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Notably, Butler considers the political tension between those trans activists who would oppose the Gender Identity Disorder as pathologizing and paternalistic, and those who insist upon its importance in securing access to medical technologies, recommending the strategic use of the diagnosis. While the latter view underestimates that degree to which such a move further empowers the existing structural arrangement and inflicts damage upon those who undergo the regulations 82—3 , the former fail to see how, in practice, movement away from some medical regulation is not going to be possible without also completely undermining access to the technology 90—1.

While Butler's modified view in some ways eases the tension between her theory of gender and the demands of trans politics, it is worth noting that the theory does not deliver many details in terms of trans oppression and possibilities for resistance. Her discussion of Gender Identity Disorder is a case in point.

It leaves us with a powerful illustration of her theoretical claims about autonomy; yet it does not offer much in terms of concrete political strategies. Bernice Hausman's Changing Sex: Transsexualism, Technology, and the Idea of Gender aims to provide a feminist analysis of transsexuality within a Foucauldian paradigm. While her theoretical framework differs markedly from Raymond's, she also shares Raymond's concern about transsexuality as well as her deep distrust of medical intervention on the body.

For Hausman, the primary hallmark of transsexuality is the sheer demand for transsexual surgeries through which transsexual subjects are constituted as such , As a consequence, she sees transsexual subjectivity as entirely dependent upon medical technology. A corollary of her view is that the very notion of gender as a psychological entity and cultural role distinguished from sex is a consequence of medical technology, and in part, the emergence of transsexuality.

Rather than arising as a consequence of sexist gender roles, Hausman argues, transsexuality is one of vehicles through which gender itself is produced as an effect of discourses designed to justify access to certain medical technology In defending this position, Hausman points to the historical emergence of the expressions gender and gender identity in the work of individuals such as John Money and Robert Stoller discussed earlier. She sees such historical developments not as moments of intellectual discovery but as discursive development. It is the precisely the development of this new gender discourse which ushers in gender and gender identity.

And such discourse is made possible, for Hausman, through the advance in technology which allows surgical treatment of intersex and transsexual individuals. In effect, gender and gender identity discourse emerges as a way to motivate and justify the deployment of certain medical technologies. Prior to gender, argues Hausman, the reproductive subject i.

With the development of gender, the reproductive subject now understood in terms of heterosexual gender role is taken to signify gender identity as the very ground for biological sex — Hausman resists Butler's call to proliferate genders, then, and insists instead on a return to the notion of sex A significant component of Hausman's account is that transsexual agency is inherently complicit in the medical model For Hausman, transsexuals are defined by their desire for surgical conversion and have their subjectivity constituted by and through medical accounts of transsexuality.

Beyond the medical model, no transsexual subjectivity is possible at all, according to Hausman. Notably, Hausman appears to misrepresent Stone as claiming that there is a single reality or truth to be told, concealed by the medical narrative This rejection, however, is empirically false as is evidenced by Stone's observations about the subversive activities in transsexual subculture discussed above. Indeed, given that Stone herself, a transsexual, seems capable of articulating an account of self that exceeds and contests the medical model, it is unclear why and how Hausman can deny that resistant transsexual subjectivity is possible.

For Hausman, transsexual autobiographies serve the function of justifying access to surgery through the deployment of medical accounts.

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The purpose of such narratives is to compel the reader to comply with the author's experience and to interpret her own life in the same way Indeed, Hausman argues, these very narratives belie several contradictions and are actually self-defeating. If one was always that sex all along, then why sex-change surgery? In response to this charge, Prosser argues that autobiographical narrative is essential to understanding transsexual subjectivity In his view, autobiographical narrative—required by the clinician, and then perhaps re-visited through a formal autobiography—allows transsexuals to confer intelligibility upon their lives.

Such accounts, Prosser points out, are always retrospective. And they involve a split between the narrated self and the narrating self. Such tensions between claims to having always belonged to a sex on the one hand and of going through a process of surgical sex-change on the other are simply constitutive of the types of tensions that arise in autobiographical narrative , — Whether or not Prosser is correct, however, Hausman's identification of self-undermining tensions is weak.

But it isn't clear that this is so. If claims to have always belong to a sex are used to flag a gender identity and perhaps the sense that one ought to have born to the other sex on the one hand , while claims to have changed one's sex are used to flag bodily transformation on the other hand , then there scarcely seems to be a self-defeating tension. Hausman also briefly considers transgender politics as a possible source of resistance to the medical conception of transsexuality. She recognizes that the possibility of trans people working in a way that is at odds with the medical regulation of gender is at odds with her attempt to reduce transsexual subjectivity to complicity.

