Several decades have passed since the West stopped considering homosexuality a mental illness. But for transsexuals, that kind of milestone has been elusive until now. Last month, France became the first country in the world to remove transsexualism from its official list of mental disorders a major victory when it comes to acceptance of this oft misunderstood condition. "I'm relieved. People might begin to look at us differently," says transsexual blogger Caphi (a blended name she's chosen to represent Philippe, the man she was born as, and Caroline, the woman she's transforming into). "It's a start."
But only a start, many transsexuals in France say. In practice, the declaration will do little to improve their legal or medical rights in the country. For example, transsexuals are still required to have a sex-change operation before they can change their gender in the eyes of the law. And to get the green light for surgery, they must still undergo extensive medical and psychiatric evaluations. "It's a symbolic victory," says Louis-Georges Tin, president of the Paris-based IDAHO committee, which fights homophobia and what it calls "transphobia," or discrimination against transsexuals. "Transsexuals are no longer mentally ill," he says. "They're normal citizens. But we haven't yet reached the point where they're allowed to make their own decisions instead of depending on doctors and psychiatrists."
Some transsexuals say the country's open-minded Health Minister, Roselyne Bachelot, removed transsexualism from the list of mental disorders because it was an outdated classification and because she wanted to acknowledge the work transsexuals have done to further their cause. But others see a potentially more troubling motive. Tin worries that politicians may be making allowances on this front to avoid engaging in debate on legalizing gay marriage or removing barriers to allowing gay adults to adopt.
Indeed, the French transsexual community doesn't exactly consider the country to be at the forefront of promoting the rights of sexual minorities. A just-released study commissioned by the Health Ministry, for example, paints a dreary picture of the treatment of transsexuals from a legal and medial standpoint. Sex-change surgeries and treatments are covered by the state as in some other countries but those who opt for surgery have little choice in selecting their doctor. Surgeons complain that they are poorly equipped to perform the complicated procedures and that few have received specialized training, according to the survey. And some even say they are ostracized by their colleagues if they perform such surgeries. For these reasons, many transsexuals choose to undergo the procedure at their own cost across the border in Belgium, home to some of the best sex-change specialists in the world.
Laure Laudet, who is scheduled to have an operation in France to become a woman in the fall, has been so worried about French doctors' lack of expertise in the field that she's done much of her own research, particularly on which hormones she should take. "In the trans community, people have to find their own information, figure out who the good doctors are and negotiate their treatments," she says. Recently, she had to travel 250 miles (400 km) to visit with a second psychiatrist not the one she's been seeing for two years to sign off on her operation. At the last minute, she says, the psychiatrist canceled the appointment to travel abroad. "And then they're surprised that some people try to commit suicide or castrate themselves," she says.
But what advocacy groups find most egregious is that France, like many other countries, requires transsexuals to undergo surgery and become sterilized before they can receive identity cards and other official documents confirming their new gender. "If we refuse, we're basically undocumented," says Caphi. According to most advocates, about half of transgender people a term many prefer, though the French state doesn't use it have no desire to go under the knife, preferring instead to simply live their lives as a member of the opposite sex in their dress and behavior.
This will be the next big battleground. Spain and Great Britain have adopted more lenient stances, even though transsexualism is still technically on the books in both countries as a mental illness. Spain requires transsexuals only to undergo some form of hormonal treatment to modify their physical appearance before it will issue new documents, while the British simply ask applicants, with recommendations from their doctors, to promise to live out the rest of their lives as their chosen sex.
In France, several members of the advocacy organization TransAide have unsuccessfully sued the state in recent years to try to obtain a legal sex change without an operation. They've since lodged appeals and intend to bring their cases before the European Human Rights Court if necessary. "We want to prove that sterilization is what's really at play here," says Delphine Ravisé-Giard, one of the plaintiffs. And the group's got friends at the European level. Thomas Hammarberg, the Council of Europe's commissioner for human rights, has been fighting to end the mandatory sterilization of transsexuals in the European Union, calling it a human-rights violation.
The tide may be turning. At least that's what IDAHO's president hopes. The French Health Ministry has already agreed to push other countries in the E.U. to drop transsexualism from their lists of mental disorders. And that, Tin says, is a start.