The Gender Identity Disorder Diagnosis

Brandon spent seven days at the crisis center. Dr. Klaus Hartman wrote up the initial report. Brandon's history would have included twelve pending charges of forgery, a possible charge of sexual assault on a minor, an untreated rape in October 1990, eating disorders, binge drinking, and an ongoing sexual relationship with a fourteen-year-old girl. The diagnosis? A mild case of identity disorder. After just a few days of counseling, Brandon told her mother that a sex change operation had been suggested by her therapist.

Was transsexualism Brandon's idea or the therapists'? Mental health clinician Deb Brodtke took over Brandon's case at the crisis center and continued to treat her for almost a year on an outpatient basis. Brandon is reported telling Brodtke she wanted to be a male, "to not have to deal with the negative connotations of being a lesbian and because she felt less intimidated by men when she presented herself as male." (Jones, 83) If this is true, what Brandon told her therapist was not that she felt like a man trapped in a woman's body, but a woman trapped in a world where it was dangerous to be female, and especially dangerous to be lesbian.

Jones' book does not record any attempt on Brodtke's part to challenge Brandon's internalized lesbophobia. There is no record in her narrative of efforts to supply Brandon with information about lesbian culture or lesbian history, information about lesbian coming-out groups or groups for young lesbians. There is no record of her attempting to connect Brandon with an adult lesbian who could counsel or mentor her. The "gender identity disorder" (GID) diagnosis reflects the historical heterosexism of the mental health field, which has traditionally understood gay and lesbian desire as evidence of the desire to become a member of the other sex.

Brandon's diagnosis appears not to have included alcoholism. It's interesting to note how prevalent the use and abuse of alcohol is in the documentary, the biography, and the feature film—and yet how absent it appears to have been from the treatment plan. If alcohol abuse had been identified as even a contributing factor to the chaos and torment of Brandon's young life, it seems logical that there would have been some attempt to incorporate a recovery program into the treatment plan.

And finally, Brandon's GID diagnosis, so replete with homophobia and gender bias, also appears to have ignored the "elephant in the living room"—the incest. The account of Brandon's treatment and diagnosis does not appear to include Complex Post-Traumatic Stress Disorder, a syndrome commonly associated with survivors of child abuse, and especially survivors of incest. This is remarkable given the fact that, at the clinic, Brandon presented with a record of years of untreated child sexual abuse, a report of a recent rape, an escalation of criminal activity, a history of multiple identities, sexual predation toward under-aged girls, extreme risk-taking behaviors, avoidance of medical care from fear of routine examinations, eating disorders, suicidal ideation, terror of being in a female body, expressed fear of men, preference for protective clothing, and compulsive bathing—six or seven showers a day with changes of clothing. (Brandon's obsession with cleanliness would continue throughout her life, and, according to friends, even in her last years, she was still taking three or four showers a day.)

Instead of a diagnosis related to trauma, the therapist apparently sent Brandon home with information about "gender reassignment" surgeries, which would include such procedures as suturing the vagina, removing the breasts, ovaries, and uterus, transplanting the nipples, constructing an appendage using skin grafts from the thighs, and administering steroids. Brandon's friends reported that Brandon expressed a marked ambivalence about these recommendations.

Her sister Tammy remembers the family's reaction:

Basically, we were getting worried about Teena. And we couldn't get any help for her… you know, not help to deal with her being gay or anything like that, but help to deal with her trying to figure out herself. Maybe she needed some counseling. And she had mentioned to us about committing suicide, so we kind of used that as a reason of getting her to there [Lincoln General Hospital], and the psychologist there said that Teena needed long-term help… which I don't know if that was really the case, but they did send her out to the Crisis Center, and… I wish I really knew what Teena had told them or what those doctors had told Teena, but basically, she came out of there saying, 'I want a sex change,' and… 'They told me I need to do this and that.' And they might have told her that, but I don't know if that's really what she wanted to do." (Muska)

In advocating for the surgery that would facilitate Brandon's transition, the therapist advised her of the professionally-mandated, year-long probationary period, a period in which the patient would be required to live as a man. Had Brandon described her current strategies for passing as a man in relationships—strategies involving the deception and statutory rape of naive and inexperienced minors who were unlikely to be assertive or educated enough to confront Brandon's sexual subterfuges? If the therapist did address the legal, ethical, or safety issues of these strategies, Brandon never saw any reason to revise them. In fact, armed with the official diagnosis of "Axis I: transsexualism," Brandon escalated her deceptions and seductions.

After this counseling, her repertory of lies expanded to include tales of her grandmother's plans to send her to Europe to have the surgery done, and of scheduled dates in June 1993 for a bilateral mastectomy. She told her various girlfriends at various times that her vagina had been sewn up, that "something" had been implanted that would eventually grow into a penis, and that she had begun hormone therapy. Like the stories of hermaphroditism that preceded the transsexual diagnosis, all were untrue.