Feminist and Trans Critiques of Health and Health Care: An Introduction
While doing my PhD in women’s studies, one of my areas of specialization was feminist theory, particularly theories about subjectivity and epistemology. In non-academese, that means how we think about ourselves in the world, and how we know what we know (or what we think we know). Reading a lot of trans theory, it struck me that often trans theorists were reinventing the wheel about gender theory, covering ground that many feminists had gone over before. Unfortunately, feminist engagement with trans theory has often been somewhat frivolous, uninformed, or just plain negative. Thus far there have been only a few examples of productive engagement. It is as if the two camps are unaware, or only dimly aware, of one anothers’ existence.
However, I am constantly struck by the similarities in the kinds of questions being asked by feminists and trans theorists (and feminist trans theorists, scarce as they currently are). It’s not so much that the two groups have the exact same interests, but they take up related issues and engage with the same kinds of larger questions. In addition, both groups could learn from the other. In fact, separating them into two discrete groups is a theoretical dissservice: there is substantial crossover and the boundaries are messy.
Reading feminist work about health and health care, and working on Trans-Health, really got me thinking about how these two camps were sort of talking past one another. I was seeing the same themes emerging over and over again, in different ways, and I thought that it might be productive to fly them both up the flagpole and see who saluted. In the next few issues, I’ll be writing a series of articles which develop the ideas I’ve been thinking about. In this issue, I will introduce the project and outline some of the central themes. In subsequent issues, I’ll develop the themes further.
This is intended to be a scholarly yet accessible study of recent research and debates in the field of feminist, gender, and trans theory, and health and health care policy. The goal is to identify the intersections between feminist and trans critiques of health and health care, in order to develop health care theory and practice recommendations to guide future research and policy. The work is inspired by the emergence of trans scholarship in recent years which defines access to health care and redefining the terms of engagement with the medical system as critical issues, but which lacks many of the valuable insights produced by feminist scholars in the course of the women’s health movement throughout the last several decades.
With the emergence of the organized women’s health movement as part of the second wave of feminism in North America, a significant amount of scholarship has been produced by feminist researchers on the subject of health and health care. Feminists have been primarily interested in improving options for women’s care, challenging hegemonic notions of women as inherently pathological or diseased, and identifying the role of social, political, and economic conditions in health and health care provision.
While research concerning trans subjects has appeared in the medical literature for decades, particularly after the mid-twentieth century, the discourse has been largely confined to discussions of trans as a deviant or pathologized state, which is studied in the context of medical or psychiatric anomalies. Kraft-Ebbing’s identification of “psychopathia transsexualis” in the 1930s set the stage for how transness was to be understood for decades to come. Gaining momentum with the work of researchers such as Harry Benjamin, John Money, and Richard Green in the 1960s and 1970s, explanatory theories of transness proliferated, and encompassed a variety of approaches, but generally situated transsexuality and transgender behaviour within a clinical context. Researchers occupied themselves with finding a “cause” of (and hence a “cure for”) transsexuality, transgenderism, and cross-dressing (which they sorted into three mutually exclusive and distinct typologies). Various interventions into the body and psyche of trans people were proposed and executed; these included Freudian family therapy, electroshock therapy, behaviour modification, hormone treatments, and surgery. In nearly every instance, the grounding assumption of the intervenor was that trans bodies and brains were inherently diseased, disordered, and deviant. Trans bodies were seen as sites of cross-gender contamination and pathology.
In recent years, trans activists have sought to change their status in medical-psychiatric literature, improve the options for care and access to them, and transform the discursive terms of engagement. Debates have emerged around issues such as standards of care, funding for surgeries and treatment, appropriate surgical and hormonal procedures, and inclusion in workplace and collective agreement language around the provision of medical leave and insurance benefits. Many of the concerns and themes raised parallel or echo feminist critiques. For example, both trans activists and feminists are concerned with improving and increasing health care service choices, and resisting the designation of their bodies as inherently disordered.
However, there is little scholarship which has situated trans debates within the types of power relations which have been identified in feminist literature. Indeed, the relationship between feminist theory and trans theory has been tenuous, often tempered with hostility and misunderstanding. The presence of trans people in feminist spaces and movements has been hotly debated in various arenas. This friction is troubling, since I believe that concepts and methodologies developed in feminist theory and practice can be productively appropriated by trans people. Perhaps the most significant potential contribution of feminist theory to trans theory is the focus on and analysis of how gendered structures of power and privilege operate to proscribe and constrain choices, and how gender (and other systemic interactions such as race, class, sexuality, age, and so forth) serves as a marker of social differentiation, organization, and stratification.
