Arthur or Martha or neither–how cultural intelligence can help untangle the transgender knot

By Roger G McDonald, Mahana Culture’s roving blogger

When doctors deny one in five members of a community medical care, and 41 per cent of that group attempt suicide, a cloud hangs over our cultural intelligence on two essential issues — health and gender.

Push the pause button on that for a moment. First, look in the mirror and ask yourself that existential teenage question: who am I? For most of us, at least one basic response is pretty clear. I’m a male, or a female.

However, for a small but expanding sector of humanity, the answer is anything but plain.

Dr Ada Cheung has three parallel healthcare careers. She’s an internationally recognised and awarded endocrinologist, and a full time medical science researcher at the University of Melbourne. She also heads an organisation probing and promoting the health and welfare of Australia’s transgender community.

Her interest in transgender issues stems from her research at the University of Melbourne. She is the recipient of a prestigious National Health and Medical Research Council (NHMRC) fellowship. NHMRC is one of 17 portfolio agencies under the auspices of Australia’s Federal Department of Health. The council is one of the world’s most respected medical research administrators with, by international standards, a disproportionately high number of Nobel laureates among its researchers.

Her research project focuses on improving the lives of people with hormone-related conditions. As well as in-depth probing into the influence of testosterone and oestrogen, she has a particular interest in the physical and mental health status of transgender and gender diverse people.

Straddling three cultures

Dr Cheung’s personal and professional lives straddle all three cultures, though they’re not always complementary and not all in constant accord. As a medical specialist, she represents and connects to a culture she loves and respects, but sometimes struggles to fully endorse.

She describes on the one hand a strong, intensely historical culture that gives us the Hippocratic oath, with its passionate respect for human life and dignity. On the other, she portrays the same culture as represented by a male doctor in a white coat standing over a compliant patient confined to a hospital bed.

Dr Cheung thinks of our contemporary Western medical culture as an embedded, hierarchical tradition. Universities and teaching hospitals make sure students receive inoculations of medical and moral expectations that can cause serious side effects for both practitioner and patient.

In an environment where doctors cannot be seen to be fallible, to falter or to fail, bullying remains a significant issue. Mental illness and suicide are rife, she says, but slide under the radar in a culture that struggles with overt signs of vulnerability. Who would not recall the New Testament warning: ‘Physician, heal thyself’?

A new approach to medical cultural intelligence

The prestigious Psychology Today magazine confirms her contention. In the United States, physicians are at higher risk of suicide than non-physicians. Suicide is responsible for a quarter of young physicians’ deaths annually. The profession needs a new approach to cultural intelligence, she believes.

Her second culture, scientific research, is both quizzical and sceptical. She jokes that scientists don’t trust or believe anything, and that nothing is true except for the data they so minutely examine. Unlike medical practice, the research is clinical and bloodless. Emotion is all but removed from the equation in favour of the facts. Yet its relative remoteness from the lives its discoveries and conclusions are meant to treat can make scientific and medical research seem almost one-dimensional.

She believes devoted researchers must work hard to design protocols and conduct research programs that do more than provide solutions to some of our most baffling physical and mental puzzles. Unravelling scientific, medical, and therapeutic mysteries may be a wonderful first step. But without a corresponding shift in cultural call and response — the marginalised pleading to the mainstream — no reformative or lasting societal change can occur.

Dr Cheung says she didn’t choose her research field, it chose her. The stigma members of the transgender community constantly endure blights our humanity because it occurs at the most fundamental level.

Biological, not psychological

She and her team face a remorseless, though not unwinnable battle to counter one of our most prevalent myths: people outside the conventional male and female boundaries go and remain there by choice. The truth of gender assignment is radically different: it’s biological, not psychological. Our hereditary DNA determines our gender just as it ordains other physical characteristics such as eye colour, finger prints, right or left handedness, and a host of other attributes and functions.

More critically, gender is not a one-or-the-other choice — for any of us — between masculine and feminine. Biologically standard infants of course display a tell-all penis or vagina at birth. While the newborn’s external sex organs might seem a give-away for her or his likely sexual orientation in puberty and beyond, it’s far from the end of the story.

