Archives for category: Medicalization and Pathology

One would expect that hermaphrodism during the time period in which Dreger writes would cause major societal rifts and would be even more controversial than it is now. However, if the subject is thought about clearly for any amount of time, it would seem as if society has made no substantial progress in the acceptance of this anomaly. Of course, we have made many technological and biological advancements that help people better understand how and why this condition can occur, but it is still very much a taboo subject. Today, it is my understanding that most children born with both sets of genitalia almost always undergo corrective surgery if it is financially and physically possible, but why? It is because contemporary society has yet to accept this specific bodily phenomena as it has others. This is most likely due to the extreme emphasis we put on issues of sex and gender. Sexual topics, such as gay marriage and gay rights, are huge points of political controversy because they challenge the deeply ingrained heterosexual norm. Therefore, an instance in which an individual physically displays characteristics of both sexes is in direct opposition to every existing perception of what we consider a man and a woman.

It is true that stories of hermaphodism or pseudo-hermaphrodism are rarely talked about in the news or other media outlets. The few cases that I have learned about have been in my medical sciences and biology classes and have involved individuals in far-off countries. Surely there have been more cases of hermaphrodism than those I have learned about, so why hasn’t anyone ever heard of them? Brown University researcher Anne Fausto-Sterling estimated that the total number of people receiving surgery to “normalize” genital appearance was 1 in every 1,000 births (http://www.isna.org/faq/frequency). This estimation is probably considerably higher than what most of us estimated, and it is doubtful that there is a precise number because of the frequency of unreported cases. However, if we take that number as being true, genital variation and hermaphrodism is way more common than society lets on. Therefore, we must ask ourselves the question as to why this is still such a controversial subject in our society, even after all of the progress we have made regarding other topics of sex and gender.

-Meredith Light

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In her book Hermaphrodites and the Medical Invention of Sex Alice Dreger charts the ideological shifts in medical consensus over the classification of hermaphroditic bodies during the mid-19th and early 20th Centuries.  While there occurred significant changes in the favored procedures of Western medicine for the treatment of hermaphrodites during this time, Dreger’s description of the Age of Gonads shows how the medical field sometimes oscillated in its favored procedures while at a deeper level remaining in the service of a static idea.  In this case the static idea is sexual dimorphism and the procedure is the favored route for determining “true” sex.  Dreger writes, “During this period, 1870-1915, what I call the Age of Gonads, scientific and medical men, faced with and frustrated by case after case of ‘doubtful sex,’ came to an agreement that every body’s ‘true’ sex was marked by one thing and one thing only: the anatomical nature of the gonadal tissue as either ovarian or testicular,” (29).  At the beginning of said Age, gonads began their reign as the penultimate determiners of sex, and self-evidently, at the end of the Age science turned to other factors such as secondary sex characteristics for sex certainty.  This characterization presents a very clear shift from one procedure of sex determination to another, but significantly, both the adoption and the eventual abandonment of gonads as the “true” sex markers were undertaken for the motivation of upholding sexual dimorphism.  To demonstrate, when discussing why gonads were initially chosen as sex determiners, Dreger writes, “The gonadal definition of true sex seemed to preserve, in theory and practice, the strict separation between males and females,” (30).  In fact, most medical professionals, (a group which, during our era of focus, was comprised almost solely of white, heterosexual males with property or wealth) preached the gospel of sexual difference: “Many men of science, following in the footsteps of the great Charles Darwin, wrote with confidence and enthusiasm about the differences of the male and female types,” (Dreger, 26).  Worthy of mention is the fact that sexual dimorphism was generally deployed for the sake of restricting men and women to certain “natural” domains of behavior and opportunity.

