Sex in Transition

Remaking Gender and Race in South Africa

Amanda Lock Swarr

• Publisher: SUNY Press
• Year: 2012
• Print ISBN:
  9781438444062
  9781438444079
• eBook ISBN:
  9781438444086
• Topic: Social Sciences
• Subtopic: Discrimination & Race Relations
• Index: Social Sciences

Argues that South Africa's apartheid system of racial segregation relied on an unexamined but interrelated system of sexed oppression that was at once both rigid and flexible.

Honorable Mention, 2013 Ruth Benedict Book Prize presented by the Association for Queer Anthropology
Honorable Mention, 2014 Distinguished Book Award presented by the Section on Sexualities of the American Sociological Association
Winner of the 2013 Sylvia Rivera Award in Transgender Studies presented by the Center for Gay and Lesbian Studies

Sex in Transition explores the lives of those who undermine the man/woman binary, exposing the gendered contradictions of apartheid and the transition to democracy in South Africa. In this context, gender liminality-a way to describe spaces between common conceptions of "man" and "woman"-is expressed by South Africans who identify as transgender, transsexual, transvestite, intersex, lesbian, gay, and/or eschew these categories altogether. This book is the first academic exploration of challenges to the man/woman binary on the African continent and brings together gender, queer, and postcolonial studies to question the stability of sex. It examines issues including why transsexuals' sex transitions were encouraged under apartheid and illegal during the political transition to democracy and how butch lesbians and drag queens in urban townships reshape race and gender. Sex in Transition challenges the dominance of theoretical frameworks based in the global North, drawing on fifteen years of research in South Africa to define the parameters of a new transnational transgender and sexuality studies.

One

Prescribing Gender and Enforcing Sex

Under apartheid, many South African transsexuals had access to publicly funded sex reassignment surgeries and were allowed to legally alter the sex listed on their birth certificates. But since the end of apartheid, most public sex reassignment programs have ceased, and while the new South African Constitution promises freedom from discrimination based on sex and gender, from 1993–2003 it was impossible to change one's sex legally. What circumstances led to this apparent paradox and what does it tell us about the constitution of gender in South Africa's political transition?

Apartheid allowed for a category—transsexual—that the post-apartheid state did not. This chapter explores reasons for this through an examination of the medical and legal treatment of transsexuals in South Africa from 1948 to 2003 and concludes that this apparent paradox is integral to ideas about the constitution of sex and gender as inseparable from South African politics and alliances. In short, the emergence of “transsexuality” as a medical and legal entity can be related to efforts to maintain apartheid order. To facilitate this consideration, I elucidate histories of medical sex reassignment procedures and their racialized and historicized sanction for particular groups of South Africans.¹ I compare these histories to legal developments concerning transsexuality in South Africa under apartheid and during the transition to democracy. Through this analysis, transnational discourse about the emergence of the category “transsexual” in South Africa is revealed, as is the temporality of this category itself. Temporality provides a useful framing of the movement and mobility of this category in conjunction with the politico-historical forces, considering how what it means to be a transsexual has changed over time.

This chapter also explores ideological differences about the fixity of gender versus the fixity of sex. These differences are reflected in dissimilar yet overlapping medical and legal histories and change over time through apartheid and the transition to democracy. Through this examination, Edward Said's notion of “traveling theories” is analytically useful to articulate the ways South African gendered and sexed categories work with theories emanating from the global North and South. The slippery importance of the idea of sex and its raced connection to heteropatriarchy are paramount here.

The medical and legal treatments of transsexuality and their contradictions must be mediated through an analysis of the co-production of sex, gender, race, and class. Like Foucault, who finds a “spontaneous and deeply rooted convergence between the requirements of political ideology and those of medical technology” (Foucault 1973: 38–9), I believe that certain forms of subjectivity can be explicated by understanding their genealogies. Consequently, tracing medico-legal discourses of gender liminality in apartheid and transitional South Africa exposes complementary and contradictory ways that challenges to sex and gender binaries were understood and policed. Following apartheid's adherence to order and simultaneous contradictions, discourses around transsexuality demonstrate conflicts over the raced constituition of gender.²

I. Foundations of “Transsexual”

As discussed in the introduction to this text, a number of recent and related works have traced the history of ideas and concepts. Within African Studies, Marc Epprecht's attention to the manifestation and movements of “heterosexuality” (2008) and Neville Hoad's focus on the production of “homosexuality” (2007) over time and space are particularly instructive. Epprecht explains the conceptual and methodological difficulties he faced this way:

Charting the history of an idea that is often unspoken and unrecorded is inherently more difficult than uncovering evidence of human activity. I acknowledge that my principle sources leave significant gaps that often require extrapolation from scant and geographically uneven evidence. (2008: 26)

The challenges of Epprecht's work were replicated in constituting this chapter. However, this kind of project is also quite valuable in that it eschews potentially troublesome topical analyses of communities based on concepts or identities that may not be uniformly adopted or applicable. In this vein, anthropologist David Valentine explains how he began to rethink his project initially focused on “transgender communities” in New York City marginalized by race and class “in terms of examining the idea of transgender itself and how it is setting the terms by which people come to identify themselves and others” (2007: 21). Unpacking conceptions of “sex” and, more explicitly, “transsexual,” can be politically salient in illuminating the borders, stability, and movement of this concept under apartheid and during the political transition in South Africa.