In reply, however, Hausman sides with Raymond in affirming that the sheer mix-and-match of gender presentation does nothing to transcend gender, relying on an unacceptable view of gender as in some ways voluntary —8. She also notes that Bornstein whom she sees as representative of all current transgender politics continues to make room for transsexual identities and transsexual surgery, which she sees as fundamentally problematic Even if Hausman is right that some transgender activists adopt this position about transsexuals, however, she hasn't fully addressed the main point that there exist forms of trans subjectivity which outstrip the medical model.

And while she is certainly right that not all gender blending is subversive, it isn't clear why none is. One of the notable outcomes of Hausman's work as well as Raymond's new introduction to The Transsexual Empire , was a heightened recognition among trans scholars of the fragility of transgender studies. Concerned by the continuing transphobia inherent in some non trans feminist writers, C. To a large extent, non-trans feminist discussion of trans issues seems to have circulated around the perceived problematic status of trans people and, in particular, transsexuals.

Moreover, there has generally been an over-emphasis on MTFs in particular. So it is worth drawing attention to significant trans feminist views which have emerged from disputes in subaltern communities among various non-gender normative individuals, particularly those assigned female at birth. Tensions among FTM-identified and butch lesbian-identified people had been leading to politically charged disputes about the significance of masculinity. For some lesbians, FTMs represented a betrayal of womanhood and a desertion of lesbian community.

It has, however, become a common way of referring to this individual. I place the name Teena in parentheses to flag the problematic nature of this linguistic construction. Similar tensions arose in the academic literature. Rather a masculine performing butch lesbian, for example, likewise fictionalizes it. Her point, however, as she later explained , was to mark out space for the notion of a transgender butch as a position which resisted a continuum in which lesbian butch masculinity is represented as less than the fully achieved masculinity of FTM transsexuals a, In his reply to Halberstam, Prosser contrasts what he sees as the oppositional positions of queer and trans.

The latter may very well involve viewing all gender as performance and identity as fictional. To distinguish butch as artificial and transsexual as real is to refuse to acknowledge the relationship of many butch individuals to gender and identity. Prosser's strategy for marking a trans theoretical vantage point is to draw a contrast between the centrality of performance in queer theory and narrative for transsexual people. He correctly notes a tendency in postmodern queer theory to raise questions about the political role of narratives , Such narratives may be seen to involve the illusion of a false unity and they may also involve exclusionary politics.

Yet narratives, according to Prosser, are central to the accounts of transsexuals and such narratives involve the notion of home and belonging , This appeal to narrative seems in tension with a picture which underscores the fragmentation of coherent narratives into diverse performances and which identifies subversion with the disruption of narrative-based identities. Coherent narratives, even if ultimately fictional, play important intelligibility-conferring roles in the lives of transsexuals, according to Prosser.

And this cannot be well-accommodated in accounts which aim to undermine such coherence. In Prosser's view, transsexual narratives are driven by a sense of feeling not at home in one's body, through a journey of surgical change, ultimately culminating in a coming home to oneself and one's body , In light of this, Prosser concludes that queer theory's use of transsexuals to undermine gender as mere performance fails to do justice to the importance of narrative and belonging in trans identities.

Feminist Perspectives on Trans Issues (Stanford Encyclopedia of Philosophy)

Drawing on Feinberg's Stone Butch Blues , Prosser argues that transgender construed as a departure from traditional transsexuality likewise involves a narrative structure. In this case, however, the narrative involves making a home of the in-between space between man and woman , Since, however, it involves more than mere performance i.


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He later alters his view slightly, placing transgender in a liminal space between queer and transsexual, admitting far more ambivalence around the notion of home and belonging , While Prosser may be right to emphasize the importance of narratives in the identities of transsexual and transgender people, however, it is hardly clear that he can maintain the fairly sharp lines he hopes to draw between transsexual, transgender, and queer. The narrative structure of identity as well as notions of home and belonging may be important for many people including queer-identified ones.

Yet this is to assume that trans people have the means by which to find this belonging in their bodies, etc. Given economic realities, however, this is far from clear. Indeed, given the meagerness of linguistic resources to even explain trans experiences, it isn't obvious how, in some cases, so much as an imaginary home might be formulated. The work of C. Jacob Hale is a kind of philosophical intervention in these borderland disputes. He offers one of the earliest theorizations of trans issues from within the analytic tradition. And in some ways, his perspective welds together trans, queer, and feminist sensibilities from a distinctive queer, feminist, ftm vantage point.

Hale uses the term ftm rather than FTM as a way to refuse the term as an abbreviation of female-to-male. Instead, for Hale, it is a community-specific term. This discussion of Hale will respect his terminological decisions.


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His work centers around the analysis of gender categories. Hale examines Monique Wittig's contentious claim that lesbians are not women. Wittig's point was to turn on its head the heterosexist view that lesbians fail to count as women by arguing that lesbians step outside the oppressive category of woman which requires heterosexual relations with men. Hale is one of the first to defend the view now adopted by many feminist philosophers that the category woman is what Wittgenstein called a family-resemblance concept.