We now know that conditions like autism, anxiety, depression, and dozens of other life-defining and life-altering states occur across a spectrum. Experts can measure them from barely noticeable to profound and severe. Which makes it all the more surprising that something as basic as gender ambivalence and ambiguity has taken so long to achieve recognition.

Transgender studies are still in their relative infancy, but a wealth of terms for different gender identities has already sprung up. Dr Cheung’s Trans Medical Research organisation lists nine categories but there are many more:

  1. Trans man or trans male: a female at birth but who identifies fully as male
  2. Trans woman or trans female: male at birth but identifying fully as female
  3. Non binary: identifies as neither trans male or trans female, preferring to identify along the gender spectrum
  4. Gender fluid: a person whose gender identity changes
  5. Gender queer: someone who doesn’t identify with either of the two main genders, or gender binary
  6. Agender: not identifying with any gender at all
  7. Demi boy or demi girl: a person who identifies only partly as a male or a female
  8. Trans masculine: identifying as more male than female on the gender spectrum
  9. Trans feminine: identifying as more female than male on the gender spectrum.

Dr Cheung says the trans community suffers doubly, first through the ignorance and bias of the wider population and health professionals, and then through division within its own ranks. Marginalised and stigmatised for decades, transgender people tote unenviable baggage compared to the rest of the gender-assured population. She cites some disturbing research figures:

  • 41 per cent of transgender people in Australia have attempted suicide
  • 54 per cent suffer from depression, five times the national rate
  • 20 per cent have been denied treatment by a medical professional
  • 50 per cent report having to educate their healthcare professionals about their status
  • 28 per cent have experienced harassment in a medical situation
  • 49 per cent put off medical care because they didn’t have enough money

With these kinds of odds against them, transgender people feel sidelined and have a mostly lower socio-economic status than the rest of the population. Some profess a distrust of the medical and scientific profession, a minority of which has shown an historic discrimination, even if unintentional.

Transgender people have to live with the enhanced sensitivities that come with gender ambiguity. Dr Cheung says she has inadvertently caused transgender people offence, even as a sympathetic researcher specialising in the field. Much work remains to be done by health professionals to gain or recover the transgender community’s trust.

She sees it as a collision of cultures. She describes a muddled conflict zone where tradition and an unconscious bias in doctors meet a difficult to grasp gender fluidity that cannot express itself in a unified voice. Further education and research, combined with enlightened goodwill on the part of the medical profession, will go a long way to easing that cultural tension.

If you would like to learn more about transgender culture or associated issues affecting you or someone you know, contact Dr Ada Cheung MBBS (Hons) FRACP PhD, Department of Medicine (Austin Health), The University of Melbourne E:

If you would like to know more about straddling cultures and untangling cultural knots to maintain cultural dignity, contact Tavale Ilalio, on 0428 504 240 or visit


Cultural dignity: the battle against otherism

We were chatting about cultural dignity and I was reminded of Viktor Frankl, author of Man’s Search for Meaning.

Frankl was a German Jewish psychiatrist, author, and psychological innovator. He was the founder of logotherapy, a successor theory to Adler and Freud. If these weren’t remarkable enough achievements, he was also a survivor of one of the most cold-blooded and savage assaults on culture and dignity the world has ever seen.

Frankl survived the Nazi death camps, where his wife and both parents were murdered. He wrote famously about dignity under the most horrific conditions where the Nazis treated Jews as üntermensch, or sub-humans.

‘Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.’

Another German, Victor Klemperer, kept extensive diaries from 1933 to 1945 chronicling the Nazi regime’s compounding humiliation of Jews at home. Part Jewish himself, only his World War 1 decoration for bravery and his marriage to a Christian saved him from deportation to certain death. They could not, however, save him from the daily attacks on his dignity.

His detailed, accurate, and mostly objective journals leave a chilling expose to the frightful damage we as a species cause when we undermine dignity.

