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MindTap Case Study: Tiana
First, complete the following activities in MindTap:
· Explore: Chapter 9 Investigate Development: Gender in Schooling
· Decide: Chapter 9 Investigate Development: Gender in Schooling
· Defend: Chapter 9 Investigate Development: Gender in Schooling
Think about the factors that influenced your recommendations for Tiana and why you chose the option(s) that you did. Then, record a video of yourself addressing the following key areas:
· What does it mean to be transgender?
· What sorts of medical interventions do transgender individuals typically undergo?
· What are the social and psychological risks associated with being transgender?
· What are the legal responsibilities of schools with respect to transgender students?
Video transcript
Introduction
Hi, I’m Dr. Carey Moses, the lead school psychologist in a large, public high school. Our team helps a diverse student body with a variety of concerns. In recent years, issues related to gender and sexuality have become increasingly common, and these continue to evolve as our understanding of gender and sexuality advance.
I’d be interested in hearing what you think about a young woman I’m working with now. Fourteen-year-old Tiana identifies as female although she was labeled as male when she was born. Tiana is transferring into our school after being relentlessly bullied at her previous school. Beyond a zero-tolerance policy for bullying, what factors should we consider in attending to Tiana’s needs? How can the needs of a student be balanced with the needs of the student population as a whole? What role should the school play, and what standards should be applied? These are the questions you will answer as you
Make a Decision.
To answer these questions, you will
Investigate the Evidence
I have collected from Tiana and others in her life.
But before you
Investigate the Evidence
, take some time to
Consult the Research
I’ve collated for you.
Consult the research
Words such as “transgender” and “gender fluid” are becoming more commonly used as people who identify as such speak more openly about themselves and their experiences. More and more students reject the notion that biologic sex determines gender identity, and recognize that gender, like sexuality, exists on a continuum. With science and society both changing rapidly, even the idea that transgender individuals will (and should) inevitably seek hormone therapy and sex reassignment surgery is now a question of debate.
Take a moment to
Consult the Research
to find out more about issues related to gender identity in adolescence. Then
Investigate the Evidence
from Tiana’s life and that of her family before you
Make a Decision
about how to best address her circumstances.
Sex and Gender
Sex refers to biological status and is typically categorized as male, female, or intersex (American Psychological Association, 2011). In contrast, gender is largely a social construction, and refers to the attitudes, feelings, and behavior that a given culture associates with being male or female (World Health Organization, 2016).
· Intersex refers to conditions in which an individual’s reproductive organs do not seem to fit “typical” male or female anatomy (Intersex Society of North America, 2008a). It occurs in an estimated one in 1,500 to one in 2,000 births (Intersex Society of North America, 2008b).
· Gender identity refers to one’s innermost concept of self as male, female, a blend of both, or neither. One’s gender identity can be the same or different from their sex assigned at birth (Human Rights Campaign, 2016).
· Gender expression refers to the external appearance of one’s gender identity, usually shown through behavior, clothing, haircut, or voice. This expression may or may not conform to socially defined behaviors and characteristics typically associated with being either masculine or feminine (Human Rights Campaign, 2016).
· Sexual orientation refers to how one is emotionally, romantically, and/or sexually attracted to other people, and includes homosexual (gay or lesbian), heterosexual, bisexual (attracted to both males and females), pansexual (attracted to others regardless of their sex), skoliosexual (attracted to people who do not identify with the gender binary or to those who are not cisgender), and asexual (not sexually attracted to anyone) (SexInfo Online, 2016).
· Spectrum-based models and gender-expansive terms promote greater understanding of the separate but interrelated concepts of biological sex, gender identity, gender expression, and sexual orientation along a continuum rather than as binary models (Gender Spectrum, 2015).
Individuals are said to be
Trans Basics
transgender if their biological sex differs from their gender identity (internal experience of gender) or cisgender if their biological sex and gender identity are consistent (Cantu Queer Center, 2016).
· Being transgender does not imply any specific sexual orientation. Therefore, transgender people may identify as straight, gay, lesbian, bisexual, etc. (Human Rights Campaign, 2016).
· Individuals who identify as gender fluid may view themselves as male, female, a blend of male and female, or neither male nor female based on behaviors, interests, or other characteristics, and they may change this identity at any time (Gender Diversity, 2016).
