KJ Selections

Kyoto Journal #64, Nov-Dec 2006

Questioning Gender
An interview with Japan-based psychotherapist Kim Oswalt
By Stewart Wachs

Kim Oswalt, an American psychotherapist who has been working with transgender clients in Japan for nearly five years, does not view transsexuality as a mental disorder. The very real suffering that Oswalt seeks to relieve is, she says, partly rooted in the client’s social context — in society’s rigid insistence on stable, binary gender role archetypes. Seen in this light, the true disorder becomes the widespread aversion known as transphobia: intolerant attitudes and discriminatory behavior towards transgender people. In many cases, Oswalt says, transgender clients themselves internalize this transphobia, setting up a severe inner conflict.

“Nearly everyone is indoctrinated into a binary mindset,” she contends.

Oswalt earned her MA in Contemplative Psychotherapy at the Naropa Institute in Colorado, where she wrote a Buddhist-inspired thesis that drew upon the Heart Sutra as a key text. She recalls “being required to go for a month each year to meditate in the mountains and watch that ego construction dissolve at your feet. And then the ways that we scrambled to put it back together again, and how that perpetuates suffering — that whole scenario, saying, ‘This is who I am and I’m separate from you, a permanent entity here, and I’ve got a story to tell and it’s very consistent.’ If you hang out in the meditation hall long enough and follow the instructions, you’re going to realize how unstable that story is.”

For years prior to Naropa, Oswalt had been deeply involved in human rights work and community organizing: peace and justice activism, refugee resettlement, advocacy for the homeless and victims of domestic violence. While studying psychotherapy, Oswalt became acquainted with a transgender female classmate, and through this relationship she came to see that transgender people and those who identify as genderqueer* sometimes face identity issues, and more threateningly, formidable social hurdles. After completing the program, she and her colleague teamed up to form a transgender support group in Boulder. Oswalt brought to this endeavor both her Buddhist perspective and her social conscience. “I had done my internship at University of Colorado Multicultural Psychological Services,” she explains, “looking at the social construction of mental illness, the ways in which the dynamics of oppression and privilege play into psychological struggles. You don’t look at a depressed person without also asking about their income, ethnicity, or sexual orientation, and then you put their depression into a matrix to understand them psychologically.”

Kim Oswalt’s earliest childhood memories are of Japan; when she was one year old, she and her mother came to Japan by ship to join her father, then in the military. The family stayed until Oswalt was three, and Japan would lure her back for several more years in the 1980s, when she began to study the koto. For many years, with a musical partner on shakuhachi, she performed and recorded contemporary Japanese music professionally. Not long after returning to Japan in 2002, Oswalt offered a workshop for about sixty members of the Japanese transgender community, mainly male-to-female (MtF). Next, she helped to organize Japan’s first female-to-male (FtM) support group, a springboard for ongoing transgender community organizing.

Oswalt lives in Karuizawa, Nagano Prefecture, and sees her clients both there and in her Tokyo office.

*Genderqueer: Someone who rejects the traditional gender binary and identifies as a) neither male nor female, b) as both, or c) as a combination thereof.


Stewart Wachs: What is it that attracts Japanese transgender clients to you, a non-Japanese therapist?

Kim Oswalt: Well, many psychotherapists here are undereducated about how to work with transgender people and what their needs are. That’s true in many countries, including the U.S. What transgender people will often ask for help with is undoing their own internalized transphobia. And there’s a lot of institutional and cultural support for that voice which says, “I must be mentally ill.” There’s also a diagnosis in the DSM-IV (the current edition of the Diagnostic and Statistical Manual of Mental Disorders). It’s called “gender identity disorder (G.I.D.).” So what people will often present when they come to therapy is this notion that for some strange reason I look in the mirror and I don’t recognize what I see as my body. I don’t identify with the gender I was assigned at birth, and because of that there must be something wrong with me. Any good therapist, in my opinion, would start with how to help the person untie the knots of internalized oppression. But some therapists instead ask, “How do we help this person recover and go back to the gender that they were assigned to at birth?” They don’t accept the fact that the person identifies as some other gender. Haven’t you heard of therapists that are trying to help “recovering” gays and lesbians? That’s a very dangerous game.

