說些醫生想聽的話－變性評估的性／別政治

Say Whatever Doctors Want to Hear: Gender and Sexuality in the Diagnosis of Transsexualism

陳美華(Mei-Hua Chen) ； 蔡靜宜(Ching-Yi Tsai)

《台灣人權學刊》 2卷2期 (2013/12) Pp. 3-39

摘要

變性者的性別實作在部份女性主義的書寫中，經常被視為是運用男性掌握的外科手術來鞏固、複製二元化的性別體系。籍由訪談七位變性者以及三位進行變性評估的精神科醫師，本文將指出變性者這個範疇同時涵蓋非常不一樣的個體；他／她們來自不同的家庭背景，擁有不同的社會、經濟與文化資源，同時變性主體認同的途徑也不盡相同，並非精神醫學的病理模型可以解釋。其次，變性評估的過程是高度不確定的，變性者的社會、經濟與文化資源，以及評估醫師的主觀評價會影響評估結果。第三，變性主體對於打造異性別身體的想像是高度異質的，變性精神評估的不確定性不僅使得變性主體背負莫大壓力，同時評估過程中的「真實生活體驗」、變更法定性別身份須以摘除生殖器為前提等社會與法律實踐才是迫使多元的變性主體必須走向一致性的原因。本文建議，精神醫學應正面回應DSM-V對於變性、性別主體去病化的路線，鬆綁現行嚴苛的評估程序。

關鍵字

性別 ； 性 ； 跨性別 ； 變性慾 ； 真實生活體驗

並列摘要

Transsexuals have been frequently represented by some feminists as using male-dominated physical surgery to reproduce gender hierarchy. Drawing upon interview data and observation on 7 Taiwanese transsexuals and 3 psychiatrists, this paper aims to reveal gender politics in the process of diagnosis of ”original transsexualism” in Taiwan. We argue that transsexuals are varied in terms of social backgrounds and grow-up experiences, and thus could not be reduced to the phathological pattern identified by the DSMIII. Secondly, we find that the diagnosis of original transexualism is extremely uncertain. Interviewees who sought sex change surgery reported that social, economic and cultural capitals of transsexuals and the doctors' subjective ideas of gender norms are key factors to shape the diagnosis. Thirdly, we argue that there are many different imaginations regarding the sex-change among transsexual interviewees. On the contrary, it is the gendered evaluation of 'real life experience', and the related regulations regarding changing sex on IDs reproduce the dichotomized gender system, rather than transsexuals themselves. We strongly suggest that Taiwanese psychiatrists should adopt newly revised DSM-V which has been de-phathologized transsexual and transgender since 2012.

並列關鍵字

gender ； sexuality ； transgender ； transexualism ； real life experience