Making and Treating Trans Problems: The Ontological Politics of Clinical Practices

ABSTRACT

This essay investigates a divergence between medical and autobiographical accounts of transexuality. By analyzing a letter to the editor in the journal Aesthetic Plastic Surgery that defends trans patients as a “special case” (Selvaggi and Giordano, 2014), I examine how medicine produces trans patients as a separate category of patients. The differential treatment paths of trans and nontrans people who pursue “gender-enhancing” medical interventions demonstrate a double standard that undermines claims to act in the best interest of the patient. Using the evidence of trans men’s accounts of themselves as well as research into the experiences of trans people from across the United Kingdom, Australia, and North America, I critique the medical management of transexuality and call on clinicians to rethink the treatment practices of trans medicine.

Acknowledgments

I am grateful for the encouragement and guidance I received throughout my doctoral candidature from Steven Angelides, whose generosity and poise makes all things seem possible. I would also like to thank Stephen Hartman, Jennifer Power, Bronwyn Wilson, and the three SGS reviewers for their astute and considered comments on earlier drafts.

Funding

This essay was produced as part of a larger Ph.D. study titled “Trans Men’s Realities: An Ontological Politics of Sex, Gender and Sexuality,” which was financed by an Australian Postgraduate Award from the Australian Government.

Notes

¹ I use trans (adjective, adverb) in the broadest sense and transexuality as its noun form, recognizing its limitations. It is important to note that not all trans people desire or seek medical services for a variety of reasons, and some people who seek these services self-describe in other ways.

² “Onto-epistem-ology” is a Baradian compound noun that describes how ways of being are entangled with and inseparable from theories of knowledge (Barad, 2007, p. 89).

³ This essay forms part of a larger project investigating trans men’s sexual, clinical, and bodily realities. As such I draw on the accounts of trans men. Although trans women’s experiences will differ and deserve to be examined in their own terms, undoubtedly there are similarities in their experiences of treatment (see, e.g., Stone, 1991; Cummings, 1993; Bornstein, 1994; Stryker, 1994, 2006; Wilchins, 1997; Prosser, 1998; McKinnon, 2013). The evidence presented in this essay is not intended to be exhaustive or emblematic. Its aim is to point out that even if only some people have described their experiences in these ways, they deserve to be taken seriously.

⁴ It is important to note that, as Heyes (2007a) points out, reports on the positive psychological effects of cosmetic surgery are “mixed (and methodologically fraught)” (p. 56).

⁵ It is important to also note, as queer scholar J. Jack Halberstam (1998b) outlines, “The idea that only transsexuals experience the pain of a ‘wrong body’ shows an incredible myopia about the trials and tribulations of many forms of perverse embodiment” (p. 304; see also Heyes, 2007b, pp. 41–42; Wilson, 2013).

⁶ “Mental health professional” is the term preferred by Selvaggi and Giordano (2014, following Coleman et al., 2012). One can presume this is because there are a wide variety of qualifications people who perform in this area hold (e.g., medical doctors specializing in psychiatry; clinical psychologists; counselors). Yet this term does other work also: it dulls the seriousness of such clinical encounters for trans people who must navigate them (usually with one or more psychiatrists); it can also be read as a euphemism.

⁷ For analysis and critiques of this pathologization and the diagnosis, see Sedgwick, 1991; Stryker, 1997; Wilchins, 1997; Prosser, 1998, pp. 99–134; Butler, 2004, pp. 75–101; Karasic and Drescher, 2005; Spade, 2006; Meyer-Bahlburg, 2009; Drescher, 2010; Davy, 2011, 2015; Goldner, 2011.

⁸ On an episode of the Australian talk show Insight about cosmetic surgery, cosmetic surgeons agree that to request a (nontrans) patient to be psychiatrically assessed would be “offensive” to the patient (Filali, 2011).

Additional information

Notes on contributors

J. R. Latham

J. R. Latham, Ph.D.,is a writer from Melbourne, Australia. His research combines science and technology studies, medical anthropology and feminist theory to consider how we might intervene in order to broaden the field of trans possibilities in medicine and beyond.