Ellen and all:

I meant primarily to raise the issue and questions, and apologize to all if I implied that pathologization of intersex conditions is somehow a simple ahistorical process.  I would like to offer some further support for your argument that the various medical conditions that underlie the "intersex" part of these conditions are ignored or deemphasized by folks in both the medicalization and the anti-medicalization camp (not that you need this, but it might help add to the discussion).

A student of mine who I have had several times in her graduate career recently wrote a fine paper for my Defining Disease course on Congential Adrenal Hyperplasia--a condition which she has--in which she made essentially this same argument.  She wished to draw attention to the fact that many "intersex" conditions are far more than "disorders of sex development", that the contested normativity largely surrounds that sex development issues and thus great gobs of medical attention are paid to those aspects of the conditions, and that this has led to what she sees as insufficient medical attention being paid to the underlying condition.  With CAH in particular, she noted that there are several forms and one is the so-called "salt-wasting" form which used to have very high morbidity and mortality.  Her conclusion was that there is a serious need in debates over medicalization of these conditions and CAH in particular to disambiguate the sex normativity issues from the metabolic issues.  And for these reasons, she found it inappropriately reductive to include CAH in any category called "disorders of sex development" because, social context being what it is, what people have and will end up seeing is the "sex" part.

Again, I meant in my own post only to raise the issue of whether medicalization necessarily pathologizes and does so in a detrimental way.  It may do so in some cases--cases related to socially loaded issues such as sex and gender, pregnancy and childbirth--but not in others.  Of course, these are the cases that most concern us as feminists.

Best,
  Alison Reiheld







-----Original Message-----
From: Feminist ethics and social theory [mailto:[log in to unmask]] On Behalf Of Ellen K. Feder
Sent: Friday, May 16, 2008 10:01 PM
To: [log in to unmask]
Subject: Re: alert regarding DSMV and reparative therapy" to "cure" LGBT

I'm just finishing an article for a forthcoming special issue of GLQ on 
intersex (coming out next spring, I believe) regarding the new nomenclature 
and the question (that Lizzie Reis takes up, though indirectly) about the 
questions concerning identity and normalization that are at the center of 
the controversy surrounding the change to Disorders of Sex Development.

I won't offer the entire argument, but I'll offer this in response to Alison 
and Renee:  The "pathologization" of intersex conditions by medicine is 
complicated by the fact that doctors have treated these conditions as social 
matters about sexual identity (and have focused treatment on damaging 
cosmetic surgeries) while ignoring genuine medical concerns, some 
life-threatening, and some very damaging to health over the lifespan; other 
might not be "urgent" but may still bear on having atypical anatomies--and 
deserving attention, much like (as Sue Rosser argued) medicine needs to 
attend to ordinary gender difference.  There are many ways in which intersex 
is not analogous to homosexuality or trans, and the various medical 
conditions that underly intersex conditions are ignored or deemphasized 
(both by physicians, and by intersex allies, interestingly enough) when 
these come up in relation to these movements.

Ellen

Ellen K. Feder
Associate Professor
Department of Philosophy and Religion
American University
4400 Massachusetts Ave., NW
Washington, DC  20016-8056
[log in to unmask]; 202-885-2931
----- Original Message ----- 
From: "Alison Nicole Crane Reiheld" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, May 16, 2008 11:15 AM
Subject: Re: alert regarding DSMV and reparative therapy" to "cure" LGBT


