In a very real sense, you don’t force the U.S. military to do anything it doesn’t want to do, contrary to what David Coombs said in a TV interview with NBC’s “Today” Show: “If Fort Leavenworth does not [provide hormone therapy for Chelsea Manning],” Coombs said, “I’m going to do everything in my power to make sure that they are forced to do so.”

Coombs is a former U.S. Army Judge Advocate, now in private practice representing military service members. Coombs defended Manning against charges of espionage and aiding the enemy after Manning, an intelligence analyst in the U.S. Army, was accused of leaking classified information on the wars of Iraq and Afghanistan. Manning, formerly known as Bradley Manning, came out after sentencing that she wanted to live her life as a female.

So what if the Army won’t be forced into allowing Manning to live her life as a female — even if Manning pays for hormone therapy out of her own pocket? In a report by the Associated Press, Coombs said he is ready to sue to get Manning what she needs.

Despite the repeal of the military’s “Don’t Ask, Don’t Tell” policy in 2011, transgender soldiers can still get the boot. “[I]f the military finds out,” wrote Colin Daileda for the Atlantic last year, “you’re gone.”

Gender dysphoria

Ed Fitzpatrick, a columnist with the Providence Journal who recently interviewed Coombs, was kind enough to allow me insight into Coombs’s work on this case. (I attempted to reach Coombs directly, but he is, at the moment, a busy man.) Fitzpatrick relayed to me that Coombs is trumpeting the APA’s guidelines on standard treatment for gender dysphoria, a condition defined as a state of feeling unwell or unhappy with the sex assigned at birth. The treatment for gender dysphoria is counseling, then hormone therapy.

The APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) previously condemned psychological distress associated with gender as a disorder. The DSM has gone through major revisions in its lifetime since its original publication in 1952, and each revision recognizes new psychological disorders and maladies, and modifies or removes existing conditions. DSM-5, the latest version, was published this year.

Note that a revision (a process that takes years) generally mirrors the politics of the time period in which the current version is being revised; in this way, homosexuality as a disorder was completely removed from DSM-3 in 1986, with the exception of a psychological diagnosis for “persistent and marked distress about one’s sexual orientation.” (See the UC Davis publication Facts About Homosexuality and Mental Health.)

Similarly, DSM-5 no longer includes “gender identity disorder,” which was replaced with gender dysphoria. Gender dysphoria can be characterized as persistent and marked distress about one’s gender identity, much like the distress that may occur in someone who is grappling with his or her sexual orientation.

The bottom line is that being transgender, like being gay or bisexual, is not a disorder. It’s not mental illness at all. Rather, significant anxiety about being transgender may be what gives rise to a psychological diagnosis, and that’s exactly where Manning finds herself.

Outdated conceptions in the military

A letter from Sigmund Freud to the mother of a son apparently suffering from anxiety regarding his sexual orientation (again, see the UC Davis publication Facts About Homosexuality and Mental Health) illustrates Manning’s quandary:

If [your son] is unhappy, neurotic, torn by conflicts, inhibited in his social life, analysis may bring him harmony, peace of mind, full efficiency whether he remains a homosexual or gets changed …

As progressive and influential as Freud was in his time, the last several words in that quote (“whether he remains a homosexual or gets changed”) are indicative of the prevailing attitude of the time. But that attitude continues, at least in the U.S. military.

The Army, for example, has so far stubbornly refused to refer to Manning’s condition as gender dysphoria, which is significant. In a public letter denying Manning hormone therapy, the Army stated:

All inmates are considered soldiers and are treated as such with access to mental health professionals, including a psychiatrist, psychologist, social workers and behavioral science noncommissioned officers […] The Army does not provide hormone therapy or sex-reassignment surgery for gender identity disorder.

Reading between the lines, this trotting out of various mental health professionals while in the same breath refusing hormone therapy and referring to Manning’s condition as a disorder implies that Manning’s transgender status can “get changed,” as Freud seemed to believe was possible for homosexuality. In other words, Manning the soldier should learn to accept herself as a man under her given name of Bradley Manning.

Despite the ample historical record concerning the fight for equal rights for LGBT individuals, including the complete removal of homosexuality as a disorder from DSM-3 in 1986 to the repeal of “Don’t Ask, Don’t Tell” in 2011, the fact remains: in denying Manning hormone therapy on the grounds that a person’s struggle with his or her gender identity is a mental disorder, the Army seems to believe that its transgender soldiers (as opposed to its gay and bisexual soldiers) are mentally ill.

Will Manning get the therapy she needs?

