'Boys will not always be boys' | Maria Ali

The new Gender Identity Bill challenges some of the traditional ‘certainties’ that many people take for granted. Psychologist and sex therapist Maria Ali outlines why these perceptions needed to be challenged

(Photo: Ray Attard)
(Photo: Ray Attard)

Jim Morrison once sang that ‘in the old days, everything was simpler and more confused’. He might not have been thinking specifically about gender identity issues at the time; but the words nonetheless ring particularly true of society’s perceptions of this obscure thing called ‘sex’. 

For millennia, it was a fairly straightforward question. One is born either male, or female. There were occasional exceptions: hermaphroditism (when a person has physical attributes of both sexes at once) was known even to ancient cultures… in fact the word itself comes to us from Greek mythology… but it was always regarded as a very rare departure from this otherwise universal, incontrovertible fact of life.

If one is born with a penis he is male; with a vagina, she is female. End of story.

But that’s where the complication begins. Reality doesn’t always conform to popular perceptions, no matter how deeply ingrained. And here in Malta, the sheer extent of confusion surrounding issues of gender identity came dramatically some years back during a Constitutional case filed by a post-op transsexual, Joanne Cassar. 

Cassar had undergone gender reassignment surgery, and the law courts gave legal recognition to her newly acquired status as a woman. But she was denied the right to marry because (if I may simplify) the Director of Public Registry argued that the legal change did not extend to all the rights associated with her acquired gender: specifically, marriage. In the eyes of the State, Joanne Cassar was still a man. 

Only, somewhat less than other men. In her case, it was argued in court that she couldn’t even marry another man. In fact, she couldn’t marry at all.

What followed was a lengthy court process, culminating in the rejection of the local verdict by the European Court of Human Rights. And it was in part to address the legal ambiguities exposed by this case – not to mention all the misconceptions and prejudices – that the Gender Identity Bill was first conceived.

Naturally, the complications do not end here. The bill was unanimously passed in parliament, denoting a transition at least in political attitudes towards gender identity in Malta. But echoes of ancestral misconceptions can still be seen in some public reactions. 

Much of this negative reception is rooted in the same traditional preconceived notions about ‘male’ and ‘female’. There is a section of society that is far more comfortable with the older, simpler view that “penis = male, vagina = female”… and any variation to that theme will be met with harsh resistance.

And yet, these labels are clearly insufficient to adequately describe the broader phenomenon of ‘gender’. Cassar’s case alone proves this beyond any doubt; and there are thousands of other people caught up in the same quandary. They cannot all be wrong about their own sexual identity. 

So if ‘gender identity’ is about so much more than being a ‘boy’ and ‘girl’… what is it, exactly? 

Maria Ali is one of local psychologists who specialised in sex therapy. Who better to ask, then, about why ‘sex’ always seems to get people’s knickers in a twist? 

“For some people, the question of gender may seem straightforward enough,” she tells me in her Birgu apartment. “Some of us will have an identity in our mind, and our body will match our perception of that identity perfectly. Great. We don’t have a problem. But for others it isn’t as simple as having been born with certain physical characteristics. For some, there will be a mismatch between ‘who they are’ and ‘what their body looks like’...”

This is partly why she welcomes the new law: it goes beyond the traditional stereotypes of gender, and acknowledges a reality that some parts of society have yet to accept. 

“What we’re moving towards is not having categories. It is not a case of ‘this is what I look like, therefore this is what I am’. We need to acknowledge that it isn’t black and white. It’s not neat little boxes. I might have been born in the body of a man, for instance, but feel – or know, rather – that I am really a woman…”

Nor is it just a case of adding a new box labelled ‘transgender’ alongside the traditional two. 

“Things are more complicated than that. Not everyone who feels a mismatch between their body and their gender identity will go on to do gender reassignment therapy. Different people cope with their gender issues in different ways.”

Gender reassignment therapy is expensive, and takes an enormous toll on the person in both physical and psychological terms. But there are reasons why not all would opt for a sex change. 

“Some people choose not to remove their sexual organs in order to be able to have children. So they live with a sexual organ that they feel isn’t ‘right’ for their body. But they have to make a complicated choice: do they give up that possibility, to become who they really are? So the issue is not restricted to any one category of person.”

Still, categories do exist whether we agree with them or not… even if only as social constructs. ‘Male’ and ‘female’ may be a convenient way to distinguish between people born with different anatomical configurations; but there is enormous amount of non-physical trappings that also come with the package. 

Social expectations of men and women differ vastly at all levels. In Malta, secondary education is mostly segregated according to sex (though that is changing); and other gender differences of all types can be discerned in various other aspects of daily life. 

Clearly, we associate much, much more with the two sexes than just their genitalia. Why is gender identity so central to our self-perception as a species?

“It’s the first bit of information the world knows about you. The first thing parents find out – before it used to be at birth, now it’s during pregnancy – is whether you are a boy or a girl. Not who you are: whether you are stubborn, what characteristics you have as a human being. That comes later. The first thing that matters is your gender. That’s how fundamentally ingrained gender issues are. We’ve attributed a lot to gender, too. It is part of the excitement of childbirth: it’s a boy! So this and this and this is going to happen. It’s a girl! So this and that will happen. It shapes that person’s destiny: what school they go to, who their friends will be…”

Even the two traditional ‘boxes’ into which new-born babies are thrust can be misleading. When discussing gender identity, one might picture cases where people may have undergone a sex change, or manifest gender traits which do not match the physical configuration of their ‘official’ sex. But even in non-transgender cases the differences between male and female are not at all clear-cut. 