> It's either exceedingly meta or exceedingly self-absorbed to respond to my 
> own post, but I want to clarify that I am not trying to make a normative 
> judgment.  I merely wanted to state some of the premises that I have in 
> engaging the issue of the compatibility of feminisms and trans movements, 
> and to solicit reactions to them.
> At some later point, we may profit from engaging in a discussion of the 
> importance of diagnostic categories for gender and sex variations.  For 
> instance, some facets of the intersex movement have advocated for renaming 
> intersex conditions "disorders of sex development".  Some literature on 
> intersex ("DSD") and on homosexuality describes these as "natural human 
> variations" of anatomy and behavior.  And yet intersex conditions have 
> clear diagnostic categories in the ICD (the internationally accepted 
> coding for diseases) even though homosexuality no longer does in either 
> the ICD or the DSM.
> Does the existence of a diagnostic category necessarily pathologize?  A 
> disease classification does.  But does any medicalization necessarily 
> pathologize?
>
>
> Alison Reiheld writes:
>> Folks: I am, myself, a bit conflicted about the relationship between 
>> feminisms and
>> the trans movement.  This dates back to my early expansion of 
>> non-academic feminist awareness,
>> sparked by discussions of the Michigan Women's Festival which was trying 
>> to
>> juggle the idea that the festival was supposed to be a place where women
>> felt safe with whether to admit pre-op MTF, post-op FTM, or other 
>> variants
>> of human sexual and gender identity. Women who had, for instance, been
>> victims of rape or sexual assault by men were experiencing threat (but 
>> not
>> being performatively threatened) from the presence of persons with 
>> penises.
>> Others testified to feeling uncomfortable at best in the presence of 
>> person
>> who had been born and reared male because they exhibited typically 
>> masculine
>> behaviors and that this was off-putting at best and threatening at worst.
>> This debate was eventually "settled" by explicitly stating that the 
>> festival
>> would be for "women-born", if I recall correctly.  This was controversial
>> even in feminist circles because it's an essentialist version of what it 
>> is
>> to be women (that you are born).  It has resulted in the placement of
>> protest camps outside the festival every year staffed by trans persons 
>> and
>> persons allied with the trans movement.  So this was my first exposure to
>> the possible conflicts between feminisms and the trans movement.   Carl 
>> Elliott's most intriguing book, Better Than Well: American Medicine
>> Meets the American Dream, also identifies a possible problem for the 
>> trans
>> movement like the one described by Renee, though he does not contrast it
>> with feminisms.  Elliott's framework in the book is the contrast between 
>> the
>> language of authenticity (that medical technology can help us to be our 
>> true
>> selves) and the tyranny of the majority (that some or many of our desires
>> and choices are shaped by the mainstream, even and perhaps especially our
>> desire to and means of rejecting the mainstream).  In analyzing sex 
>> change
>> operations, Elliott persuasively recounts the story of a person who 
>> wishes
>> to undergo a sex change operation (MTF).  He presents it as a tale of
>> authenticity, persuasively, so persuasively that when I teach this 
>> section
>> of the book even most of my conservative students feel compassion for the
>> trans person's existential angst.   Elliott then goes on to say that even 
>> the trans person whom he discusses was
>> reluctant to adopt the authenticity argument because it seemed 
>> essentialist
>> but eventually did so for rhetorical purposes because only then would the
>> medical establishment perform the procedure and there was some truth in 
>> the
>> authenticity argument.  Ultimately, though, Elliott's analysis is that 
>> when
>> trans folks who choose surgery (or, presumably, full bivalent gender
>> performance) do so, they are both reacting against the limitations of
>> society's bivalent gender model and simultaneously reifying it: "I do not
>> feel like A; society allows A or B; therefore I will choose B." (that is 
>> my
>> paraphrase rather than a direct quote from Elliott) What do the rest of 
>> you think about these two cases (Michigan Women's
>> Festival and Elliott's analysis)?  I haven't made up my mind, but because 
>> of
>> them I already understand Renee's position even though I do not know 
>> whether
>> I fully concur.  I am convinced that the relationship between feminisms 
>> and
>> the trans movement is fraught, and that goals and means for particular
>> feminisms can indeed conflict with goals and means for trans folks at a 
>> very
>> basic level and not merely on a pragmatic one. Best,
>>   Alison  -----Original Message-----
>> From: Feminist ethics and social theory 
>> [mailto:[log in to unmask]]
>> On Behalf Of Renee
>> Sent: Friday, May 16, 2008 1:44 AM
>> To: [log in to unmask]
>> Subject: Re: alert regarding DSMV and reparative therapy" to "cure" LGBT 
>> Ann and Loren, et al; I wanted to address what you have shared and I 
>> wanted to respond rather specifically why I feel the trans movement as it 
>> understands and constructs itself is antithetical to feminism. Ann, I may 
>> have made blanket statements but I haven't seen any exceptions to what I 
>> said and therefore I am pretty comfortable what I said. First of all, I 
>> don't think feminism is all that diverse. I think there are people who 
>> call themselves feminists who diverge from it and this divergence is one 
>> on of the major reasons why feminism has come to so politically 
>> ineffectual. In my own experience, I became a radical because I came to 
>> see major problems in liberal feminism. But I wanted to focus on why 
>> feminists should take issue with trans ideology and what the problems 
>> are. One of the most serious anti-feminisms in trans ideology is the 
>> treatment of gender as a noun, as if gender is a natural entity and 
>> gender is something someone has. I'd submit that gender is a verb because 
>> it's a social and perceptual process. People simply behave. Observers 
>> gender(verb) the behavior and in doing so behaviors that are gendered are 
>> compared to prescriptions and norms. These behaviors are held in place by 
>> the insistence that gender is real and occurs in a nativistic fashion. 
>> Out of these constructions women are seen as being inferior to men 
>> because of supposed pre-social determinants of gender (as a noun). "I 
>> have never heard one remark that could be considered anti-feminist. I 
>> have had numerous heart-felt conversations with trans-women who, while 
>> celebrating the physical changes of transition are finding just how 
>> precipitous a plunge they have taken in terms of social privilege. 