I have a client here in Japan who collapsed one day in the street, just from looking at a particular female and seeing her as a mirror. This person, forty-something and biologically assigned at birth as male, went to a psychiatrist who said, “You’re suffering from bipolar disorder.” But the client said, “No, I don’t think that’s it. I may be talking very fast, and not sleeping at night, and I may look very manic to you, but I think there’s something about seeing that woman on the street and realizing that I was looking at myself.” And this person presented as very stereotypically male. It was a tipping point of consciousness: someone finally getting it that “my problem up until now has not been that I’m an unhappy person or that I suffer from a mental disorder, but that I am not the male that I have up until now tried to be.”

This client has now so altered her physical appearance that she now recognizes herself when she looks in the mirror. She speaks much more slowly and articulately; she looks much more comfortable in her body, she is happy, and her wife is not divorcing her. And I must say, in my experience, this is the first time I’ve watched a couple who initially identified as heterosexual go through this transition together and stay together. They also did couples counseling to help them with their adjustment. The wife had concerns about her shifting identity, her own sense of looking like a lesbian couple, and feelings of loss that the person who used to be her “husband” is now her female partner. This couple has stayed together and so far so good. The client, whom I have been seeing individually, is as happy as she’s ever been, and she’s even kept her job. That, too, is unusual: for an employer to maintain the employee after gender transition. She’s scheduled for gender reassignment surgery in a couple of weeks, and she’s altered her legal documents to conform with her female identity.

Another client who came to me was a schoolteacher. He very much identified as male but presented as female. The greatest concern, aside from losing his teaching job, was that his family of origin would never accept him as male. And he agonized over how to maintain the intimacy that he loved and shared with his family while coming out to them as a transgender male. Over a period of many months we talked about how he was going to do this. Finally, one day he showed up for counseling just elated, and said, “I finally did it!” The family had lined up in a washitsu, a tatami room. He, on the other side of the room, bowing to the family: father, mother, and all of the siblings.

“I have something I want to talk with you all about,” he said. “From now on, I want you to pronounce my name differently. The same kanji, but I want you to call me by a more male-sounding name. The reason I want you to do that is because I don’t identify as female, but as male. I may look the same to you, and I may never even alter my appearance, but I identify as male, and it would mean a lot to me if you would all call me by this name.” And much to his surprise and joy, his mother burst into tears and said, “How you have been suffering and I didn’t know! If I had known I would have always called you by that name. We want you so much to be happy.”

These positive examples suggest that transphobia can be overcome. How might the experience of transgender and genderqueer people in Japan be different from, say, the U.S.?

The moral and spiritual roots of Japanese culture are different from Judeo-Christian roots. Japan has a history of polytheism: many small gods. There are the gods of the mountain, the kitsune fox god, and the gods that live in trees, and even today Shinto priests offer prayers essentially asking for forgiveness from the tree spirits before they cut trees to build a house. It’s almost like a shamanistic root that goes back beyond Buddhism, and they still live in Shintoism and shamanism. Monotheism can foster the notion that “my god is right and yours is wrong,” or doesn’t exist. But if your god is a god of the mountain, and mine is a god of the trees, we’re probably going to get along fine because mountains need trees and trees need mountains.

Spiritually speaking, this is a very pluralistic society. People get married in a church, and on the same day they may go to the Shinto shrine, and when a relative dies they'll go to the Buddhist temple. On a wedding day, if they want to put on a kimono and then switch to a white lacy dress nobody’s got a problem. The more the merrier. My inkling is there’s something here that makes life a bit easier for transgender people than in the U.S. They're not told that they’re going to hell for being transgender. God does not hate them; you don’t hear that here in Japan. You may have social prejudice, but you also see people like Miwa Akihiro, a transgender female with blonde hair, being consulted on NHK-TV by everyday people, like Dear Abby, and she’s elevated. Folks really want to know what she thinks about things, and they’re not even talking about the fact that she’s transgender. That is probably not likely to happen in mainstream U.S. culture.

