outline/notes for thesis

so...these are mostly notes/ an outline for my paper, although parts of this will be included in the paper. sorry it is all over the place and contains huge logical gaps. i will re-post something more coherent soon, as i sit down to write the narrative that connects each of these fragmented paragraphs and quotations....


This paper seeks to reveal the culturally constructed nature of gender within and through biomedical discourses. Because a binary of biological gender is assumed, bodies that transgress the boundaries of ‘male’ and ‘female’ are overlooked, and often left unaddressed when it comes to health care. Transphobia and other forms of discrimination create extreme difficulties for gender non-conforming individuals in accessing quality healthcare(insert 2009 lambda legal survey results, hrc healthcare equality index 2010).
Bodies which do not fall neatly into the landscape of binary gender allotments are also often marginalized in other ways (describe violence of health care refusal, cruel touches) notes: Need new language, new terminology…has emerged within queer subcultures in order to navigate and re-negotiate the territories of sex, gender, and sexuality. In lieu of ‘male’ and ‘female,’ which excludes combinations and embodiments outside the allowed domains of those terms, queer discourses opt instead for ‘male-assigned,’ ‘female-assigned,’ and intersex bodies. This adjustment loads the terms used to refer to embodiments with acknowledgement of the socially constructed nature of biological gender, and its non-causal relationship with gender identity and expression.

Doctors turn down care for individuals whose bodies are not outlined in medical texts Female to Male transsexuals (and many intersex patients) are overlooked for procedures such as PAP smears and mammograms, declined services and insurance when their paperwork shows incongruencies between ‘biological sex’ and their presenting gender, and pathologized in order to conform with culturally defined gender norms. [Discuss violence and lack of care in survey results, including HRC patient bill of rights without gender identity in hospitals]…when we examine how to make medicine better for transgender individuals, we must begin with an understanding of how medicine works to create the transgendered subject: we must reframe the ways in which gender, sex, health, illness, normality, and abnormality are understood.
In a 2007 article on transgender care in Pulse, Dr. Richard Curtis, a gender specialist in London, comments on the trans-sensitivity of General Practitioners: “Some GPs are very good with trans people – they are sensitive and will do as much as they can. But there is another group who will say to patients that it is all in their head. They tell them to go away, have a beer, and think about it – and then they will be fine” (Duffin quoted in Jenner 403).
Transgender individuals refused treatment because they are not in line with the cultural narratives about gender… Cases of outright discrimination and refusal of care may be less frequent than cases of provider ignorance and inexperience, but they continue to occur (Jenner 404, GLBT Health Access Project 2000). [see pg. 404-405 jenner on transhealth demographics]
On the Discursive Power of Biomedicine
[in this section: despite all of the problems for transfolk…little attention is paid to gender/sex/sexuality in biomedical ethics, how biomedicine has achieved great legitimizing force in our culture, how biomedical models are reductive and paint themselves as “objective,” how knowledge is tied to power, and discourse acts as power (a postmodern account of truth), listening to transsituated accounts of gender and health]
The major texts on biomedical ethics, including texts by Beauchamp, Childress, Jonsen, Veatch, Mappes, and Degrazia offer no discussions that deal with the ethical concerns surrounding sex, gender, or sexuality (insert citations?...HOW). Eugenics, Euthanasia, and Organ Transplantation are discussed in biomedical texts from various perspectives, and the field of medical ethics has examined how medical practices impact cultural definitions of “death” and “consent.” Not only has the field of biomedical ethics focused relatively little attention on gender, sex, and sexuality, it has avoided examination of the assumptions that inform its discussions on these topics. The philosophical method central to modern bioethics, principlism, is reductionist, provides a limiting understanding of power, truth, and subjectivity, and as I will argue, is ultimately harmful to the gendered subject.
Although…[insert paragraphs on the attention focused on human sexuality, sexology, in nineteenth century…repressive hypothesis and foucault’s history of sexuality, Havelock ellis, etc see goethals 7]…little attention has been paid to the discursive constructions of these terms and their relationships within the field of biomedicine. In recent years, the medical profession has been re-evaluating treatment protocols for intersex infants as well as patients diagnosed with Gender Identity Disorder (GID) (Goethals 29). The more recent proliferation of biomedical texts dealing with the intersecting categories of sex, gender, and sexuality, however, appears to lack a critical approach to these issues. The field, according to James Nelson, focuses too much on “patients and providers as autonomous, individual moral agents and too little on the social and political structures that form, nourish, and distort that agency” (Nelson 226). Medicine must take up the task of examining the sociocultural constitution of gendered “selves”, with special attention paid to the discursive power within biomedicine itself.
Here, I would like to situate the discussion of biomedical ethics within postmodern understandings of discourse and power. In Power/Knowledge, Foucault discusses the ideological functions that the political status of science can serve. He acknowledges that medicine is “profoundly enmeshed in social structures” (Truth and Power 109). [see goethals 10]The values ingrained in science, as well as the assumption that science forms the only defensible basis for knowledge claims, are all characteristic of our current “technocratic” social form (Roszak 458). Foucault began to critique the “truth” of biomedicine alongside the reductive “physician’s gaze” in his work entitled The Birth of the Clinic. [insert foucault’s points, modernist view of ‘truth’]
Foucault examines the development of biomedical dominance beginning with the moment in which clinical experience was reduced to the “anatomo-clinical gaze” (1973 Foucault 145). This idea of the “clinical gaze” references the reductive medical mode of interpreting the body, disease, and health: one of visible anatomy and physiology. This perspective, according to Foucault, evolved into a “hegemonic discourse which marginalized, or even excluded, other forms of knowledge” (McGrath 520-21). George Engel, in his 1977 essay, claimed that the biomedical model attained the status of “dogma” in the early twentieth century. Nearly everyone bought into its powerful “dualistic, mechanistic, and reductive” logic (Morris 8). The institution of biomedicine enjoys “an unqualified prestige as a repository for truth” in our culture; medical science, more than other institutions, tell us “who we are, what can truthfully be said about ourselves, and what should and should not be done for our well-being” (Goethels 7). The biomedical model, according to Engel, separates mind and body, views bodies as machines that can be read as a text, and reduces health and illness to biomedical languages of anatomy and chemistry. The postmodern opposition to this model, then, views human illness and health as unique and situated experiences of embodied beings.

