Recognition and citizenship
Typically, transgender people find ways to express their strong desire for the recognition of themselves and their identity. Many of the strategies they use to achieve this recognition are brought into play in their interaction with health services and health professionals. Commonly, transgender people have an ambivalent relation to medicine: on the one hand resisting the over-medicalisation of their lived experience; and on the other, recognising their need of the interventions of medicine - such as hormone treatment and surgery - in achieving the desired social and inter-personal recognition.
In our recent study on the health and wellbeing of transgender people in Australia and New Zealand (Couch et al 2007), a central pivot in the concerns expressed about health services is that of forms and processes of recognition. Practices of medicine are implicated in many of the attempts by transgender people to achieve positive health and the self- and socialrecognition for their preferred gender. Additionally, recognition on formal documentary records is, in many cases, dependent upon certified medical intervention. We found that there is, generally, a lack of congruence between the complexity of the lived transgender life, its 'recognition', and the systemisations required by health services.
In addressing the data collected in this study, we were struck by the salience of Axel Honneth's proposal for an 'ethics of recognition' (Honneth 1995), which he has elaborated in dialogue with Nancy Fraser (Fraser and Honneth 2003), and which encompasses both the recognition of rights and cultural appreciation. As Deranty and Renault (2007:97) argue, Honneth moves from a hermeneutic of experiences of injustice to an ethics of recognition, 'because the various feelings of injustice point to three main spheres of recognition': recognition through intimacy by which affective needs are fulfilled, leading to selfconfidence; recognition of the equal dignity of persons, granting self-respect; and recognition of the individual's contribution to the social division of labour, which provides self-esteem.
For transgender people, a full experience of recognition (built up through the layering of selfconfidence, self-respect, and self-esteem) demands formal recognition, through the multitude of documents which constitute and recognise us all as citizens.
Rights attached to citizenship are predicated on evidence of contributions to the common good. Carl Stychin, in his exploration of 'governing sexuality' lays out a logic applying to the possibility of rights and citizenship for homosexuals, as a sexual minority:
... rights ... follow from responsible behaviour. Homosexual acts are not what 'good' citizens do. The family, by contrast, is a realm of self-discipline and selflessness opposed to the hyperindividualism characteristic of late modern societies ... the rights of sexual citizenship seem only to flow to responsible citizens who contribute to the common good (Stychin 2003:123).
The idea of 'sexual citizenship', within this framework of responsibility and the common good, and bestowed as both the sexual rights of specific groups and the confirming of access to general rights by sexual minorities, has been well developed since the 1990s (Bell and Binnie 2000; Evans 1993; Plummer 2001; Richardson 2000; Seidman 2001; Weeks 1998). Cooper (2006) argues that appeals to 'citizenship' have only been effective, and then only partially, in changing policy in local government in the UK to benefit gay men and lesbians, and has not been useful in the recognition of bisexuals, let alone transgender people. One reason for this is the distance between the perception of bisexual and transgender people and the norms of heterosexual binaries of sex and gender.
One way in which this distance is evidenced is in the arguments required by courts before the recognition of the preferred sex of a transgender person. …