Beyond ‘invisibility’: queer intelligibility and symbolic annihilation in healthcare

Abstract

Sexual minority health is increasingly receiving attention by health sciences education and healthcare, with the core argument being that health can be improved by challenging sexual minority invisibility. Invisibility as a concept, however, does not allow for a deeper theoretical engagement with the reasons and consequences of the lack of representation of queerness in healthcare. Drawing on empirical research with queer healthcare users in South Africa, I argue that ‘invisibility’ actually encompasses two distinct, though related, concepts: queer symbolic annihilation as the reason for the exclusion of queer identities in health professions education and, by consequence, in healthcare; and queer (un)intelligibility as the consequence of this systemic erasure. By simply attributing discriminatory healthcare experiences of queer people to ‘invisibility’ we are missing opportunities to address underlying issues of queer symbolic annihilation and unintelligibility.

Résumé

La santé sexuelle des minorités sexuelles bénéficie d’une attention croissante de la part des sciences sur l’éducation à la santé et sur les soins de santé qui se basent sur l’argument clé selon lequel la santé des minorités sexuelles peut être améliorée par la remise en cause de l’invisibilité de ces dernières. Cependant, en tant que concept, l’invisibilité ne permet pas un engagement théorique approfondi fondé sur les raisons et les conséquences du manque de représentation de la queerness dans les soins de santé. En m’appuyant sur une recherche empirique conduite avec des usagers des soins de santé en Afrique du Sud, je soutiens qu’en fait, « l’invisibilité » englobe deux concepts distincts, quoique liés : l’anéantissement symbolique queer qui explique l’exclusion des identités queer de la formation des professionnels de santé et, en conséquence, des soins ; et la non-intelligibilité queer, en tant que conséquence de cet effacement systémique. En attribuant simplement à « l’invisibilité » les expériences de discrimination dans les soins, vécues par des personnes queer, nous manquons des occasions d’aborder les questions sous-jacentes à l’anéantissement symbolique et à la non-intelligibilité queer.

Resumen

La enseñanza en el sector de las ciencias de la salud y los servicios sanitarios prestan cada vez más atención a la salud de grupos sexuales minoritarios con el argumento principal de que es posible mejorar la salud de las minorías sexuales si se aborda su invisibilidad. Sin embargo, la invisibilidad como concepto no permite una investigación teórica más exhaustiva de las razones y consecuencias de una falta de representación de la homosexualidad en la asistencia sanitaria. A partir de un estudio empírico con usuarios de asistencia sanitaria para homosexuales en Sudáfrica, sostengo que para ser exactos la “invisibilidad” abarca dos conceptos distintos pero relacionados: aniquilación simbólica de la homosexualidad, como motivo para la exclusión de las identidades homosexuales en la formación de las profesiones sanitarias y, en consecuencia, en la asistencia sanitaria; y la (des)inteligibilidad homosexual como consecuencia de esta supresión sistémica. Al atribuir simplemente la “invisibilidad” a las experiencias discriminatorias en la asistencia sanitaria de los homosexuales estamos perdiendo oportunidades para abordar cuestiones subyacentes de la aniquilación simbólica y la desinteligibilidad de los homosexuales.

Keywords:

• Symbolic annihilation
• queer health
• intelligibility
• South Africa
• healthcare

Acknowledgments

Thank you to all participants who generously shared their experiences and stories with me. Thank you also to Talia Meer, who provided insightful feedback on a draft of this manuscript.

Notes

1. Labels such as ‘queer’ are never universally accepted nor enduring. However, following queer theorists (Jagose 1996; Warner 1991), I purposefully use the term queer to demarcate a position that is out of the heteronormative, which challenges the norm. However, the terminology used by the various disciplines and historio-socio-geographical contexts referenced in this paper are multiple. In healthcare discourse, ‘sexual minorities’ is by now widely used as term of choice to refer to people who defy the heterosexual norm (who do not, or not only, have sex with a partner of the opposite sex), whereas in the South African context, the acronym LGBTI (grouping together people identifying as lesbian, gay, bisexual, transgender and intersex) holds most recognition value. Throughout this paper, I use these terms interchangeably, with the understanding that they hold different values in these different disciplinary and social contexts.

2. People whose gender identity is aligned to the sex assigned to them at birth.

3. The pervasive socio-cultural-political bias that privileges and normalises opposite-sex relationships and desires. It is based on the premise of a gender binary, and justifies the socio-politico-historical marginalisation of non-heteronormative people and identities, leading to homo- and trans-phobia, and heterosexism, the discrimination against non-heterosexual people and relationships. As a concept, heteronormativity can be traced back to Rich (1980), Warner (1991) and Butler (1990), as I will elaborate in the background section of my article.

4. I deliberately use lower case for descriptors of racial identity. This serves as a political marker of the socially and historically constructed notions of race, especially in the South African context, and to remind the reader of the heterogeneity that exists amidst people who share a racial identity.

5. A pervasive socio-cultural-political bias that assumes the congruence of gender identity with assigned sex (cisgender) at birth for all people.