We must begin by discussing the ways in which this foundational biomedical “truth,” seen as objective and rational, is tied to power. In modernist biomedical understandings of subjectivity, the “self” is transcendent, existing prior to its citation (Koch 338). This citation is what Judith Butler calls “the performative” (Butler 17). Performatives, are “forms of authoritative speech: most performatives…are statements which, in the uttering, also perform a certain action and exercise a binding power” (17). This power within discourse produces that which it names; the “subject” which acts is a nexus of power, a coalescence of discursive iterations that continues to cite past gestures of power. Thus, the power of the citation of a gender norm itself lends the legitimizing force to doctor-patient discourses. This citation of prior authority, or normalcy, confers upon itself power in its reiteration. [multiplicity of truths of gender, produced in a variety of cultural locations, we must change what counts as knowledge about gender- goethals top 12]

[Autonomy- problems with the a priori subject and self-contained actor]
McGrath argues that the process of applying autonomy as an abstract, objective, reified principle veils the power plays inherent in biomedical discourse, ultimately affirming the status quo and undermining any “autonomy” that the individual supposedly possesses.

Postmodern thinkers generally regard knowledge as “historically situated and culturally inflected” (Morris 7), where even the most seemingly objective and accurately produced science is inflected and filtered by society, history, and politics. In a postmodern model of disease and illness, biophysical mechanisms tell only part of the story. Our bodies intersect with stressors of the cultural landscape, from environmental toxins and high-fat, nutrient-bereft diets to social pressures influencing anorexia in teenage girls.
[Potential for feminist and queer critique lies in deconstructing this metanarrative which presents itself as “objective,” and forming what Donna Haraway deems webs of “situated knowledges” (___)[expand on haraway and need for critical and locatable knowledges…~1page]
Sociologist Arthur W. Frank has illustrated the postmodern shift of representational control from doctors to patients (Morris 8). While modernism located the truth about illness and normative embodiment with the knowledge of the doctor, postmodern narratives increasingly tell patients’ stories. Both formal and informal narratives on health, illness, and the patient experience provide situated accounts as an alternative to authoritative, “objective” doctor accounts.

