As Spade himself says, “Mutilating Gender” examines the relationship
between individuals seeking sex reassignment surgery (SRS) and the medical establishments
with which they must contend in order to fulfill their goals. While the piece
primarily focuses on medical governance of transsexual bodies, it can be broken
down into several subthemes, including (but not limited to): cisgendered
gatekeeping and the resulting dominant trans* narrative, perpetuation of the
gender binary, and presumed heterosexuality.
The “gatekeeping” metaphor Spade uses throughout the piece is fairly straightforward.
It refers to the authority given to medical professionals – usually cisgendered
– to determine who may medically transition. However, not just anyone can be
given the go-ahead to do so. In order to be seen as eligible for sex
reassignment surgery, the individual in question must first meet the rigid
demands of diagnostic criteria, which generally means adhering to a dominant
trans* narrative: the dissonance must stem from childhood and the individual
must be sufficiently masculine or feminine, depending on which gender they wish
to transition to.
Afterwards, they must “prove” that they are truly ready for and committed
to their transition by “inhabit[ing] and perform[ing] ‘successfully’ the new
gender category” for a preset amount of time (13). The emphasis here on success implies a “right” way to perform
gender, and thus perpetuates the idea of the gender binary. Spade also mentions
the impact that presumed heterosexuality has on the determination of
eligibility for SRS: one is more likely to be allowed to transition if doing so
will align them with the “correct” sexual orientation, i.e. changing gender in
order to pass as heterosexual.
- - -
By setting up diagnostic criteria at all, the medical world is prescribing certain qualities to transsexual individuals. It is demanding of them a trans*
narrative – something innate, something universal, something that can better proclaim
individual identity than the individuals themselves. The fact of the matter is
that in order to gain access to medical resources, you must identify with the
gender binary. The problem must be “within the mind of the ill rather than within
the construction of what is healthy,” and the treatment must be seen as “fixing”
that problem, thereby allowing the individual to better conform to a gender
role (7).
The medical regime, then, both perpetuates society’s ideas of what it
means to be male or female and negates the experience of anything in between. Using
behavioral criteria to diagnose gender still functions to emphasize the
differences between the genders themselves, implying that one who identifies as
male would not perform acts seen as characteristically “female” and that one
who identifies as female would not perform acts seen as characteristically “male.”
This assumption of a lack of middle ground is ironic in the sense that SRS is generally
seen as a “freeing” process; however, in taking away the potential to
transition for sake of freedom of self-expression, it devalues gender
self-determination and fluidity, thereby stifling the individual. The fact that
the “trans* narrative” must be strategically employed by the person in question
goes to show the true nature of the process: they are not being asked to express
themselves, but rather to present an image that complies with the preconceived
societal notions of what it means to be a “real” transsexual and thus “deserving”
of medical assistance.
The politics behind this procedure are problematic for a number of
reasons. For one, who has the authority to determine an individual’s identity
if not the individuals themselves? Furthering that, who is to decide whose
story is more “legitimate” or “real” than another’s? How can we place objective
criteria on something so purely subjective as experience, anyway? And why do we
feel the need to constantly adhere to what is “normal” when “normal” is nothing
more than a social construct?
- - -
Discussion Questions
If you prefer to keep rhetorical questions rhetorical, here are a few
others to consider:
1. Where else can Spade’s idea of gatekeeping be seen in LGBTQ lives
and politics? For example, how does this concept relate to intersexuality?
2. Who, if anybody, is to benefit from the rigid diagnostic criteria of
sex reassignment surgery?
3. Why do you think other forms of cosmetic surgery are seen as more
acceptable than (and are more accessible than) SRS? How does this relate to gender?
Medicine and science are viewed as fields that are logical and infallible, but like every other human endeavor, they are colored by prejudices and issues related to gender, sexuality, race, etc. However, because medicine/science believes itself to be completely and absolutely logical, it doesn't question itself, nor does it better itself in terms of internal prejudices. This is at the root of the medicalization of the trans and intersex experience, where you must have x, y, and z to be considered for SRS or you are a boy because your ambiguous genitalia is greater than x centimeters, as measured by the completely trustworthy, sensible, and, of course, knowledgeable doctor who birthed you. TL;DR, despite the "First, do no harm" that sits at the heart of medical ethics, cisheteronormativity is so deeply ingrained in our society that even medicine isn't immune to it.
ReplyDeleteTo answer your third question, I find that other forms of cosmetic surgery are more acceptable because they support rigid gender norms, and thus perpetuate the oppressive system that is gender. For instance, breast implants or a tummy tuck are two of the many examples of cosmetic surgeries. The aforementioned examples are also two easy ways to describe how such "enhancements" support the standard notion of what it means to be a woman (i.e. physically and sexually appealing). In a sense, these cosmetic surgeries implicitly tell people that they should look a certain way, and if they do not look that certain way, then they must take measures to look that certain way (i.e. the various cosmetic surgeries one could choose from). On the other hand, SRS is less acceptable, and accessible, than other surgeries because one who undergoes SRS is effectively saying "Fuck you!" to the narrow, degrading gender norms that have been taught to them since their birth. Instead, these individuals are taking a much more conscious role in their gender identity, and thus their overall identity.
ReplyDeleteIn response to question 3: while I echo the other comments on why cosmetic surgery is more acceptable, I wouldn't say it is entirely more accessible in every way. In regards to the ridiculous gatekeeping to SRS, I absolutely agree there are less parameters and pre-requisitions to meet for cosmetic surgery. On the other hand, SRS is now covered in some states (go Massachusetts!) by Medicaid and by many private insurers (e.g. Blue Cross Blue Shield) whereas cosmetic surgery is not. Obviously Spade's piece explains how problematic it is that current medical professional categorize being "transsexual" as an illness with an exclusive diagnosis. But one thing to consider is how important cosmetic surgery is for some trans people. Cosmetic surgery, I'd argue, is more about gender presentation, whereas SRS is more related to one's own perception of gender; I'd say this because everyone you meet will see your face and make judgements, whereas most people (generally) don't see your genitalia. Cosmetic surgery can be life saving for those trans people who are severely distressed by how others perceive them (no fault of their own, everything comes back to society's rigid gender norms) and also how they perceive themselves. And with all that being said, cosmetic surgery is not (as far as I know) covered by any insurance and can be (depending on the specific procedure) as much if not more expensive than SRS. So in terms of monetary accessibility, an argument could be made that SRS is more monetarily accessable. All this being said, I'd reiterate that SRS has a lot more gatekeeping bullshit in terms of living as a "true" man/women (whatever that even means...) for a year with a year of hormones and 2 diagnoses from special doctors, and that everything I said doesn't necessarily disagree with Spade but questions what is accessable in one realm is not in another.
ReplyDeleteI had never considered the idea of cosmetic surgery as being possibly covered by insurance before. I agree that it can make a big difference, but I'm still not sure whether it should be covered. I'm glad that SRS is covered in some states, and I see that cosmetic surgery is often necessary or helpful for trans people. I definitely need more time to think about it, but I'm interested in what others think regarding covering cosmetic surgery. I'm not against the idea of cosmetic surgery especially if it will help a transition, however I'm hesitant when it comes to having such a surgery covered because of what it might mean for the future of cosmetic surgery in general. I feel like the gatekeeping potential would increase, but at the same time if only those can afford it get it then that's another way to gate keep.
Delete