>> Transmen, like myself, have our own experiences of crossing the great 
>> gender divide." What gender divide? Feminism sees two gendered (verb) 
>> classes of people. What divide are you referring to? What kind of Being 
>> are you proposing that this divide has? "Of course, whether one 
>> physically transitions or transgresses gender in other ways, one can 
>> barely help but consider the very difficult questions of what gender 
>> means in our society, the strengths and weaknesses of essentialist views, 
>> and how the psychological establishment holds a dominant position in our 
>> quest to be ourselves and to be understood by others as such." From a 
>> feminist perspective, gender is a system of privations imposed upon women 
>> (verb statement). It is not mysterious and its meaning is pretty clear. 
>> It manifests itself in terms of women making seventy cents to the male 
>> dollar, and eighty three percent of congress being men. It manifests 
>> itself in terms of the deep hatreds unleashed on Hillary Clinton during 
>> this election. Gender mean no women CEOs in the fortune fifty and two 
>> percent of the fortune 500 have women CEOs. That's the "great gender 
>> divide" as feminists understand it. Feminist analysis doesn't mystify 
>> gender - the trans movement does. What strengths in essentialists views? 
>> To borrow one of the most succinct quotes, "Essentialism and feminism 
>> cannot occupy the same space." "I would hope that this would be an 
>> opportunity to have these groups work
>> together as opposed to having some groups (those who identify as B, L or
>> G) distance themselves from the concerns of transpersons for fear of some
>> kind of political contamination." I think defining oneself around a 
>> social construct and making that construct the most salient thing about 
>> you actually shows a deep paradigmatic misunderstanding of gender as 
>> feminist analysis understands it.  For me personally, I don't want to 
>> work with people who propagate these understandings and who have 
>> internalized trans-culture. I'm not worried about contamination, I worry 
>> about what trans ideology does to UNDO feminism and to situate women. 
>> We've see the phrase "gender variant". Such a term implies gender norms 
>> which is exactly what feminists want to eradicate. What I see is that 
>> trans-ideology is a set of distortions and unsupported declarations. It 
>> also is an extremely coercive movement. If I do not accept husbands and 
>> father as women, then I am transphobic. I don't accept husbands and 
>> fathers as women because women aren't husbands or fathers. The 
>> trans-movement presents a demand, that I pretend that I do see them as 
>> women. Along with that is a demand that my experience be trumped by 
>> someone else's voluntary life choices. I am supposed to relate to these 
>> people as if I accept them in a wholly undiscerning manner, as if they 
>> are all the same and as if they have the same degree of credibility. I do 
>> not think they do. I think some have quite a bit of credibility and other 
>> have very little. That's the politically homogenizing function of the 
>> trans umbrella.  If I voice that, the consequences are dire and punitive. 
>> To be honest, after looking at this, I've concluded that transphobia is a 
>> set of valid feelings and people are punished for having those feelings. 
>> But saying that takes enormous courage. Why should I fear saying, "this 
>> is what my experience
>> is."? I am supposed to accept people with penises as women and pretend 
>> that they do not have penises. If I do not play the game, again the 
>> social consequences are dire. It's next to impossible for feminists to 
>> publish critiques of the trans movement. In these manners, feminist women 
>> are being silenced. It feels like the 1950's and the McCarthy era. 
>> Trans-ideology seems very twisted to me because of the placement of the 
>> "alter of gender" (noun as used by the movement). It doesn't have to be. 
>> People don't have to be constructed as natural objects who are 
>> pre-socially determined by "brain sex". Radical feminism has done a huge 
>> amount of work to unravel constructions around gender. Trans-world is 
>> busy re-tangling them. It isn't about contamination, it's very much about 
>> a reification of deeply rooted constructions providing patriarchy with 
>> its most bedrock justifications for the systematic oppression of women 
>> and treatment of gender as a noun and as if gender is some/thing that 
>> someone contains or conversely is contained in. It's also about a culture 
>> that has inherited from transvestites and crossdressers. Often people who 
>> are opposed to the trans movement speak for individuals constructing 
>> strawmen and then arguing against the strawmen. I hope I don't do that 
>> because I feel that there is enough wrong with the ideology that I don't 
>> have to. Ann, you mentioned transfeminism. What I have seen has either 
>> been pro-sex feminism which supports pornography and the prostitution of 
>> women or has a centrality in trans-issues. When feminism is seen as human 
>> rights movement perhaps it fits but when feminism is seen appropriately 
>> as a political movement addressing the material concerns of women, trans 
>> feminism just doesn't have much in common with feminism and I would 
>> assert is actually frequently at odds with it. I have seen a little of 
>> Julia Serano's writing which is essentialistic and again begins with a 
>> declaration, "I am a woman". There is never a statement of what 
>> constitutes this individual with male anatomy as a woman. Is she saying, 
>> "I am this kind of object"? Then there is the use of 'trans misogyny". 
>> Looking at the roots of misogyny, I understand it to apply to people with 
>> vaginas. However Serano is treated, I wouldn't think the word is 
>> applicable and that looks like yet another linguistic distortion and 
>> begging of the question. I have never seen transfeminism address choice 
>> or equal pay for women. On the other hand I have often seen many of the 
>> arguments employed by the men's rights movement against women in the form 
>> of "women do it too." I think there are places where these people could 
>> make contributions. There has to be a linkages between identity (not 
>> "identify as" but identity), epistemology and gendered standpoints.  But 
>> in order to look at these phenomenon, one would have to read and 
>> understand feminism in significant depth. I've never really seen that 
>> occur in a trans-identified person. One would have to see that ALL of our 
>> identities are constructed and that most people's identities are 
>> validated by patriarchy. The trans movement is not looking at such issues 
>> or asking such questions. It is for these reason that I'd say that the 
>> trans movement is not a friend to women. renee
>