Within rubrics of gender liminality, people who have altered their physical bodies have been documented worldwide in various forms and time periods.³ However, it was not until the 1940s that “transsexualism” emerged as a modern medical category. European scientists first recorded their attempts to perform “sex transformation” procedures on animals in the 1910s, basing their experiments in theories that all beings are “bisexual”—part female and part male—and sex reassignment surgeries on humans began to occur with increasing frequency in the 1920s (Meyerowitz 2002). Jay Prosser suggests that Michael Dillon was the first transsexual to undertake surgical and hormonal transition in the 1940s, and he did so before the inception of transsexual as an official medical category. Early cases such as this demonstrate “how transsexuality constitutes an active subjectivity that cannot be reduced to either technological or discursive effect” (Prosser 1998: 10). Transsexuals are thus not an effect of discourse or of technological innovation but have complex histories and materializations beyond these external factors.

Despite exceptional cases, surgical procedures did not become publicly recognized in the United States and Europe until Christine Jorgensen's widely publicized male-to-female sex reassignment transition in Denmark in 1952.⁴ In the wake of the publicity surrounding Jorgensen's transition, endocrinologist Harry Benjamin brought international attention to transsexuality as a medical category. His text, The Transsexual Phenomenon, was published in 1966, the same year that the first sex reassignment surgery was performed in the United States.⁵ Benjamin's work provides an essential backdrop to an analysis of South African transsexuality because of the enormous impact of his theories. Beginning in the mid-1950s, Benjamin began a campaign for recognition of transsexualism that differentiated him from other physicians of his time in two regards. First, by seeing gender “disorders” on a continuum, Benjamin distinguished transsexualism from transvestitism and homosexuality, writing: “The transvestite has a social problem. The transsexual has a gender problem. The homosexual has a sex problem” (Benjamin 1966: 28). Second, he perceived himself as a humanitarian who could save transsexuals from self-harm or suicide (Califia 1997). In this sense, Benjamin represented himself as trying to assist transsexuals in achieving their desired bodies.

As protocol surrounding the treatment of transsexuality developed, sexologist John Money emerged as the most prominent physician writing on and treating patients through sex reassignment surgery and arguing that gender is learned, not innate. Based in the United States but with global influence, feminist theorist Suzanne Kessler points out that almost all of the published literature on intersexed infant care management has been written or co-authored by Money. The overwhelming majority of U.S. physicians interviewed for her 1990 analysis of the medical construction of gender in terms of intersexuals and transsexuals “essentially concur with his views and give the impression of a consensus that is rarely found in science” (Kessler 1990: fn 9).⁶ Those complicit in this consensus maintained that gender identity is changeable until an infant reaches eighteen months. Later research and Money's own patients eventually suggested otherwise.⁷

Nevertheless, in this time period emerging treatment protocols for transsexuality developed from treatments for intersexuality such as Money's. Among medical professionals, intersexuality is essentially linked to discussions of transsexuality, as these are the two most common gender “disorders” treated through hormone therapy and surgeries. They are also related historically and technically, as techniques used in sex reassignment surgeries and hormone therapy programs were developed out of (and are often the same as) those used to treat intersexuality. Clinical experience with intersexuals established surgical techniques of genital reconstruction and hormonal therapy as well as theories of gender-role learning and self-identification as independent from anatomy.

The ideas of those who promoted sex reassignment surgery such as Benjamin, Money, and Anke Erhardt were extremely unpopular among physicians when they were first introduced in the 1950s and 1960s.⁸ Treating transsexuals with surgery was considered elective and dangerous, and such procedures undermined commonly-held beliefs that sex was immutable. At the same time, three factors increasingly motivated physicians to fight for the medical efficacy and desirability of sex reassignment treatments. First, physicians such as Benjamin saw themselves in the role of healing patients and attending to their considerable mental distress. Second, psychiatrists and surgeons recognized opportunities to conduct groundbreaking research on the treatment of gender disorders. Several surgeons interviewed by sociologists Billings and Urban from 1978–1982 asserted that they regarded sex-change surgery as a “technical tour de force which they undertook initially to prove to themselves that there was nothing they were surgically incapable of performing” (103).⁹ Many physicians wanted to master the body; their ability to change sex proved the victory of science over nature. Furthermore, procedures on transsexual patients were often seen as experiments that could advance physicians' careers (Califia 1997: 72). Third, an excess of cosmetic surgeons in the United States resulted in competition for patients and an increased number of unnecessary operations; some authors suggest that transsexuality fit into this trend as an expensive elective treatment (Hausman 1995: 63).¹⁰

