More on Michelle Kosilek, with a Primer on Trans Issues

Posted: September 9, 2012 in Gender
Tags: , , , , , , ,

I set off a firestorm on my Facebook page when I suggested that transgender murderer Michelle Kosilek should receive her gender reassignment surgery at taxpayers’ expense this week.  Some folks said that only the most liberal of liberals would say such a thing; other people, who I would consider at least as liberal as I, said that this was a waste of Taxpayer dollars.  Some suggested that prisoners forfeited their right to health care and that they should have let Kosilek kill herself.  Others suggested that a “sex change” could not be medically necessary.  Others still demonstrated a complete lack of understanding of the difference between sex and gender.  Throughout my conversation – and other similar ones that I saw spawning across the internet – an unexpected amount of vitriol was being tossed around as casually as people today discuss the weather.  I found the whole experience rather disturbing.  I’m going to try to address all of these pieces in what is bound to be a rather long post.

First, a primer on language:

I think it’s important that we work from the same set of definitions.  Anyone who knows me should know that I think language is incredibly important.  It’s possible that I’m wrong about some of these terms – I am not blessed, to my knowledge, to have any really good friends who identify as transgender – so my working definitions of these terms are purely academic.

Sex: For simplicity’s sake, we’ll use the traditional chromosomal definition of “sex.”  XX = female.  XY = male.  This becomes incredibly complicated in the case of persons who are intersex, but this is not part of our discussion for now.

Gender: Gender is not a biological concept.  Rather, it a socially constructed identity that entails a number of different roles and expectations.  In my view, gender is something that is determined by the individual and how he or she (I’ll avoid the neutral pronoun xe or any of its alternatives for simplicity’s sake, again) identifies.

Transgender Flag

Transgender (adj.): Someone who is transgender identifies with gender roles incongruent with their biological sex.  Often, people who are transgender say they feel as though they are a “female trapped in a male’s body” or vice versa.  I think the part of speech is important here: transgender is an adjective and not a noun.  We talk about a person who is transgender; we don’t talk about a transgender.  This is because saying “a transgender” is similar to saying “a gay”—you are defining someone based on one characteristic.

Transsexual (adj./n.): I’ve been told that some people differentiate transsexual from transgender in the following way: that transsexual individuals have had gender-reassignment surgery and now have the physical anatomy to match their identified gender.  I’ve also been told that this word is problematic because it has negative clinical connotations.  It is also much more often used as a noun than “transgender” which makes someone’s gender identity their defining characteristic.  So I will avoid using this term, but I wanted to throw it out there.

Cross-Dressers: Cross-dressers are not the same as transgender people.  Cross-dressing may have nothing to do with gender identity.  Cross-dressing can be for performance (drag), sexual fetishism, and more.  Some cross-dressers are transgender; many are not.

Cisgender (adj.): The quality of identifying with the same gender as your biological sex.  For analogy sake, gay:straight::transgender:cisgender.  It’s not an apt analogy, really, but it’ll do.

Pronouns: It is important to use the pronoun of the person’s identified gender.  Some people make it a practice to ask people what their preferred pronoun is (typically he or she, but sometimes gender neutral pronouns such as xe).  When I discuss Michelle Kosilek, for instance, I will be referring to her as “she” because that is the pronoun with which she identifies.  This is the same reason that we should refer to Chaz Bono as “he.”

MTF/FTM (adj.): Male-to-Female or Female-to-Male – these are sometimes used to describe people’s original sex to their new gender.  These are problematic because transgender females are not people who were male and became female; instead, they were always female and they just began living the roles with which they always identified.  Make sense?

Some famous Transgender People:

The two that pop into my mind immediately are Chaz Bono and Laura Jane Gabel, the lead singer of Against Me!  Keelin Godsey also comes to mind because he almost qualified for the Olympics this Summer.  Truth is, though, there aren’t many reference points in popular culture for transgender individuals.  This is a subject only recently being examined by our culture.

A quick transgender fact sheet:

26% of transgender individuals have been fired for their gender identity.

15% of transgender people live below the poverty level.

Between 16% and 60% of transgender individuals experience physical abuse.  Between 13% and 66% are survivors of sexual assault.

Suicidal ideation is reported in 38-65% of transgender individuals, with attempts having been carried out by 16-32%.

Depression has been reported in 43-60% of transgender persons.

So why the big range?  The truth is, the research is sparse and there are a lot of factors that weigh in on someone’s mental health, including the support of the community, access to resources, whether or not they have been assaulted, etc.  I imagine that as more research is conducted, and as trans issues reach public awareness, the numbers will point to a greater consensus.

So, now onto Michelle Kosilek:

Michelle Kosilek is in prison for murder after having strangled her wife with a wire.  She is sentenced to life in prison with no possibility of parole.  She sued in 2000 for access to hormone therapy while she was in prison, and sued again in 2005 to gain access to Gender Reassignment Surgery.  A federal judge last week (notably a Reagan Appointee) stated that the Massachusetts Department of Corrections needed to provide the surgery.  This sent off a nationwide backlash against tax-payer dollars being used to fund “sex changes for murderers.”