[goethals 23…main points of section: gender as a set of discourses, biomedicine as agency of power that produces and deploys discourses, discourses produce subjects, subjects produced are able to de-center those discourses]
Transgender experiences are shaped by the reductive biomedical model, and we must now turn our attentions to the roles that mental, emotional and social health play in biophysical well-being. We must consider the experiences of gendered embodiment that are influenced by social pressures and norms of gender.
How has binary gender been legitimized, how is it maintained?
[in this section: the “natural attitude” or “truth” about gender, how this attitude came to be → capitalism, history of the gender binary, how the binary is maintained within medicine (larger sections on GID in the DSM and intersexuality, variance in ‘biological gender’), violence of understanding and how binarized gender harms transsituated identities, deconstructing the humanist logic of the body]
Bornstein: the “natural attitude” about gender…there are 2 and only 2 genders, genitals are the essential sign of gender, male=masculine and female=feminine, one’s gendr is invariant, and everyone must be classed as a member of one or the other gender. Thought to be anchored in “human nature.” Gender is “natural,” and a reflection of biological truth. (see pg 6 of Goethels) The natural attitude legitimizes medical practices of “correcting” intersex infants and pathologizing cross-gendered individuals as well as reinforces the attitude beyond the confines of medical discourse (Goethels 6).
According to gender theorist Kate Bornstein, “gender implies class, and class presupposes inequality” (113). Gender, in this view, is a system of oppression that keeps the bi-polar division in place, functioning to maintain itself with violence to ensure the domination of one gender over another. Bornstein also points out the ways in which gender is policed, internally and externally. She describes what she calls “gender terrorists:” those who “bang their heads against a gender system which is real and natural; and who then use gender to terrorize the rest of us. These are the real terrorists: the Gender Defenders” (72). Gender-policing takes place each time we are forced to chose “male” or “female” on medical forms and documents, when we are given the selection of “men” or “women,” and every time our genders are defined by others.
The definitional intersections between sexuality and sex, sex and gender, and sexuality and gender, form conceptual maps between acts, identities, knowledges, expectations, and intimate or social relations. Gender, sex, and sexuality, although distinct as analytic axes, are continually complicated through their inter-definition and mutual construction (Sedgewick). Although I will be discussing the ways in which ‘gender’ has been policed within biomedical discourses, the categories of ‘sex’ and ‘sexuality’ are necessarily implicated in the discussion. It is nearly impossible to speak of one of these categories without the others being implicated. ’ Medical interventions are routinely implemented in order to achieve this congruence between the categories of what are dominantly understood as ‘sex’ and ‘gender.’ I will henceforth refer to the category of ‘sex’ as ‘biological gender’ and differentiate it from ‘gender identity’ or ‘gender expression.’ (why? Insert Bornstein)

… As highlighted by Foucault, the “psychiatric, medical category of homosexuality was constituted from the moment it was characterized…less by a type of sexual relations than by…a certain way of inverting the masculine and the feminine in oneself,” appearing as “a kind of interior androgyny” (History 43).

(begin discussion on entanglement of sex-gender-sexuality)
Non-binary gender has been ‘naturalized’ among other cultures: anthropologist Miranda Stockett notes that the Aztec, Olmec, and Mayan cultures understood "more than two kinds of bodies and more than two kinds of gender" (566). Anthropologist Rosemary Joyce also writes of the Maya: "gender was a fluid potential, not a fixed category, before the Spaniards came to Mesoamerica. Childhood training and ritual shaped, but did not set, adult gender, which could encompass third genders and alternative sexualities as well as ‘male’ and ‘female’” (Joyce). The categories and numbers of biological genders and gender expressions have varied throughout many other cultures as well, and have changed markedly over time. In contemporary capitalist societies, however, the gender binary is enforced, based on the meta-narrative that describes binary conceptions of gender as “natural.” Foucault highlights the “numerous and diverse techniques” beginning in the 1600s for “achieving the subjugation of bodies and the control of populations,” which served as “an indispensable element in the development of capitalism” (History 140).

The control of bodies and genders, including their mediated relationships and reproduction, guaranteed “relations of domination and effects of hegemony,” and joined “the growth of human groups to the expansion of productive forces and the differential allocation of profit” (Foucault History 141). Thus, control of gender and sexuality enabled optimal insertion of bodies into the machinery of production. The nuclear family proved to be the most efficient unit for controlled production of workers, who were imbued with values ensuring reproduction of the relations of production.