When, in 1915, the Age of the Gonads as identified by Alice Dreger comes to a close, it is by the hand of a medical professional named Blair Bell: “Until 1915 when William Blair Bell did so, apparently no medical man dared to openly question the gonadal definition of true sex,” (Dreger, 158).  However, while Blair was the one to conspicuously conclude the Age of the Gonads, his reason for prescribing a change in procedure is one which strives to uphold the same ideology of sexual dimorphism which originally catalyzed the advent of the Age.  Blair’s abandonment of gonads as the true sex determiners was prompted by his experience with patients such as Dr. Russell Andrews’ patient (as referenced on Dreger’s page 161) who looked like, behaved like, and believed herself to be a woman, but in whom was discovered testicular gonadal tissue.  In such a circumstance, if the gonads were to be considered the authorities, there would be a confusing incongruity between the medically official sex and what is aesthetically observable about the person such as the appearance of secondary sex characteristics and gender presentation. This confusion is the antithesis of what is desired by a system which subscribes to sexual dimorphism: the co-mingling of “oppositional” sexual allegiances on a single body dangerously blurs the distinction between the sexes and shatters the glass wall so carefully cultivated by sexual dimorphism between the essential “natures” and capacities of men and women.  Dreger writes, “Blair Bell was, like his predecessors and successors, motivated in theory and practice by an interest in maintaining clear, medically sanctioned divisions between the two sexes… Indeed, this was largely the reason Blair Bell suggested the abandonment of the gonad-as-exclusive-marker rule.  … If men and women were to be kept distinct, Blair Bell realized, hermaphrodite-sorting would have to be accomplished in such a way as to quiet sex anomalies, not accentuate them,” (165-166).  Thus, it is significantly evident that both the rise and fall of the Age of Gonads were dictated by a curiously strong medical loyalty to sexual dimorphism; even more significantly, this persistent piece of ideology has not yet found its overdue grave, and it still continues to influence the practice of medicine and other sciences today.

 

By: Rosalind Rini

As a pre-med student at IU, it sometimes stings to see what harm medicine has done in the past. The effects of medicalization have helped and harmed communities for centuries. Historically, lepers were locked away from civilization until medicine found a way to treat them. When HIV was first discovered, the same kind of confinement was proposed. I think the initial thought is that medicalizing something different at least gives people an excuse for why others don’t fit in to the status quo. I feel like humans fear what they don’t know, but medicalizing some peoples’ lifestyles lead to more acceptance because these folks have medical issues instead of deviant intentions. But instead of making excuses, we should just realize there will never be a wrong and right way as people. The billions of us share billions of differences though on the inside we look almost the same.  As soon as people come to terms with the fact that it is all right to be different, we will begin to see changes in society.

Even though this class has pointed out a lot of trouble with medicine and the LGBTQ community, it drives me to be a doctor even more. Demedicalization of some “disorders” is necessary and can likely only be accomplished if people deeply connected to the medical community can open eyes and make changes. want to provide services to as many people as possible. I have always wanted to be an OBGYN, so with the knowledge I have, I hope to be able to serve all female bodied patients, whether surgically so or not, and learn about how to work with different sorts of people. Doctors are allowed to decide who they want to take on as a patient, and I think very few doctors have been trained in trans medicine and most do not know how to treat a trans patient, even just as a general health physician. We need to recognize the growing need for trans-medicine and enable doctors to seek training in that field.  I think there are positive and negative consequences to demedicalizing the identity of trans. On one hand, fitting into this category may help provide people with social and medical services that they would not qualify for if they did not have a “condition”.  On the other hand, if I were a trans person, I would not want to be diagnosed with a disorder when I was completely healthy and happy, as well as confident in knowing who I am. The current viewpoints towards the trans community in our nation needs to be refigured, but I can see the trouble with restructuring our system as it seems that either way, some will lose access to healthcare. Instead of a few people taking on this responsibility, it would be amazing for more doctors to take on the responsibility to learn about a group of people that need medical attention.

This blog shows one person’s feelings about the medical community deeming them as having a disorder for being trans. They view the medicalization as being hurtful and harmful. While their points are valid, it would seem like many arguments can be made for the positive aspects of medicalization as well, making this topic complicated and also necessary to discuss.

Parisa Mansoori

After researching sex reassignment surgery, I found the standard of care for gender identity disorder. As mentioned in class and Spade’s article, the medical considerations and standard of care for sex reassignment surgery is much more in depth and complicated than any other elective plastic surgery. For example, a breast augmentation (the most popular procedure) is easy to acquire. There are numerous doctors (and imposters) that are more than willing to perform a breast augmentation. Some plastic surgeons are willing to work out a payment plan! While a breast augmentation is seen as a rather routine procedure, patients still have horror stories about their experience with the “routine” procedure. There are countless woman that regret their decision to have a breast augmentation and many have the implants removed. “Fear” that sex reassignment patients will regret their surgery leads to such extensive medical consideration while breast augmentation does not. Why is it so difficult for individuals who desire a sex change to undergo surgery? The procedure is much more invasive and life-changing than a simple breast enlargement but the reasoning is even more compelling than wanting to “enhance” one’s looks and proportion or land a modeling/acting gig or seem even more feminine and desirable. (I have nothing against wanting to enhance one’s look/appeal to bolster confidence in one’s body.) It seems rather superficial to want to enhance your outward appearance. So why then is it so difficult for those that want to enhance their outward appearance as well as there inward to bolster confidence through sex reassignment surgery?