And then there’s the koseki (official family register) issue that has finally been altered here in Japan. If one goes through x number of medical interventions and meets a list of strict criteria, one can change one’s legal gender designation. But that’s a very recent change in policy, and it was led by the (conservative) LDP party, of all things. Is that going to happen in the Republican Congress? Highly unlikely! So although there is trans-oppression here in Japan, I think there is a degree of tolerance in this culture that distinguishes it from the U.S., and this benefits transgender and genderqueer people. Here are two examples: the longstanding tradition of kabuki theater, where men play female roles, and more recently the Takarazuka Review [see KJ #64, P. 96], where the reverse holds true. These are ways in which Japanese culture tolerates and even celebrates gender diversity.

With that said, transgender still seems to be a cutting-edge human rights issue here.

Yes. There’s just no way you can work in the transgender communities effectively and not be politicized. It’s everyone’s issue. As they say, gender rights are human rights. Those professionals who offer only a diagnostic medical model misunderstand gender variance to be a pathological mental state. And as mental health providers we’re supposed to be doing no damage, yet I think that is damaging.

When you say “medical model,” I assume you’re not talking about the doctors who actually perform the surgeries and hormone therapies for gender reassignment?

Right, that’s different. That also involves human rights issues. But I’m talking about doctors who might keep a patient waiting for hours for a five-minute session that determines whether or not they’ll be prescribed with hormones. And it’s a very fine line: The reason why somebody would be given masculinizing hormones, for instance, with coverage under the Japanese medical insurance system, would be because they have a diagnosable mental illness. So there’s some advantage and disadvantage: if you buy into having G.I.D., with the support of a psychiatrist, Japanese national health insurance pays for hormones. On a practical level, that’s very important financial support. Then there’s the question of male privilege. Many in the FtM community who have been treated like second-class citizens all their lives discover, after taking masculinizing hormones, that their voices drop, they start growing beards, and they’re being given privileges they never had before. These people, while changing their bodies, do not want to lose their feminist values by exercising male privilege.

What are the developmental stages with transgender clients, keeping in mind individual differences?

There’s no one way that things go, in a universal sense. But an initial step would often be to look at the degree of internalized oppression, and identifying the sources of it, so that the person can access a new voice, like waking up after a bad dream, and say, “Maybe there’s nothing wrong with me at all.”

Another step would be to help clients feel comfortable with whatever changes they may want to go through with clothes, makeup or hormones — to help them start considering the possibility that all of those things are within reach. I have a client who in the very early stages was extremely transphobic and afraid to go out dressed up in more “female” clothing. So we agreed to meet in Shinjuku at a very classy place for coffee, so that we could walk in and the maitre d’ would simply ask, “How many?” And this client felt so happy just to be able to go out in public dressed as she felt most comfortable.

Another stage may be outrage: “What’s going on here that I would feel so twisted, unable to be myself?” Recognizing that there is oppression in reality, and where it comes from.

Yet another stage might be, “I thought I had to have long fingernails and makeup and three-inch stilettos, but I can still be a female and wear a T-shirt and jeans with hiking boots. Maybe even no makeup. Why do I need to pass, and for whom?” Having said that, it is also true that many do need to pass in order to get and keep a job. These issues are complicated. A person needs income.

Now, again, these linear-sounding stages are not universal to everyone. I have a client who’s perfectly happy to stay in three-inch high heels, buy handbags at Gucci, wear lots of makeup and speak in a falsetto voice, and she doesn’t feel that she needs to “progress,” you know? She likes herself just exactly the way she is right now and she’s happy to be “beautiful” in a very stereotypic way. That’s what she understands herself to be. On the other hand, there are many identifying as women who see that a woman is also more vulnerable to rape or domestic abuse. It’s not up to me to patronize any client by convincing them they should be some “other way.” If a transwoman wants to ask those questions herself, we can surely explore them in the name of her being more free to wear more comfortable clothes, and be able to run in her shoes if she wants to. I’d also like to say a few words about class differences within transgender communities which make medical intervention possible for some yet unavailable to others, for example expensive facial reconstruction or gender reassignment surgery.

Which raises the question: Is there any infighting in transgender or genderqueer communities?