Moral and legal opposition to the removal of healthy organs initially prevented the recognition of transsexuality as a medical disorder, but eventually conflicting views were overwhelmed by legitimizing publicity. It is important to note transnational influences on the development of global medical opinion, including opinion in South Africa, which can largely be traced to medical networks of professional associations and internationally-circulated journals. For instance, the globally-focused Erickson Educational Foundation became a significant mediating force shaping medical opinion surrounding transsexuals. Founded in the United States in 1964 by Reed Erickson, a wealthy American female-to-male transsexual, one of the missions of this foundation was to convince physicians of the significance of transsexuality as a disorder (Meyerowitz 2002: 209).¹¹ This Foundation achieved enormous success by convening international medical symposia and conferences (attracting medical professionals from the U.S., Canada, Mexico, Morocco, and Australia [Devor and Matte 2007: 63]), sponsoring workshops at medical schools and professional meetings, and disseminating films and pamphlets about transsexuality to doctors, police, clergy, and social workers. The Erickson Foundation even funded publication of a major anthology on how to treat transsexual patients, which served as a handbook for doctors internationally.¹² Foundations, journals, and professional associations all contributed to commonalities in protocol and philosophies emanating from the United States and Europe.¹³

This powerful and influential advocacy, coupled with increasing numbers of publications outlining the medical necessity of sex reassignment treatment, eventually led to a shift in medical opinion. In the mid-1960s, the majority of physicians in the United States opposed sex reassignment surgery and said that they would refuse a request for it from a patient (Green 1969: 235–42); 94 percent of psychiatrists surveyed in 1967 said that they would refuse to grant sex reassignment surgeries on “moral and/or religious grounds” (Green 1969: 238). However, by the early 1970s, gender dysphoria was widely recognized and was eventually conceptualized in U.S. medicine as a “serious and not uncommon gender disorder” (Billings and Urban 1996: 101).¹⁴

In conjunction with this shift, physicians increasingly referred to patients' desire for sex-reassignment surgeries as an indicator of their mental illness. The origins of Gender Identity Disorder were perceived as psychological, not physical. Within this context, solidifying the distinctions among transsexuality, transvestitism, and homosexuality remained of great concern for physicians. This is clear in Norman Fisk's summary of what eventually came to be behavioral guidelines for recognizing “true transsexuals,” characterized by:

1. A life-long sense of being a member of the opposite sex.
2. The early and persistent behavior of cross-dressing without erotic feelings attached to it.
3. Disdain for homosexual behavior. (Fisk in Billings and Urban 1996: 105)¹⁵

This emphasis on psychological causality allowed patients to exercise agency in obtaining their desired treatment. But the shift from physical designators (like measurements of hormone levels and chromosomal testing) to behavioral evaluation also granted increasing legitimacy to physicians' particular perceptions of gender and sex. This gatekeeping took place through a trope of “true transsexualism” that I explore below.

II. Prescribing Gender: South African Medical Conceptions of Transsexuality

Sex reassignment surgeries in South Africa began to grow in numbers at the same time as did these surgeries in the United States—in the mid 1960s. Statistics for sex reassignment procedures from this time period are difficult to ascertain; anecdotally, between 1969 and 1984, 150 transsexuals were treated at Groote Schuur hospital in Cape Town (South Africa Law Commission 1994: 6), and between 1969 and 1993, 58 sex reassignment surgeries were performed by Dr. Derk Crichton of the University of Natal Hospital in Durban (Crichton 1993: 347). Like statistical estimates of many medical procedures in South Africa, inconsistent records of sex reassignment surgery were kept during apartheid. A few additional sources offer estimations. For instance, within this complicated context, transsexuality is estimated by some South African physicians to occur at 1/37,000 people (Taitz 1993), which would mean there were approximately 1,081 transsexuals in South Africa based on 1996 census reports. Other official estimates suggest that there are 2,500 transsexuals in South Africa (Minister of Home Affairs 2003). Precise numbers are impossible to ascertain and are probably quite understated because of the concealment of doctors and their patients, as well as those who are unable to attain medical treatment.

The discussions that surrounded the decision to begin to perform such treatment are largely undocumented; unlike in the United States, widespread public debates are not part of the history of transsexuality in South Africa. However, one a...

Table of contents

• Title Page
• Acknowledgments
• Introduction: Transition Matters
• 1. Prescribing Gender and Enforcing Sex
• 2. Medical Experimentation and the Raced Incongruence of Gender
• 3. Redefining Transition through Necropolitics
• 4. Stabane, Raced Intersexuality and Same-Sex Relationships in Soweto
• 5. Performing Hierarchies and Kinky Politics: Drag in South Africa's Transition
• Conclusion: “Extra-Transsexual” Meanings and Transgender Politics
• Notes
• Bibliography