Another interesting thing about breast augmentations is that the manufacturers of the implants do not undergo rigorous testing to ensure that their product is safe inside a human body. Many implants erupt, leak, and adhere to tissues of the body. This poses many health risks. Women have reported flu-like symptoms, neck and back pain, blurry vision, insomnia, anxiety, dizziness, chronic fatigue, COPD, IBS, connective tissue disease, and the possible symptoms go on.  These patients are not even required to see their plastic surgeon annually or schedule follow up appointments (unless complications occur immediately). The FDA is currently investigating the effectiveness of the protocols surrounding breast implants and procedures. If so much time and effort is put into studying and analyzing date surrounding an elective procedure, why not for sex reassignment surgery?  Breast implants are almost guaranteed to fail within a patient’s lifetime. About 80% of implants fail within 10 years of insertion. The more I looked into a breast augmentation the more I realized that the seemingly routine and low risk surgical procedure posed high risks after all. It even guaranteed failure and required more surgeries every 5 to 10 years to replace the silicone implants. It does not seem fair to require extensive mental and physical examinations for an elective surgery such as gender reassignment when voluntary procedures are done by the thousands daily that present many complications to both mental and physical health too.

FDA panels put silicone breast implants back under microscope:

http://www.cnn.com/2011/HEALTH/08/31/silicone.breast.implants/index.html

Standard of Care for GID: http://www.tc.umn.edu/~colem001/hbigda/soc9.pdf

Sex Reassignment Surgery: http://en.wikipedia.org/wiki/Sex_reassignment_surgery

-Melissa

A recent hot topic in the news today concerns “hormone blocking therapy” and its use to delay puberty in children. At least one story has made headlines over this controversial topic. A lesbian couple in California has given their child, a biological 11-year old boy, hormone blockers in order for the child to decide what sex he wants to be (http://www.foxnews.com/us/2011/10/17/controversial-therapy-for-young-transgender-patients-raises-questions/). The boy, Tommy, has expressed his desire to be a girl and go by the name “Tammy,” but some say the boy is not old enough to be making these kinds of decisions on his own. Opponents of the decision are worried about the side-effects of such treatment, especially at such a young age. Dr. Paul McHugh, a professor of psychiatry at Johns Hopkins University, says that this practice is child abuse. This raises several concerns over not only the moral and ethical dilemma but also potential backlash by the gay and lesbian community.

Most transgendered individuals go back and forth for a number of years before making a decision as to what sex they want to associate with. Is allowing an 11-year-old child who cannot speak to decide such a major life choice the right thing to do? One also may wonder what role Tammy’s parents played in his choice to live as a female. “Undue influence on the child simply has to be ruled out” says psychiatrist Keith Ablow. Another point of controversy for the opponents of hormone blocking is the question of whether a young child is psychologically and physically capable of making such a vast decision. Does an 11-year-old really know that they want to live as the opposite sex. This is where the questions about parental influence lie. Since it is such a major life choice, many believe that such drastic decisions that may have a physical effects on the body should wait until a later age.

-Meredith Light

After reading Dean Spade’s article, I realized how many issues need to be worked out between society and the trans-gender community. I’ve never thought so deeply about all the unnecessary troubles trans people face in the world. Spade mentions that he is disappointed there is only one “type” of trans-gender. This point stood out to me because when dealing with such a dynamic situation, an individual, each person has been formed into their sexuality through personal experiences and no two transsexuals should feel that they are exactly the same transsexual, because each person is different. One of Spade’s main political goals was to develop more categories of trans gender and thought no one should be reduced to only being thought of as a trans person.

Majority of Spade’s piece was about the de-medicalization of trans gender. His ideas about the outcome of de-medicalization, should it ever occur, include:
an end to gender designation on government documents, end of gender segregation of bathrooms and locker rooms, end of involuntary “corrective” surgeries for babies who are intersex, self identification would be the determining factor for a person’s membership in a gender category to the extent that knowledge of the person’s membership in such a category is necessary, and psychiatric and medical evidence would no longer be furnished by trans to establish legitimacy.