· Historically, the term “gender identity disorder” has been applied to individuals who are transgender. The term gender dysphoria has more recently been adopted to remove the connotation that transgender is, in and of itself, a disorder. Only those individuals who experience clinically significant distress of functional impairment as a result of being transgender may be diagnosed with gender dysphoria (American Psychiatric Association, 2013).
· The number of transgender individuals in the U.S. has been estimated as about 700,000 or 0.3% of adults, but this is widely recognized as an estimate that may be flawed (Paquette, 2015).
· There is increasing evidence that transgenderism has a biological basis and is associated with prenatal neurohormonal factors (Corsello et al., 2011) and neuroanatomical differences (Saraswa et al., 2015).
Identifying as Trans
A family environment and parenting practices that affirm a child’s own sense of gender strengthen a child’s self-esteem and sense of self-worth (Gender Spectrum, 2016).
· Between two and three years of age, children begin to develop a gender identity and by ages five or six, children have gender scripts or a sense of what behaviors are male and what behaviors are female (Putnam et al., 2013). It should therefore come as no surprise that even very young children may express a transgender identity (Gruener and Sillman, 2016).
· Transgender children as young as five years of age express a gender identity that is like that of cisgender children with the same gender identity (Olson et al., 2015).
· When transgender children who live socially in their gender identity are supported by their parents, they do not differ from cisgender children in terms of depressive symptoms and have only marginally elevated symptoms of anxiety (Olson et al., 2016).
· Coming out (identifying to others as trans) can be fraught with difficulty at any age, including during childhood and adolescence; 80% of trans students feel unsafe at school because of their gender identity and 59% have experienced verbal harassment at school as a result of their gender expression (Trans Student Educational Resources, 2016).
· Despite the age at which individuals may first identify or come out as transgender, most transgender individuals do not transition (to live full-time in their gender identity) until ages 18 to 44 (Grant et al., 2011).
Transitioning
It is estimated that about 55% of transgender people live full-time in a gender identity different from their sex at birth; 27% would consider doing so at some point in the future and the remainder do not want to do so (Grant et al, 2011).
· Some trans individuals transition socially and may change their name and appearance without any medical intervention (Glicksman et al., 2013).
· Trans children who are entering puberty may take hormone blockers that will prevent the development of secondary sex characteristics associated with their biologic sex. This gives these young people more time to be certain that they wish to undergo medical transition (Center of Excellence for Transgender Health, 2016a).
· Medical transitioning refers to both nonsurgical (e.g., hormones) and surgical procedures. About 61% of transgender individuals undergo medical transition of some type (Grant et al., 2011). For example, the use of cross-sex hormones for transgender individuals is becoming increasingly common throughout the world (Center of Excellence for Transgender Health, 2016b).
· Only about 33% of transgender individuals report surgical transitioning. This is in no small part because the costs of transitioning are typically paid for out-of-pocket and prohibitively expensive for many (Grant et al., 2011).
· Male to female surgeries may include orchiectomy (removal of the testes), vaginoplasty (creation of a vagina using penile tissue), breast augmentation, and facial feminization. Female to male surgeries include chest reconstruction/mastectomy, hysterectomy/oophorectomy (removal of uterus, fallopian tubes, and ovaries), metoidioplasty (construction of male-appearing genitalia employing a testosterone-enlarged clitoris), phalloplasty (construction of a phallus using tissue from another part of the patient’s body), scrotoplasty (construction of a scrotum) and urethroplasty (creation of the urethral canal through the neophallus) (Center of Excellence for Transgender Health, 2016c).
Living as Trans
Stigma and discrimination remain major issues for individuals who are transgender.
· Outright discrimination against individuals who are trans or gender nonconforming is common; in a recent survey, 65% reported experiencing discrimination in public accommodation (transportation, restaurant, retail, public gathering, or health care settings) in the previous year. Such discrimination has significant impacts on mental and physical health of trans and gender nonconforming people (Reisner et al., 2015).
· Stigma also seems to play a role in “bathroom bills” that seek to force individuals to use public restrooms associated with presumed or assigned natal sex, even when it is clearly inconsistent with their gender identity and despite the fact that there is no evidence that allowing trans individuals to use the restroom consistent with their gender identity puts others at risk (Lambda Legal, 2015).
· Greater exposure to stigmatizing results in higher levels of depression and anxiety (Yang et al., 2015) and can create difficulties in accessing medical care (Kosenko et al., 2013).