It’s important to note that Kosilek’s doctors have established that this is the only treatment that would help with her Gender Identity Disorder (A term in the DSM-IV which will likely be replaced in the upcoming edition).  Kosilek has attempted suicide twice, and has attempted to manually castrate herself in absence of the prescribed surgery.  Although the American Psychological Association has not officially declared Gender Reassignment a treatment for GID, it is the standard of practice espoused by most practitioners who treat transgender individuals and it and part of the WPATH standards of care (  In nations that have adopted universal healthcare (e.g., Canada), gender reassignment surgery is covered as medically necessary.  Some private insurers in the USA cover the surgery as well, but only after strict criteria are met.  Otherwise, the surgery can cost up to $20,000.  In order to legally have the surgery in the US, one must live as the new gender for at least a year and undergo extensive psychological evaluation.

Do Prisoners Forfeit their Rights to Health Care?

This is a complicated question, to be sure, and I believe it comes down primarily to the eighth amendment – do we inflict cruel and unusual punishment on our most heinous criminals?  The Constitution says we don’t.  The purpose of the prison system is not to inflict suffering on inmates; it is to remove them from society and, for those who will eventually leave prison, rehabilitate them for reentry into civilization.  For prisoners with Cancer, we do not withhold chemotherapy.  For prisoners with severe depression, we do not withhold antidepressant medication.  For prisoners with schizophrenia, we do not withhold antipsychotic medication.  To do so is inhumane.

Some argue that Kosilek lost any right to humanity when she took another’s life – so do we just withhold treatment from murderers?  What about the number of false convictions?  And if murderers, what about rapists?  Pedophiles?  Drug Dealers?  Exactly which prisoners do we withhold treatment from?  I find the whole logical progression of this argument disturbing – such withholding of treatment amounts to torture, and I’m not comfortable living in a country that tortures its criminals.  The same applies to Michelle Kosilek.  She is by no means sympathetic (although more on that later) – it is understandable that our basest instincts would say “let her suffer.”  She did, after all, murder her wife and leave her in a parking lot.  But she is still a human being, and she is suffering immensely without the treatment her doctors have prescribed.  Besides, since when do we allow our basest instincts determine public policy?

If it’s a question of cost, chemotherapy can cost up to $30,000 or more.  Stopping cancer treatment doesn’t seem to be as popular as withholding Michelle’s gender re-assignment.

But It’s Not Medically Necessary!

Here is the one that frustrates me the most.  People go on and on about how a “sex change” cannot be medically necessary.  I guess that really does pose an important question: Do we believe doctors, psychiatrists, psychologists, and scholars about what is medical necessary?  Or do we defer to the armchair clinicians spewing their “common sense” truths from talk radio, twitter, or the legislature?  Isn’t the reason that people are so afraid of “ObamaCare” that they’re afraid unqualified bureaucrats will be determining healthcare?  One would need to be the Gabby Douglass of mental gymnastics to overcome that cognitive dissonance.   On this one, I’ll trust the doctors and the people who say that gender reassignment surgery saved their lives.

He’s Not REALLY a Woman:

Really?  And you live inside Michelle Kosilek’s mind and can say, with certainty, that she does not identify as a woman?  Some folks out there would respond that it doesn’t matter how she identifies.  But gender is socially constructed, and one’s self-identification is all that matters.  This blog post is going on for too long, so I won’t get into everything that’s wrong with this sentiment.  Anyone who would like to do more can google “social construction of gender,” or take some introductory courses in sociology, gender studies, feminist theory, or queer theory.  Here is a brief summary:  Michelle is just trying to make her external self match her internal self; in an ideal world, we could decosntruct gender roles entirely.  That’s not where we are yet.

Good, Hard-Working People Can’t Afford GRS, So Why Should the State Pay for a Prisoner’s?

This is probably the most compelling argument, and I think the question is backwards.  It should read: “If part of being humane is giving prisoners access to health care, why do we not give that same access to good, hard-working people?”  The problem isn’t with the DOC providing the surgery; it’s the fact that access to good health care in the United States is a problem.  It’s a problem that our current president has tried to fix, and it’s a problem that’s seen great progress in recent years.  But it’s still a problem.  Taking healthcare away from prisoners only makes it worse and it imposes undue pain and suffering to boot.

So what?

So why does any of this matter?  Why have I gone out of my way to defend Kosilek or the decision of Judge Wolf?  Because it’s a matter of principle, and not of politics.  This has nothing to do with me being an uber-liberal.  It has to do with me believing that we have a moral obligation to help those on the margins of society, and that as a public we treat Transgender people like crap.  It’s interesting to note that Michelle Kosilek got life in prison without parole, but someone who strangled a transgender person in Massachusetts only got two years.  It’s interesting to note that the person Kosilek murder – her wife – was originally her therapist in a half-way house that seduced her.  It’s interesting to note that her wife, Cheryl, physically abused her by pouring boiling hot water on her and attacking her with a knife.  It’s interesting to note that she was also abused by her stepfather who attempted to stab her for asking if she was a girl.

If people only took some time to understand the issues that trans people face, maybe Kosilek never would have been abused?  Maybe she never would have checked into that halfway house?  Maybe she would have never murdered anyone?  We’ll never know the truth.  But it’s time that we start allowing compassion and sympathy back into our lives instead of judgment, hate, and fear.  So if you’re going to talk about this case – and you should, there’s a lot to talk about – do it respectfully, do it with integrity, and remember that prisoners – no matter how heinous their crimes – are people too.


P.S. – This piece tries to make the moral case for granting Michelle Kosilek her surgery.  For the legal reasons, I would suggest reading the actual decision — there is more to it (basically depraved indifference on the part of the DOC) than what the media would portray:


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