Yet another fact remains: Manning was convicted of leaking classified information related to the wars of Iraq and Afghanistan. It was the largest such leak in U.S. history. Alternately praised as a heroic whistleblower and despised as a traitor at trial, a military judge ultimately sentenced Manning to 35 years at Fort Leavenworth, after entering a conviction on charges of espionage, among others.

Discharged transgender soldiers, as civilians, are presumably free to pursue hormone therapy. This isn’t the case for Manning. Gender dysphoria diagnosis or not, Manning must remain in prison until she becomes eligible for parole.

“[Hormone therapy] changes their outlook, makes them feel whole as a person, makes them feel comfortable in their skin.”

So the question becomes: Does Manning deserve hormone therapy?

This is what Coombs said, according to Fitzpatrick: “I am helping Chelsea get the type of treatment she deserves.” According to the APA’s fact sheet, “Gender dysphoria is manifested in a variety of ways, including strong desires to be treated as the other gender or to be rid of one’s sex characteristics, or a strong conviction that one has feelings and reactions typical of the other gender.” Even by removing Manning’s subjective claim on the female gender, it seems pretty clear that she suffers from a manifestation of gender dysphoria as described in DSM-5.

Manning announced her rejection of the name Bradley one day after sentencing and requested that the media use female pronouns. This in itself generated conflict. One has a choice: to use either Bradley or Chelsea, he or she. The choice has consequences in the debate over the rights of transgender people, because as much as Manning may feel like a woman, hers is a subjective claim, subject to prevailing thought among psychiatrists who publish the DSM, as well as military leaders. Manning’s detractors have the (arguably stronger) objective claim, the irrefutable sex organ — the fact that Manning has a penis rather than a vagina.

If the Army gets its way, that’s how it will remain throughout Manning’s confinement at Fort Leavenworth. (It should be noted here that we’re talking about hormone therapy, which is the start of the male-to-female transition process, and may be an end in itself. Manning is not asking the Army for sex reassignment surgery.)

Yet: “If [Manning] were to sue for the right to treatment for her gender dysphoria, she might just win,” wrote Margaret Talbot for the New Yorker. Putting aside for the moment how Talbot’s statement — that Manning “might just win” — seems grounded in raw hope more than anything else, at least when it comes to military policy, the fact that Manning is at once confined and suffering from untreated gender dysphoria makes the filing of a lawsuit, as Coombs suggested he’ll do, only more crucial, should the Army decide against treatment.

For now, Fitzpatrick’s impression on strategy is that Coombs plans to work with prison officials to get Manning the therapy she needs. The Army will perform a psychological global assessment of Manning (despite the fact that this rating system is apparently no longer part of the DSM-5), to determine how well Manning is adjusting to life as a transgender individual confined in Fort Leavenworth, and Coombs has expressed confidence that the Army will diagnose Manning with gender dysphoria and treat accordingly.

(As an aside, I originally assumed that “global assessment” meant a broader attempt to gauge whether or not the sky would fall if the military began to treat transgender service members the same way it was forced to with the repeal of “Don’t Ask, Don’t Tell” regarding its treatment of gay service members — that is, with dignity.)

According to Fitzpatrick, Coombs said: “[Hormone therapy] changes their outlook, makes them feel whole as a person, makes them feel comfortable in their skin.” If hormone therapy is standard treatment for gender dysphoria, if it would provide some measure of dignity for Manning, the Army should be held accountable to providing that standard of care, regardless of its comfort level with Manning’s transgender status. The Army’s denial is nothing more than “an antiquated view of how you would treat this,” as Coombs has said.

Perhaps antiquity is Coombs’s strongest argument, second even to the constitutional argument that the Army’s denial of hormone therapy is cruel and unusual punishment. If “Don’t Ask, Don’t Tell” was the antiquated view of how you would treat gay or bisexual service members, the same bell rings true, if in a slightly different key, for those service members who identify as being transsexual or transgender.

Certainly it rings true for a soldier in confinement, suffering from a treatable condition, no matter the sins that led there.

One Comment

  1. Liberalsaurus says:

    If they keep Chelsea Manning from getting hormones, this has the quality of torture. If she feels the need to live as female, she has to change her hormonal status to estrogen as soon as possible. The younger the body, the better you can reshape it to female. So if Chelsea will be forced to wait years or even decades, this will have an effect on the condition of her body until the end of her life. That’s why I compare this case to torture. If president Obama wants the liberal-progressives to get behind him in the 2014 campaign, he should prove he also cares in cases like this.

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