The concept woman , in Hale's view, has thirteen, differently weighted characteristics none of which are necessary or sufficient for category membership , — This position enables Hale to then argue, pace Wittig, that some lesbians are women, others are not, and for some there is no fact of the matter , In Hale's view, the category woman is inherently normative , Individuals who fall within it can be assessed on the degree to which they conform to the thirteen characteristics.

For Hale, the category is governed by both positive and negative exemplars. Negative exemplars serve to proscribe certain forms of behavior and threaten the possibility of falling out of the category altogether , Yet while the threat of falling outside of the category must be in place to regulate conduct, owing to the cultural requirements of preserving the prevailing common sense about gender, very few individuals must actually fall outside of the category altogether —6.

Similarly, Hale argues, there is no single feature which can distinguish between butch and ftm individuals except, perhaps, the sheer self-identification with the very labels butch or ftm. Not all ftms self-identify as men and not all butches self-identify as women, some butches identify more strongly with masculinity than do some ftms, and some butches avail themselves of body-altering medical technologies, while some ftms do not a, —2. However the centralization of one surgery is especially problematic in ftm contexts. Double mastectomy and hysterectomy are other important surgeries. Instead, Hale suggests that both categories would be better analyzed as family-resemblance concepts a, If so, claims Hale, it would be better to speak of a border zone where the categories partially overlap with each other than to search for a firm boundary between the two He argues that given the evidence, Brandon Teena appears to have been such a border zone dweller —9.

Attempts to claim the dead or the living who live in such border zones, argues Hale, make it even harder for such individuals to live there It makes it more difficult to live there by threatening to eliminate border zone space altogether by trying to force individuals who occupy it into other frameworks. Similarly, border zone dwellers may face pressure to claim identity categories that do not work well and which threaten to erase the specifics of their lived experiences Such subject positions constituted by a lack of any central identity category are important, albeit difficult place to speak from partially because there doesn't seem to be any available language.

Yet such specificity must be maintained, argues Hale, partially through calling into question the function of definitions and categories, partially through artistic endeavor that attempts to creatively give voice to experiences not well captured in the available language —7. Hale expands on his notion of the border zone dweller in order to outline what it might be to articulate an ftm feminist voice b.

However, since these border zone dwellers are marginal with respect to the categories, their fit in all cases will be only limited and tenuous. By contrast, Lugones' conception insists upon the multiplicity of languages and systems of meaning, which is de-emphasized in Hale's model.

This is difficult, however, given assumptions by non-trans feminists who do not have the experience of certain forms of gender oppression such as transphobia It also requires caution with respect to the types of identifications one makes. For Hale, identification as a member of a category involves both identifications with members of that group as well as identifications as not -members of some other category There may be pressure, through uptake of the category ftm, for example, to identify primarily with non-trans men and to dis-identify with butch lesbians.

Such pressure, for Hale must be avoided Identification with may operate independently of identification as a member of category on the basis of, for example, historical ties. The making of such identifications must be guided by the exercise of moral and political agency. In light of this, Hale argues, gendered self-identities must be made secondary to moral and political identifications After Butler, there have been notable non-trans feminist contributions to the study of trans issues, focusing largely on the issue of feminist solidarity and trans identities. In marked contrast to the works of Raymond and Hausman, these contributions constitute sincere efforts at promoting trans and non-trans feminist coalition.

‘Social epidemiology’ gains a name …

Instead, Scheman aims to contest the normative center by centralizing those who have been marginalized —7. Scheman draws on her own lack of clarity about Jewish identity, as a secular Jew, in order to help trouble the unproblematic status of her own gender. She sees a Jewish people conceptually required by Christianormativity, and yet rendered unintelligible by its representation of all religions as entirely conversion-based , Under such conditions, it becomes hard to explain what it is to identify as a secular Jew.

Likewise, she sees transsexuality as involving a required incoherence. In this respect, Scheman notes, Christianormativity and heteronormativity are contrasting: The former represents all religions as driven by choice and conversion, the latter represents all gender as naturally determined at birth However those who have been assigned to the category Jew on the basis of ancestry or to a gender on the basis of birth form the basis of such concepts without which the concepts would not exist at all In both cases, such individuals are no less real than those who have been assigned the categories at birth While she notes several disanalogies e.

The notion of joining a collectivity is important, for Scheman, because it stresses the importance of shared bonds, values, and commitments. Cressida Heyes continues this non-trans feminist project of finding grounds for solidarity between non trans feminists and trans folk. Following Hale, she argues that woman is a family-resemblance concept, regulated in different ways for different political purposes , 84—5. She offers a critique of the non-trans feminist positions of Raymond and Hausman, while also critiquing what she sees as troubling tendencies in some transgender politics such as the work of Leslie Feinberg to adopt a liberal conception of the self as atomistic In this way, she seeks to find some middle, common ground.

