Note: Since I originally wrote this post about a year an a half ago, I have dramatically altered my views on Science and medicine. Rereading this I notice my derisive mention of the “medical model.” My first impulse would be to take the post down, but instead I will leave it. I will preface it, though, by saying my views have advanced some recently and I no longer agree with these sentiments. -Nov/11
As well as causing grief for administrators, we can also be trouble for the medical system. Those people who handle our bodies and psyches with the intimacy of lovers, but the distance of the corner-store clerk. We demand treatments for diseases many of us do not believe exist, manipulating diagnosis to get what we want or need.
Reforms we demand of the medical system do little to prefigure or create any sort of new health care model. Many of the broad issues raised by trans folks about the medical system were issues previously raised by feminists, I would say to much more effect. The overarching issue of paternalism, for example, has been more than adequately covered by feminists over the past 40 years—actually the popular and women’s health movements extend back into the nineteenth century if you want to be really accurate. This is not to say that trans experiences do not add more depths and detail to the existing critiques, because I think they do.
I’ll admit freely that my feminist background has provided me with high expectations of any other group which claims or desires to criticize the health system. I contrast in particular to the feminist health movement (FHM), an important part of the Second Wave, one which for reasons that are not too clear to me, seems to have almost completely dissolved by the time I was old enough to notice. Nevertheless, it is worth examining as a model of a radical health movement.
The one remnant of this movement that most of of us have at least heard of is Our Bodies, Our Selves (OBOS), which was originally published in 1973 by the Boston Women’s Health Book Collective.1 The title says it all: the book was conceived of in order to bring a sense of power and entitlement to women when it came to controlling their bodies. The Collective that put this book together were not the only ones, in fact it is a (somewhat) surviving artifact of something which was so powerful I am baffled as to how it’s not more well known among even today’s young feminists.
The most recent edition, the one you can buy from the grocery store, is a bit of a travesty when compared to previous editions. Frankly it surprises me that they can use the same name. Last time I picked it up, “feminism” was only mentioned once in the index. My edition is a bright red tome, “updated and expanded for the ‘90s” and sports a picture of the back cover of a banner reading “FEMINISM LIVES.” Contrast this to the white and pastels of the newer edition, which has been stripped of the righteous rage that made the older ones so wonderful. I don’t consult my outdated OBOS when I want to find out medical information (I have the Internet and more recent texts for that) but when I want to find out a feminist angle on a specific health care issue. (It is notable that trans and gender identity are absent from the index entirely.)
The FHM traces it’s origins to the consciousness-raising movement, another subsection of feminism which I will touch upon. The FHM began in a context where women’s realities were pathologized and then treated by a medical establishment run by the other gender, as articulated in the title of Ehrenreich & English’s book on the subject, For Her Own Good.2 Does that sound familiar to you? Feminists and their allies worked to bring the concerns of women, in all their manifestations, to the center of their care. Many envisioned a radically different model of care, one which is based on the individual knowing as much as possible, doing as much as possible for herself, as well as a return to lay practitioners in the community to deal with easy ailments and preventative medicine. For example, the clinic described in A New View of a Woman’s Body, “we spent the first half of the evening doing self-examination [of genitals, cervix and uterus] on a desk in an alcove. Then we sat in a circle on the floor and talked for the last half of the evening, discussing our health care and experiences with the medical profession.”
These “clinic” groups spawned actual brick-and-mortar institutions where women could go to learn how to know their own bodies. It also created a base of lay people who were more informed about their bodies and the social conditions which affected them than most of the practitioners who were trying to tell them what to do. They were knowledgeable and they were organized, successfully advocating for a feminist-inspired approach to care in many areas. The effects on the broader health care culture were immense, if not everything that was desired.
“Pro choice” was ideological short hand not just for access to abortion and contraception, but also in ways of giving birth. Feminists advocated with some success for the legalization and even public funding of midwifery. Hospital births have undergone intense changes since the 60s, when a mother was often knocked out so that she hardly remembered the experience and the doctor was said to “deliver” the baby. Self care such as manual breast exams took root even though cervix gazing eventually fell out of favour.
I evaluate the radical nature of the FHM not just in terms of it’s effects as we see them retrospectively, but also on the vision it did not manage to achieve. Public health care which funded so-called “alternative” and “complementary” therapies as well as mainstream medicine, extensive reproductive health care and an emphasis on in depth patient education are unrealized goals of the FHM.
I tell this story not to inform about the FHM, although I think it is immensely interesting, but to show an example of an attempt to radically shift the way care is provided and demanded.
In contrast, the trans community debates within itself whether we should be included in the DSM V, the minutia of certain procedures and we talk about the need for more resources and education. I think that trans has a lot more to demand of the system (which has the side effect of making things better for everyone else, too). Again I am not disputing the usefulness of these debates and campaigns. I am just saying that they are essentially reformist and there’s no need to be pretending otherwise.
What are the issues we have with standard health care and how can we address them? And what would trans-positive specialist gender care look like? I believe the best way to engage in action is to visualize, collectively if possible, what we want it to look and feel like to get health care. Then, we can focus our energies most powerfully.
Trans health care seems to be heavily invested in the medical model. In classic form, there is a lot of pathologizing followed by administration of chemicals, and adding and removing of body parts. My aversion to this model of care earlier in my life put me off investigating medical transition for a good long time. While I am now more comfortable around this form of medicine, I am skeptical that in its current form it represents anything near the best possible method of care.
The medical model of health is characterized by an apparent urge to view everything on the micro level. This kind of health care was developed in tandem with technological and scientific advances that made it possible to dissect matter and life with a granularity hardly dreamed of previously. Cells, germs, DNA, hormones, nutrients, radiation and many other concepts were theorized about and then proved. The medical model is one that awaits an acute crisis state, which it treats for the most part with the addition or subtraction of chemicals or body parts. While healing disciplines other than medicine are making steady advancements in affecting care, they are still all subject to this particular view of the world. We are beginning to see the shortcomings of relying so heavily on micro-level care, with issues such as diabetes and obesity, which are often mentioned, but also fibromyalgia, asthma and other allergies, addiction, abuse and assault and many other health conditions.
What I am trying to get at here is that I would like to see trans look beyond the medical model. I am interested in what we have to contribute to public health. While surgeries and hormones will probably always be an important part of trans health care, what other ways can we work with thehealth system to remodel the way care is given to everyone?
1Boston Women’s Health Book Collective, . The new our bodies, ourselves: A book by and for women. Updated and expanded for the ’90s. New York, NY: Touchstone, 1992. 14. Print.
[...] Medical magic – Reforms we demand of the medical system do little to prefigure or create any sort of new health care model. In this post I compare the trans health care movement with the feminist health movement, and suggest ways trans folk may be able to build on their successes. [...]