· Trans individuals are known to be at elevated risk of suicidality, a risk that is attributable to both individual factors such as internalized stigma about being trans as well as structural stigma (Perez-Brumer et al., 2015). For example, denial of access to gender appropriate restrooms and housing is associated with increased risk of suicidality among transgender college students (Seelman, 2016).
· Hate crimes, including homicide, against transgender people are a significant problem (National Coalition of Anti-Violence Programs, 2015). Although there are significant limitations to federal hate crime statistics (including the likelihood of under-reporting), gender identity-related hate crimes more than tripled between 2013 (the first year in which they were reportable) and 2014 (Criminal Justice Information Services, 2016).
Investigate the Evidence
Here is a portion of my conversation with Jason, Tiana’s father. Click any of the questions below to view Jason’s responses during our meeting.
Meeting with Tiana’s Dad
Q: Thank you for meeting with me today. Would you explain Tiana’s situation by giving me some background?
A: Thank you for meeting with me as well. Well, Tiana is trans. We had the usual pregnancy ultrasounds and thought we were having a boy. He looked like a boy so we started raising him as our son. By the time he was a toddler, though, he clearly had an interest in all things girly. And it wasn’t just a phase he was going through; his interests never changed to include boy stuff. He wanted to wear princess costumes for Halloween and wear dresses. I thought he might be gay, which, to me, isn’t an issue, but by that time, he was in elementary school and I didn’t want him to get beat up either. So I took him to his pediatrician. By then, my wife and I had separated and she was living across the country. She isn’t really in Tiana’s life at all at this point, which is good, because she’s, well, transphobic would be a kind way to describe her.
Q:What happened with the pediatrician?
A: He talked to Tiana and told me that Tiana, then known as Mike, felt like she was a girl. She hated being a boy, hated her penis, even hoping that she would be in some kind of accident and it would be cut off. So it wasn’t “just” that she was gay. The doctor referred us to the University Center for Gender and Sexuality and, over time, it became clear that Tiana is trans. When she was 11, Tiana started showing signs of puberty and, with the endocrinologist’s support, she decided to start hormone blockers that would keep her from going through puberty, something she was dreading. And that’s when things started getting really bad at school. There had been teasing before, but now, as the boys were going through puberty and Tiana clearly wasn’t, Tiana was targeted. She wasn’t officially “out” in public and was still presenting as a boy at school, but everyone knew she was different.
Q:What exactly happened when things got bad for her at school?
A: It got really ugly really fast. Name calling, making gestures and comments that were clearly aimed at Tiana, even pushing and grabbing, and on a daily basis. And the school administration knew about it. They mostly blew it off as age-related. The principal did speak to several of the boys, but if anything, that only made things worse. Tiana got to the point where her grades, which had been nearly all A’s, went down considerably. She just didn’t want to get out of bed on weekday mornings, much less go to school. She was diagnosed with depression and is on medication for that now, but it became clear that something more had to change. We talked to the treatment team at the Center, and they suggested transferring to a different school and presenting as female from the start. Tiana and I both agree that this is the best possible solution.
Meeting with Tiana
Q: Hi Tiana, Would you please tell me a little about yourself?
A: I’m in eighth grade, and really wanting to switch schools. Basically, I feel out of place at my current school. I was born with a medical problem that made some people think I was a boy. I can’t ever remember feeling like anything other than a girl; I’ve just never wanted to be a boy. Now I take hormone blockers so that I won’t, like, wake up with a mustache one morning.
Q: I understand you had some problems in your oold school?
A: A bunch of transphobic bullies decided it would be fun to “make a man” of me by demonstrating how “real men” act. I was pushed into and held up in a locker last month. So, yeah, I’ve had some bad stuff going on. And people at school saw things happen, like they saw me get hit and pushed and grabbed at, and heard me getting called names – they know I’ve gotten texts telling me to kill myself, and no one really tried to stop it. So my dad and I decided I should probably change schools.
Q:What would you want to have happen here, in the best of all possible worlds?
A: I’d like to be treated just like any other girl. I’d like for teachers and the other kids to use my name, Tiana and “she” and “her,” not “he” and “him.” I want to dress like any other girl at the school and wear make-up like them. I am hoping I won’t have to have my guard up all the time because I’ll really be just one of the girls.
The principal from Tiana’s former school sent a letter to explain how the school handled conflicts involving Tiana and her classmates.
Tiana’s psychologist provides information on how Tiana’s circumstances have impacted her and outlines Tiana’s current medical treatment
The counselor plans to distribute the following flyer on the school campus, obtained from the local university’s Gender Equality Center.