Dignity — humanity’s first distinction

Humanity’s first distinction from all other species lies in our mutual acceptance of dignity. At our very least and poorest we know, or should know, we are worthy of honour and respect. Cultures, religions, and social movements the world over, uphold the central notion of dignity, from the sacred potential of childbirth, to the reverence of age, and the mourning associated with death. We thrive in the presence of dignity, and falter in its absence.

As civilisation continues to advance, and our knowledge of other cultures grows, the world around us shrinks. Dignity is an unalienable birthright, a gift we universally celebrate. Dignity is the moral foundation on which we survive, live, and thrive. Only aberrant cultures like Nazism deny it. Dignity and courage in the end defeat them.


But for all our vigilance, indignity is never far away. It begins with comparisons and judgements that we as humans are too often unable to resist. Our unconscious wants to believe that one culture — usually ours — is superior to another — usually theirs. These judgements lie at the heart of all the isms: racism, sexism, ageism, and many more, all parcelled together into a box that we might term otherism.

Expressed publicly, these judgements diminish others’ dignity in order to bolster our own.

World-renowned child and youth neuroscience researcher, Dr Bruce Perry, talks about the six stages of adolescent development of which the last stage is maturation, represented by an appreciation of diversity.

His definition of diversity requires worth, celebration, respect, and dignity. He believes we should be surrounded by them all, and act towards others with each. In recognising and celebrating dignity in others, we enrich innate dignity in ourselves.

How to preserve our cultural dignity

To preserve our cultural dignity, we need to understand other cultures, not just our own. That understanding has to rest on the unshakeable belief that every human is intrinsically worthy and valuable. Only then can we begin to grasp our own biases and blockages, and see them as the impediments that obstruct otherwise rewarding human relationships.

Dignity — identifying it, restoring it if it’s gone missing, and certainly celebrating it — is the beginning and end of Mahana’s work. We preserve, protect, and replenish cultural dignity through mental, emotional, and cultural intelligence.

Call Tavale on 0428 504 240 if your team’s cultural dignity could do with a polish.

Article written by Roger McDonald and Gregg Morris, co-facilitator of Mahana Culture’s Culture Connects program

Shame to flame – how awakening stokes the fire of culture

My mother has the honey-brown skin and the pearl-white smile that sets the tone for Samoan culture.

She’s part of the magic of the Pacific. She belongs to a people whose culture is the poetry of the waves, the canvas of the stars, and the music in the language of her island race.

As a young boy, I used to lie in bed at night and listen to her speaking on the phone in her native Samoan to her sisters, my aunts, overseas. I would try and pronounce some of the words. Her culture was strong, but she admitted that she didn’t teach us Samoan customs and language because she didn’t think it would be helpful to us growing up in New Zealand.

Easier to fall culturally asleep

As a powerful force in the family, she was immensely proud of her Samoan heritage. But when I went out from the family into the other three of Bronfenbrenner’s* four worlds — school/work, peers, and community — I felt a kind of shame. So it was easier, or less difficult, to fall culturally asleep.

I’ve seen this same cultural slumber in many young people with whom I’ve journeyed as a youth worker.

In my early thirties I did some social work study, part of which examined Maori culture. The curriculum called for everyone to explore and share their own cultural heritage.

It touched me profoundly. I underwent a cultural awakening in both my mother’s Samoan culture and my father’s Scottish heritage, along with my own experience of Maori and New Zealand culture. And I realised that what had been missing or empty could nonetheless be replaced.

It was an awakening to something I innately knew but was too immature as an adolescent and young adult to acknowledge. Young people, of course, want to fit in at almost any cost. It’s only in adulthood that they realise there is something more, a void to be explored and filled. That’s where the cultural awakening, or enrichment, can begin. It goes from ‘so what’ to ‘wow.’ And it’s never too late.

Transform your organisation with culture and story. Call Tavale Ilalio of Mahana on 1800 MAHANA (624 262) for more information on how culture and story boosts organisational effectiveness and productivity.

Article written by Roger McDonald and Gregg Morris, facilitator of Mahana Culture’s Culture Connects program

* Urie Bronfenbrenner, US psychologist known for his work in ecological systems theory in child development