Queer theory has also been a significant influence on feminist and trans theory, but has tended to be restricted to issues of trans representation and performance, rather than material conditions. However, queer theory does provide a few useful points of entry. For example, queer theory points out the way in which labels in medical literature, such as “hysterical”, “homosexual” or “invert”, are produced ostensibly for medical purposes of classification, but which perform the function of bounding and circumscribing specific types of behaviour and identities. To apply that notion to this context, the term “transsexual”, when used in a clinical context, does not intend to describe behaviour which has existed throughout human history and across all cultures, but rather to denote identities and people. To that end, clinical literature has even attempted to develop criteria distinguish the “true transsexual” from other, perhaps more “inauthentic” manifestations of cross-gender behaviours. Feminist theory which draws on queer theory also identifies medicalized typologies of identity which attempted to categorize “unruly” female bodies, such as lesbians, or “frigid” or “hysterical” women. In both cases, feminist and trans theory based in queer theory strives to disaggregate representations of deviance from the experiences and identities they purport to describe, situate the process of labeling within processes of social power, and perhaps even produce alternative, subversive representations.
The goal, then, of this series is to identify the intersections between feminist critiques of health care and trans critiques of health care in order to develop health care theory and practice recommendations to guide future research and policy. Though one must be careful not to conflate the specific and diverse needs of each population, it is nevertheless clear that the theoretical and practical tools and strategies developed by feminist critics of health care can be applied to research into trans health. I am not beginning this series from the premise that feminists and trans people share exactly the same needs, questions, and concerns about health and health care, nor am I assuming that “feminists” and “trans people” are each homogeneous, easily classified groups. Indeed, it is precisely the richness of feminist and trans experiences, identities, and political inclinations that provides the foundation to critique a health care system which has assumed that all women and all trans people are all the same, and prompts me to call for a framework of health care philosophy and provision that productively addresses this diversity. Rather, I am suggesting that feminist interrogations of health and health care represent a toolbox of ideas and strategies which may then be applied, in modified forms if necessary, to trans peoples’ struggles around health and health care. In essence, I hope to avoid reinventing the wheel when formulating activism and scholarship around trans health, by drawing on related work which has gone before.
- Richard Green, Sexual Identity Conflicts in Children and Adults (New York: Basic Books, 1974), Richard Green and John Money, eds., Transsexualism and Sex Reassignment (Baltimore: Johns Hopkins University Press, 1969).
- Robert Stoller, “Parental Influences in Male Transsexualism,” in Transsexualism and Sex Reassignment, ed. Richard Green and John Money (Baltimore: Johns Hopkins Press, 1969), Robert Stoller, Presentations of Gender (New Haven and London: Yale University Press, 1985).
- Gelder and Marks, in Green and Money, eds., Transsexualism and Sex Reassignment. (Baltimore: Johns Hopkins University Press, 1969).
- Ki Namaste, Access Denied: A Report on the Experiences of Transsexuals and Transgenderists with Health Care and Social Services in Ontario (Toronto: CLGRO: Project Affirmation, 1995).
- Sheila Jeffreys, The Lesbian Heresy: A Feminist Perspective on the Lesbian Revolution (London: The Women’s Press, 1994), Janice Raymond, “The Politics of Transgender,” Feminism and Psychology 4, no. 4 (1994), Janice Raymond, The Transsexual Empire: The Making of the She-Male (New York and London: Teachers College Press, 1994).
- See, for example, Foucault and J. D’Emilio, Sexual Politics, Sexual Communities: The Making of a Homosexual Minority in the United States, 1940-1970. Chicago: U of Chicago Press, 1983.
- Feinberg, Leslie. Transgender Warriors: Making History from Joan of Arc to Dennis Rodman (Boston: Beacon Press, 1996). Bolin, Anne. In Search Of Eve: Transsexual Rites of Passage (South Hadley, MA: Bergin and Garvey Publishing, Inc., 1988). Walter L. Williams, The Spirit and the Flesh: Sexual Diversity in American Indian Culture (Boston: Beacon Press, 1986).
Bibliography of Selected Sources
Green, Richard. Sexual Identity Conflicts in Children and Adults. New York: Basic Books, 1974.
Green, Richard, and John Money, eds. Transsexualism and Sex Reassignment. Baltimore: Johns Hopkins University Press, 1969.
Jeffreys, Sheila. The Lesbian Heresy: A Feminist Perspective on the Lesbian Revolution. London: The Women’s Press, 1994.
Namaste, Ki. Access Denied: A Report on the Experiences of Transsexuals and Transgenderists with Health Care and Social Services in Ontario. Toronto: CLGRO: Project Affirmation, 1995.
Raymond, Janice. “The Politics of Transgender.” Feminism and Psychology 4, no. 4 (1994): 628-633.
——. The Transsexual Empire: The Making of the She-Male. New York and London: Teachers College Press, 1994.
Stoller, Robert. “Parental Influences in Male Transsexualism.” In Transsexualism and Sex Reassignment, ed. Richard Green and John Money. Baltimore: Johns Hopkins Press, 1969.
——. Presentations of Gender. New Haven and London: Yale University Press, 1985.