘wrongness’ of gender identity is external to an individual’s experience.  Any ‘wrongness’ is in our society, in our staunch determination to fit people into neat little boxes, and our unwillingness or discomfort when we can’t.

Here at the gender program, I’m watching the trends. Hang on to your hats, friends.  The world is changing, because we now know the truth.

It isn’t about them.  It’s about us.

And society needs to transition.  Right here.  Right now.