The assumption of binary gender manifests itself in several ways within medical discourses. The definitions and standards of care for transsexualism, GID, and intersex births are informed by the heteronormative imperative, that is, the imperative to create congruence between what is understood as ‘biological sex’ and ‘gender identity. The binary of biological gender, with its basis in medical science, is maintained and controlled from the beginning of our lives, serving to assign us to one or another category at birth. Here, gender policing takes the form of hormonal and surgical molding of intersexual infants by the U.S. medical establishment to fit one of two categories as neatly as possible. Often without the consent of parents, and never with consent of the infant whose genitals are being mutilated, doctors judge whether a clitoris is “too large” or a penis “too small” – and reshape bodies accordingly. When biological gender and gender expression appear to be at odds, Feinberg describes the issue as a “social contradiction that can only exist in a society that mandates – with coercive force – that gender expression must conform to birth biology” (29). Gender-benders, transsexuals, cross-dressers, intersexual folks, butches, queens, genderqueers, and other gender non-conformists extend the understanding of how many ways there are to be human. Either/or categories of biological gender leave no room for the variance of intersexual bodies. Our anatomical spectrum, in the words of Leslie Feinberg, “continues to burst the confines of the contemporary concept that nature delivers all babies on two unrelated conveyor belts” (7).
Conformity to the gender binary is also reinforced in the medical model used to pathologize gender-nonconforming individuals. Transgender individuals and “deviants” of the system are categorized and diagnosed with Gender Identity Disorder or gender dysphoria, and “treated” with hormonal and surgical therapies (Bornstein 62). This medical model serves to place the “illness” with the individual, instead of with a system of narrow options that demands conformity. In order for individuals seeking hormone therapies or surgical modifications of their bodies to obtain these medicines and procedures, they must first provide letters of diagnosis and therapy to medical institutions. This means that they must conform to a set “gender narrative” that matches with the guidelines in the DSM. Too many deviations from the prescribed model and the gatekeepers will not fork over the necessary permits. However, elective alterations and surgeries that remain consistent with the status quo, such as breast-augmentation for non-transwomen, are generally welcomed and encouraged.

…we must reconsider the legal and social ramifications of gender policing supported by biomedical discourses:
Other laws prohibit falsification of gender on official documents: you can be fined and jailed for checking “F” on driver’s license permit if you were assigned male at birth, unless you have completed the requisite genital surgeries for sexual reassignment (and can provide the necessary forms of proof that you have conformed to standards of the “opposite” box). And it is actually a felony to check off the “M” box on passport applications if you were assigned female at birth (Feinberg 21).
The ideologies that reinforce binary gender norms pervade even transgender communities. “Trans-hierarchies of legitimacy” are created and policed on the individual and community levels, as some receive acceptance from the dominant ideological apparatus for “passing” as their desired gender. Alaina Hardie describes the hierarchies that formed within her transgender community in San Francisco: “surgical status...attractiveness (by conventional standards) and heteronormativity were the criteria. Being ‘normal’ was the ideal” (Hardie 124). In this way, diversity among even transgender individuals is subdued, to “make difference more tolerable to a society that values conformity while giving lip service to individualism” (127).

Towards a redefinition of autonomy, plurality of gendered embodiments, and a holistic approach to biomedical care (examine “two-spirit” healers)….reclaimation of power for transsituated identities within discursive spaces, openness to “otherness” and process of becoming, intercorporeal ethics within biomedicine, politics of possibility
The historical nature of discourse problematizes efforts to negotiate language within institutional and cultural contexts, and continually acts to inhibit the radical democratization of discourse on sex and gender. BUT Judith Butler allows that by "inhabiting the practices of [discursive] rearticulation," we can resignify norms, subvert metanarratives of dichotomized gender, and thus move towards a decentralization of power. oppositional discourse is essential to queer and trans liberation; we are entitled to challenge knowledge practices that are foreign and disempowering.
Leslie Feinberg defines trans liberation as the ability of people to “define their sex, control their own body, and develop their gender expression free from violence, economic barriers, or discrimination – in employment, housing, health care, or any other sector of society” (48). This notion of trans liberation attempts to divest the current gender categories of their hierarchical relation to one another by obliterating the boundaries that contain their meaning. This is a revolution against fixed gender constructs, against fixed notions of being, and against conformity to ideas of universality.
Non-binary gender as openness to otherness,
The task of poststructural and critical analysis, then, is not “to replace one set of axiomatic structures with another but to provide a reading of scientific, cultural, and social texts such that the contradictions, assumptions, and a prioris are made explicit” (Aronowitz cited in Koch 339). As assumptions are revealed, the connections between language, power, and the production of truth can be made visible.
Recognizing our contextual plurality enables “resistance to that which would impose universals” (Koch 329). We must embrace diversity and plurality collectively, because, as Feinberg puts it, “my right to be me is tied with a thousand threads to your right to be you” (101). We must stand in solidarity against these powerful, universalizing mechanisms. According to Butler, subversion, or “working the weakness in the norm” becomes “a matter of inhabiting the practices of its rearticulation” (Critically Queer 26). This exposes the failure of “heterosexual regimes to legislate or contain their own ideals,” thus destabilizing gender and normative sexuality (26).



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