Many problems stand in the way of the de-medicalization though…

Insurance claims are a main worry and are foreseen to be a problem with de-medicalization. There are also limited disability rights claims and problems finding doctors to do trans operations. Also, many trans people are of low income, minority areas and are not familiar with the gender model. This prevents them from understanding themselves within the gender model and understanding what they wish for in a trans identity.

 

Alexandra Fath

It’s a sad world where people can’t express the way they truly feel and act the way they want to act without public ridicule.  Laws are made to try to protect people from this ridicule and harassment, but that isn’t enough to effect the change needed in our culture for people to be accepted for the way they are.

Dean Spade, a transgender attorney, writes about this topic where trans people are denied the chance to feel comfortable in the world around them and be the person they want to be.  He writes in hopes that someday trans people can get the respect they deserve and allowed to become the person they feel inside without medical boundaries and “professional” opinions on who they are or not.  At the end, however, he writes stipulations on effects he wants to see on society.  He writes about ending gender designation on government documents, bathroom and locker facilities, involuntary “corrective” surgeries for babies with intersex conditions, limiting factors on self identification on gender categories, and psychiatric and medical evidence to establish trans legitimacy.

I believe it’s important to note that these wishes don’t involve more work on the trans person but on society’s role to accept people for how they want to be.  While it’s hard for me to agree with people who really want to change their bodies, I can respect their desire to live in a society that accepts them.  I think it’s society’s fault for people’s desire to change to try to “fit in” – instead society should work to be more inclusive.  This can apply across to everyone who may feel different.  Take what you got and be the best person you can be and someday soon I hope society can learn to adapt for the progress of mankind.

–Brian Falatko

After reading Dean Spade’s article, Resisting Medicine, Re/modeling Gender, I was particularly interested in his discussion of Gender Identity Disorder. I had read a little about GID in previous gender classes, but they way in which he approached/analyzed it interested me.Gender Identity Disorder is known to occur within children at an early age and has the potential to carry on into adulthood. When children are believed to have GID, this involves “…childhood participation in stereotypically gender inappropriate behavior” (Spade, 24). This seems pretty straightforward; a boy with GID will gravitate toward playing with dolls and will avoid being aggressive, while girls will gravitate toward playing with trucks, wearing boy clothes, and will avoid playing with dolls ect.

So yes, people know that GID exists in children, but I wanted to find some opposing viewpoints of individuals about how they think that GID reveals itself in children.

While researching for various opposing beliefs, I happened to come across an episode of the Dr. Phil show that was dedicated entirely to the debate about children with Gender Identity Disorder. Of course Dr. Phil had parents on this episode whose children were “gender confused,” but he also had a psychiatrist and researcher who were able to contribute to the conversation and offer their own opinions and views about the topic.

The psychiatrist, Dan Seigel, believes that children are born in a certain way, and it’s not just their genitalia that constitute whether they are a girl or a boy. He strongly asserts that a child’s brain is on a different scale than one’s genitalia, and that a child’s brain may get a different gender identity despite their visible genitalia. He also makes an effort to point out that even though our society creates gender roles that are so black and white, our brains are on completely different scales/spectrums, which is what allows GID to occur in children. To further elaborate on Seigel’s position, I’ll let him do the talking:

(Speigel begins talking around the 4 minute mark)

In contradiction to Seigel, Dr. Phil then introduces a researcher, Glenn Stanton, who works for a Christian-based organization called “Focus on the Family.” Stanton specifically studies gender as a social phenomenon, or social construction. In other words, he is interested with how the parents play a role in the shaping of a child’s gender. It’s evident that he disagrees with Seigel’s claims, and believes that parents are the ones who should be held responsible for guiding their children into their appropriate gender. In other words, he looks at children as being a blank canvas, but with genitalia, and it is up to the parents to paint the appropriate onto their children, based on reproductive organs. And again to further elaborate, I’ll let Stanton do the rest of the talking:

(Stanton begins talking around the :41 second mark)

Both men obviously have very different opinions on how, and why, children obtain GID, but their juxtapositions mirror very similar arguments around the notion of Nature vs. Nurture. Seigel very deeply roots his research in the influence of nature upon GID in children, where Stanton takes the nurture route. Regardless, both men have valid and intriguing points, but it’s ultimately up to the parents of these children to decide how their Gender Identity Disorder will be handled.