With marginalized groups you tend to have a lot of infighting, instead of looking at where the ultimate power really is. On the one hand it’s important to realize that the FtM and MtF people have differences, but if we use that to divide ourselves from the greater issue of transgender oppression then we’ve defeated ourselves. Even within the MtF community there are all kinds of divisions going on, and it’s very sad. It’s all about the pecking order of, okay, if you are, for example, a cross-dresser and you cross-dress after five, but in your nine-to-five job you stay in your male mode, then you’re not threatened with the loss of your job. Your family may or may not know. You’re still functioning pretty well but just going out and buying pretty clothes, and after five you get to drag around in the bars. But if you say, “I’m transgender,” and you go fulltime, you’re putting your job on the line, you may lose your children, your spouse may divorce you, and maybe you don’t even have the money for laser surgery and you’ve got beard growth. That’s a different level of risk. Then there may be some internalized oppression saying, “Oh look, you’ve gotten the money to have cosmetic surgery, so you look more beautiful than I do.” I have a client who’s going this week and spending millions of yen on cosmetic facial surgery to get rid of facial hair so she will look more feminine. There are all these little divisions even within just the MtF community. If I can afford costly facial surgery am I somehow better than you? Or, why would a cross-dresser be less important than somebody who identifies as transgender? I’m just giving you a little taste of it here.

And then on the ultimate level, the Heart Sutra says no man, no woman, no I, no you, none of this is ultimately true. But on the relative level it’s very true. And so how do we be compassionate and honor the relative level as something that teaches us about the ultimate level of truth? They’re all mixed in together. If we weren’t in this messy, three-dimensional world we might not be able to understand things as well about the ultimate. In a way it’s a teaching ground. If you want to put your compassion to work, in my opinion you’re not going to be able to avoid messy battles and conditions. Things are just not clean, and they’re sometimes very confusing.

Speaking of confusion, many people have trouble understanding genderqueer people — that is, if they know anything about them.

Yes, the idea of transgender is transitioning towards something, having an endpoint in mind: for example, female, or at least female-ish. Whereas genderqueer folks are saying “neither/nor, both/and, I don’t even want to talk about gender because I don’t believe in it, and don’t genderize me. I don't want to be called female or male. I just want to be myself.” It’s as if to say the whole idea of gender is oppressive.

Do they organize politically?

Yeah. One example would be FtM groups here in Japan. A lot of those people might take masculinizing hormones simply because they want to transform their bodies, or have chest reconstruction if they can afford it. But they may not identify as male. For many, genderqueer is a revolutionary term implying anarchy and overturning established binary structure. They are about not assimilating, not trying to pass, or look like anything that makes another person feel comfortable.

And this is all within the Japanese context as well?

Yes, there’s that element as well in Japan. One example is the Queer & Women’s Center in Osaka. Several people I know very well started that organization. They’re about queer politics, which are a lot more about upsetting power structures than about getting electrolysis and passing. On the other hand, everything has another voice, and that’s why I want to be really careful. I am an ally and an advocate but I don’t identify as transgender myself, so I want to be very careful in not making blanket statements. After all, there is something very important to be recognized about the need to pass — for one’s safety, for one’s job. You can’t just say, “Oh well, who cares and I’m just genderqueer” when you’ve got to pay your electric bill this month and be able to keep your job. In the U.S., there are certain neighborhoods where if I don’t pass pretty well, my life is going to be endangered. So I don’t want to say that passing is a sellout.

Each case is different. What I hold in the back of my mind when I work with my own clients is, “How do I help this person feel most empowered, and most themselves, whatever that means on any given day, since it’s subject to change.”

For anyone oriented toward Buddhism these cases offer opportunities for our minds to wake up. My own mind has been through so many revolutions just because of having to change my language and my way of seeing the world. Nevertheless, our egos will sometimes get in the way even though we’ve meditated and meditated. I myself still get threatened, really scared, going into uncharted territories, and I think, “Well, I don’t know where this client wants to go, but I am going to walk with them and hopefully be their companion while we walk through some pretty scary places."

Stewart Wachs is KJ's associate managing editor, and was inspired to write this article by UK transgender activist Mark Rees. Copyright is held by the author.

---

Back to Selections
Subscriptions