One recent example concerns a social media stir caused by the child of a celebrity couple – Angelina Jolie and Brad Pitt – who reportedly took time to identify with either gender. And you don’t have to be a celebrity child to have doubts, either. Very small children may not even be aware that different sexes exist, let alone which category they themselves belong to. This raises the question: how much of our perceptions of our own sexuality is, in fact, completely unrelated to the physical aspect of sex... how much of it is in the mind?

“Gender identity is an issue of how you see yourself. There is more to it than just the physical aspects which come with the label. The case you mentioned is not unique. It is common to have young children – toddlers – who will strongly identify with one gender and not the other. That really shows how much gender is imprinted, in a sense. It’s already there…”

This points towards an underlying physical dimension… that it is all ultimately chromosomal: imprinted into our genes at conception…

“Yes and no. We don’t know enough about the chromosomal level to say for sure. But that’s where it starts, certainly. And there are cultural factors as well. But I would say that the cultural factors will influence how or to what extent one chooses to express gender identity. Let’s start with the family: if I live in a family where my parents will let me play with toy trucks instead of dolls – or vice versa in the case of a boy – then the choice is not about ‘who I am’, but ‘how much do I get to express it?’ That’s where I think the societal factors, or the ‘nurture’ part of it, come in…”

Naturally, the ‘other family’ also exists: where parents would be horrified if their darling little boy started playing with his sister’s Barbie dolls. And moving beyond the family, there is a cultural level at which gender roles and expectations are very clearly defined, though these definitions are slowly changing. Working women were once a rarity; now, the government urges more women to join the labour force. Female politicians are likewise occupying more prominent positions today than ever before. And the recent civil unions bill – which had far-reaching ramifications for gender roles – would have been considered unthinkable just a few years ago. 

This places the Gender Identity Bill in a context where Malta is changing at a very fast pace. It might also explain why some people seem to be so horrified by some of the changes.

“There is still quite a lot of resistance to changing gender roles in Malta. In other countries, too; but in Malta it is often expressed. Gender stereotypes are still taken for granted. Many people still express opinions that, in other circumstances, they would keep to themselves. That’s how ingrained it is…”

Is there a psychological dimension to this resistance? What is it specifically about gender issues that seems to make people afraid?

“Any change instils fear in some people, simply because it’s unknown. They will think: ‘Today, government has introduced law. What will it change tomorrow? Where are we going?’ People worry about change in itself. And when it comes to gender issues, there are other arguments about morality, about threats to society. However, I think there needs to be a distinction between ‘liberal’ and ‘casual’. Yes, I think we are becoming more liberal, but not more casual. Some people are panicking that one will lead to the other. I disagree. I think it means we are more willing to move past prejudices, and let people be who they are.”

However, there is considerable evidence that many are unwilling to make this move. Statistics indicate that transgender people are victims of much higher rates of hate crime than any other sectors of the wider gay community. Even the crimes themselves – which include murder – tend to be more violent. Suicide levels among transgender people are likewise much higher: attributable to depression caused by social bullying. 

This is true for Malta, but also the rest of the world. How does one account for the existence of so much hostility directed at this one category of people? Is there a psychological explanation for why issues of gender ambiguity excite so much anger and violence?

Ali posits that it is a reflection of both how deeply ingrained our ‘certainties’ about gender are; and also how much these certainties have impacted our social formation. 

“As I said, it’s the first thing that defines a person when they’re born. Boy, or girl. So then, when someone actively comes along and changes his or her own sex… challenging the idea that these things are set in stone... that instils fear. People may react: does it mean that everything I take for granted can be questioned? It becomes quite murky… it will force people to question themselves. If they see someone else go through gender reassignment surgery, or have a different perception of themselves than their external gender… some people might ask: ‘but what about my own gender identity? Are my own assumptions about who I am correct?’ I doubt that, on a day-to-day basis, people go through life asking themselves these questions. But I wonder whether, at a subconscious level, the concern is there. When they see someone else challenging the certainties so much of their perception of life is built on… the underlying question is, ‘what does this imply for me’? Otherwise, why would they get so uptight, because someone else chooses how to live their own life? But this is my own opinion.”

There have been other, less openly homophobic concerns, too. Parts of the law also touch on an area where one traditionally steps at one’s own risk in Malta: children. The bill recognises that children may not identify with the gender they were assigned at birth, and prohibits surgery until a point where the child’s consent can be achieved. It may have ramifications for the way gender issues are dealt with at schools. 

“Some of the objections I have heard were: ‘but I won’t be able to choose what my child is exposed to’. My answer to that is that you can never 100% control what your child is exposed to. And if they are to be exposed to anything, better at least be informed about it.” 

Meanwhile there is another form of ‘control’ implicit in this reaction. Some might fear the loss of control over their children’s lifestyle choices, too. They might have their own ideas about their children’s gender identity, which are not shared by the children themselves.

One innovative aspect of the law concerns the issue of precisely who controls such matters. Ali explains that the Gender Identity Bill departs from a system where the decision regarding gender identity fell to the professionals in the medical field.

“Under the previous system it was the medical professionals who made the ‘boxes’. In fact the law marks a significant movement away from the previous medical model, on two counts: one, it moves away from a definition of gender based on external physical characteristics; and two, it addresses the issue of who actually decides. This is not just about sexuality; it’s also about power. Who should take decisions on behalf of other people? Professionals, or the people themselves? The Gender Identity Bill answers that people are the experts of who they are. Not a doctor, not a psychologist, not a priest.”

The ramifications are many and various. “It has implications for mental health. Who decides what is a mental illness and what isn’t a mental illness? Transgender issues were in fact once classified as mental disorders. Up until fairly recently, homosexuality too was listed in the DSM… the psychology textbook listing mental pathologies. This changes with culture. And it’s a big change: we are now saying it isn’t [a pathology]. As a psychologist I find this exciting. It means it’s more about the individual than about imposing a label. It really changes how we do therapy.”