-Aubrey Merrell

In class we talked about the new National ID that might pop up sometime in the future. I hadn’t really heard anything about it so I decided to investigate it. It stems from the Real ID Act that was adopted back in 2005 that would allow the DMV to link up to all the other DMV’s around the nation. This would allow police officers to have quicker access to anyone’s driver license records no matter what state they come from. This would also make it a lot easier for police to detect card theft. However, not all States have complied with this ID Act. Right now in Indiana we have what is called the Secure ID. To get it you must present your birth certificate, SSN, prove you are legally in the US, and reside in Indiana. Essentially, its a “more secure” driver license, whatever that means. I could find little information on the actual DMV website for the state of Indiana explaining why the new ID was needed, what was actually on it, and what benefits it provided. All they included was what was needed to obtain the new ID and how to get it. I thought it was interesting that not even an image of the new ID was on the website, which leads me to assume it is the same as the driver licenses that are issued. However, this is probably not the case. Other websites have said the Real ID stores and scans personal information such as your Social Security number and birth certificate information. Sounds a little dangerous right? Carrying all this information around in your back pocket.

Now there is another card in the works, a National ID card. It’s sort of a Social Security card on steroids. While right now its not supposed to have nay personal information on it, this could easily change. What is to stop it from containing private information, medical information, or tracking devices. Also, because its supposed to be universal what would stop it from being required to get medicine, or receive treatment?

It is especially important to think about the implications of a National ID card after reading Dean Spade’s essay. While the process to receive hormones or surgery is already difficult, a National ID card would make this an even more complicated process. To be considered transsexual by the medical community requires individuals seeking surgery or hormones must conform to the diagnostic criteria for a GID diagnoses (Spade 25). Only once they have attained the notes from their doctors proving their sex can they change their sex on official documents or legally change their name (Spade 26).  The addition of a National ID card would make this process even more difficult. Not only would it be one more document to change, but it is probably a much more difficult and time consuming document to change. Also, if the card does contain personal information, such as medical information, a transsexual individual’s private medical information would be visible for anyone who can scan for it. Lastly, if this card is required to get hormones or receive surgery and for some reason they don’t have it, its lost or stolen, then they don’t have access to their hormones or their surgery could be pushed back.  While this card is meant to provide protection it in many ways limits and causes hindrances on peoples lives, especially transsexuals.

By Kristy Wilson

One of my fraternity brothers reserved the Collins Cinema this past weekend and we prepped ourselves for a movie marathon, starting with Mean Girls. Unfortunately, the plans went from marathon to just watching Mean Girls because more than half of us started to complain about food. Hunger ravaged my brotherhood, so we decided to ravage the local Steak n Shake. We piled into a few cars, sang with the radio, and soon enough arrived at our greasy destination. Our group of ten gathered inside next to the “please wait to be seated” sign and continued in our giggled conversations as we patiently waited. The mood of one of my brothers made a quick turn for the worse when he noticed a table of guys talking about us. More specifically, they were taking photos of him and debating whether he was a man or a woman. This whole situation was incredibly uncomfortable because they were talking about him as if he was an object, just a material they wanted to decipher. He wasn’t a person to them, and I didn’t want to know how this larger group would treat us had we confronted them.

This situation wasn’t completely new to me. I had experienced homophobia growing up; at one point a group of guys bashed in every window on my car because I was just a fag in their eyes, but I thought we had grown out of that when people went to college. The newness of the situation wasn’t from homophobia, but their reaction was for his androgynous gender. I had never had to deal with people unless they knew I was gay. My brother just stood out where I didn’t.

I started to connect this to other friends and their reaction to androgyny. Even the most open minded gay friends will turn to me, giggling, and ask if I think someone is a man or a woman. Looking back on these seemingly-harmless comments made by my close friends in comparison to the group of guys deciphering my brother, the same type of comments that reduce a person to their gender presentation coming from two very different groups really concerns me. Anxieties related to gender variation are very real and far more common than most would like to think, which tells me that only a small group of people have noticed the consequences these anxieties produce.

The pathologization of gender variance has yet to draw mainstream concern. Unlike past movements related to people of color or the gay and lesbian communities, the transmovement has yet to garner enough attention to concern a majority of problems with gender policing. Even a great deal of gay, lesbian, and bi individuals don’t notice this issue unless they face gender androgyny on a daily basis. This is surprising because you would think queer individuals would be more in tune with this, but somehow this slips under the radar.

hmm…

-Lucas Zigler