Depathologizing the Body
@benjaminmintzer
Depathologizing the Body
In tears, I huddle into a corner of the locker room, trying to obscure my shame — i.e., my body — by way of a bench that is bolted to the carpeted floor. Two towering walls of lockers provide a post hoc sanctum. An overwhelming feeling of ‘not-belonging’ saturates my quivering skin. The cool central air excuses the appearance of gooseflesh.
As a child, I never felt more thrown into the deep-end of the pool than when socio-normativity pushed me into the polarity of a locker room.
* * *
That summer, nearly two decades ago, my (now late) maternal aunt, Trudy, invited my mother, sister, and me to her home, as a refuge from my alcoholic father’s violence. Aunt Trudy’s house was in a gated community, north of Lake Pontchartrain. The opulence, piety, and sterility of an affluent Louisianan suburb was a far cry from my daily experience. My family was fed and sheltered through a combination of social services; WIC, SNAP, SSDI were the acronyms of my childhood. And yet, at my young age, I still imagined my socioeconomic class, much like the gender I was clinically assigned at birth, to be mutable, impermanent, and weightless.
The events that unfolded at my aunt’s fitness club, however, would water the seeds of immutability. For some reason I was segregated from my family that day (perhaps to help facilitate the cisfemale bonding between my sister, mother, and aunt). From the center’s sign-in desk, I was shuttled through the locker room to change into my bathing suit and then off to the pool. But afterward, not even the chlorine could strip away the shame I felt as I was forced back into that locker room. Terrified, I hid behind the bench and searched frantically for my clothes.
When a body occupies a space that is incongruent with its perceived social station, it feels displaced. The atmosphere becomes viscous as that body wades through the indicting gaze of peers. And even if the body is lucky enough to go undetected, selectively invisible to the others occupying the space, the body is never truly buoyant; the impact and weight of its density is still felt, as the body continuously treads the social waters to keep afloat.
The counselors conveyed my horror and tears to each other, and no one seemed to understand what had upset me. At the time, neither did I.
This was my first encounter with the violence of social currents; the waves of expectancy and conformity chopping against my fragile body, and dragging me into the undertow of cisheterorepro- (cisgender-heterosexual-reproductive-normative) binary. The social anxieties I experienced internalized, festered, and muddied the waters of my identity. Seeing the dismay of my peers, I began to recognize the incongruence between my body, and those who occupied the locker room. I wept, longing for the cisfemale-normativity of my family. Why wasn’t I like them? Why doesn’t my body belong? Something must be wrong: with me.
The narrative of gender non-conforming people being born into the ‘wrong’ body — an incongruence with one’s assigned sex marker— is a pervasive one. The story finds its origins from the Stanford University Gender Dysphoria Program (SGDP), which opened its doors in 1968. Mostly staffed by white cisgender straight males, who acted as stringent gatekeepers to gender-affirming medical treatments. As renowned scholar and gender studies professor Sandy Stone explains in her seminal article, The Trans Manifesto (2000), Stanford’s program used endocrinologist and sexologist Harry Benjamin’s The Transsexual Phenomenon (1966) as a rubric. Stone clarifies that, according to Benjamin, being born in the ‘wrong’ body was the kernel criterion for diagnosing a patient with gender dysphoria.
The vestige of this outmoded criterion is found in much of the rhetoric about gender non-conforming bodies to this very day. Liberal and leftist media coverage seeks to garner sympathy, empathy, from cisgender people by confining and reducing our experience to a medical condition. This past August, satirical journalist John Oliver’s Last Week Tonight ran a much lauded segment on trans* identity issues. Oliver announces [rhetorically] to a confused weatherman from a local news station that a person’s transition is “medically speaking, none of your business”. Oliver is right: whether we chose to participate in affirming regimens from health care providers is not owed to the public.
However, wrapping up trans* and gender non-conforming issues with medical red tape is tactical. Social and legal conventions construct firm boundaries around the disclosure of personal medical histories. Thanks to the American Disabilities Act, for example, employers are prevented from discriminating against an employee’s disability. And Section 1177 (a)(1)(2)(3) of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) punitively prohibits the discussion of an employee’s medical history. But as we have seen time and time again, this legal privilege is not always afforded to trans* and gender non-conforming people in practice. And while public outcry of invasive interview questions has curbed some of these uncomfortable interactions, it does not address the ever-prevalent medical gate keeping.
Employment of the trans-bodies-are-a-medical-issue tactic defers gender to a clinical diagnosis. And we end up perpetuating the pathological narrative of the SGDC, which ultimately limits our conception of gender identity to a sexual dimorphism. Sexual dimorphism is the divvying up of physical features, and psychological and behavioral dispositions into the two, discreet sexes of male and female. Conforming to dimorphism is depicted as the “ultimate goal” for trans* people. Any aberration from this binary, namely gender non-conforming and intersex people, is viewed as a malformation to cis people, and a threat to the authenticity of trans*binary people.
Non-binary people, including myself, are held to cisnormative gender roles and presentation, which alienates us from trans*binary and cis people alike. Take What I Wanted to Wear (#wiwtw), for example. Because of salient morphological features, many non-binary people mute their gender expressions in fear of facing violent transmisogyny on the streets. Worse still, identity-affirming treatments are still measured against this binary rubric. The ‘success’ of a hormonal or surgical treatment is commensurate to the nominal development of ‘secondary sex characteristics’.
Thus, dimorphism has left non-binary healthcare research as uncharted waters, dangerously limiting treatment modalities. And much healthcare information relies on the false dichotomy of testosterone and estrogen. It’s telling that most of the published research available on PubMed (a digital library of clinical articles) centers around the necessity of testosterone in ciswomen, but not about the role estrogen plays in cismen, let alone trans* people. As Vernon A. Rosario points out in the 2009 article, “Quantum Sex: Intersex and the Molecular Deconstruction of Sex,” the binary gendering of gonadal hormones reinforces the mythical binary as some kind of a biological, infallible truth. This obscures the spectrum of gender and sex by conflating hormonally-related morphologies to gonadal morphologies. In doing so, assigning societal roles and beauty standards to particular gonads.
Unfortunately, seeking appropriate healthcare means becoming our own best advocates. We must inform our healthcare providers about the treatments we need. Indeed, according to the 2010 National Transgender Discrimination Survey Report on Health and Health Care, 50% of participants “reported having to teach their medical providers about transgender care”. And that sometimes means the expenditure of cognitive, emotional, physical, and economic resources many of us, due to systemic oppressions, cannot afford.
But it wasn’t until now, nearly two decades later, that I received the best advice while attending the 2015 Annual Philadelphia Trans* Health Conference: prepare a list of goals in advance of your health-care appointment. Which types of morphological changes are you seeking? Are you comfortable with the chance of your voice lowering? Would breast growth trigger dysmorphia? Work closely with your health care provider to understand how these treatments work. A provider that will not take the time to explain things to you does not respect you.
So, in this deluge of trans* visibility, now is the time to redirect the currents, away from these waves of praise for binary conformity. The prominence of non-binary and agender advocates and public figures, like Alok Vaid-Menon and Tyler Ford, signify the tearing away from this cultural mooring. But we must steer the ship through these uncharted media waters away from a diagnosis of identity, which seeks to reductively codify the continuum of gender, sex, and sexuality via medical taxonomies, and towards the dismantling of the infrastructures that buttress the binary system. Only then can we make non-binary treatment modalities accessible to everyone who needs them.