Heyes argues that both Raymond and Hausman are caught in the grip of a picture which precludes any examination of their own gender privilege while foreclosing the possibility of perceiving trans resistance , This foreclosure is accomplished through assimilating all transsexual subjectivity into to a hetero-patriarchal medical discourse about transsexuality , Using Feinberg's book Trans Liberation as an example, Heyes also raises worries about a transgender politics which says that individual gender expression ought not be subject to criticism, restriction, or oppression.

She observes that gender is not merely an aesthetic style or expression of an isolated self. It is relational and often embedded in problematic systems of oppression. This means that forms of masculinity involve interacting with women, for example, in particular ways. Certain forms of masculinity involve misogyny. Such gender behavior ought to be critiqued. Cosmetic procedures do exist which aim to modify ethnically or racially marked features e.

While Overall offers a far more nuanced analysis, claims Heyes, she still treats race and sex in a way that is abstracted from the historical conditions and assumes that such history is irrelevant to ethical assessment , — In particular, Heyes argues that in drawing analogies between race and sex there is a danger in not paying sufficient attention to the contrasting histories of race and sex. For example, since sex has been viewed as a core ontological fact in a binary scheme, the conditions are in place for the possibility of sex-change as well as medicalized transsexual discourse which reinscribes this basic, ontological binary , ; , , By contrast, while race has also been viewed as a natural category, there is another racial discourse which understands it as a superficial feature under which human beings are all the same.

Heyes points to the historical role played by heredity in determining race but not sex. Heyes notes, then, that those promoting cosmetic procedures which change ethnic or racial features take care to avoid issues around racial betrayal by emphasizing individual self-expression and aesthetics —4. By contrast, argues Heyes, since sex is not viewed as hereditary, the possible of sex-change has been more viable.

In such a view, the trans person is represented as either deceptive or deluded. Overall argues that both the delusion and deception are implausibly applied to the diverse lives of all trans people and, indeed, belied by the lives of many trans people She rejects the second masquerade account on the grounds that it relies on a suspect metaphysics Some of the examples she gives include becoming an immigrant; joining a twelve-step program to give up alcohol, joining a religion, becoming a mother.

What remains constant is not some reified gendered self. One unfortunate consequence of this view is that a trans man for example cannot truthfully claim to be a man prior to transitioning. To be sure, there is a sense in which being a man is a core part of his identity both prior to transition and afterwards, since becoming a man is a life-changing aspiration subsequently realized. Her account is therefore importantly different from the first masquerade account in that it takes seriously trans identities, viewing them as striving for a kind of authenticity.

But his claim to be a man or male prior to transitioning is still false. To see this more clearly consider that insofar as Overall effectively defines sex in terms of genitalia 11 , it follows that a trans man who has not undergone phalloplasty has not yet changed his sex and is still therefore female, and possibly still a woman. The problem is that, in part owing to its cost, many trans men elect not to have this type of surgery. Nonetheless, they may still regard themselves as men and even male. This leaves open the possibility for the charge of self-delusion or self-deception to re-emerge despite Overall's attempt to avoid this.

Her goal in doing this is not to elide the forms of violence and discrimination to which trans people are subject as trans, but to call into question the view that being cisgender is normal, while being trans is deviant She distinguishes between acquired and aspirational identities. The first are assigned or earned in such a way that no further work is required to maintain them For example, being a biological mother is an acquired identity. Aspirational identity, by contrast, requires constant work to maintain For example, being a mother as in a caregiver for one or more children requires constant maintenance.

She also argues that sex itself may be becoming an aspirational identity at least for some insofar as both cis and trans people alike seek out surgery and other medical procedures e. Overall then argues that trans and cis people have the following features in common with regard to aspirational identity. Both are immersed in a system of compulsory gender maintenance, both are subject to constraints on how their gender identities are maintained while also afforded various opportunities to express their identities, both are subject to various dangers connected to gender maintenance e.

In this way, Overall continues this non-trans feminist project of finding grounds for solidarity between non-trans feminists and trans people. She revisits the dispute between Judith Butler who claims that the gendered self is socially-constructed and trans theorists, such as Jay Prosser who, rather than taking transsexuality as evidence of the constructedness of gender, points to it as evidence of something that transcends such construction , 7 and Aside from arguing that Prosser misreads both Freud and Didier Anzieu , , Salamon defends the implausibility of viewing proprioceptive awareness of the body as somehow culturally-transcendent.

She argues that the body postulated in such a view is ultimately unrecognizable as human Consider that not all trans women possess a conscious self-identity of being a woman or a girl from a very early age, and not all trans men possess a conscious self-identity of being a man or boy from early on. This person should, in the environmental account, develop a body image that would be described as roughly 'male.

Thus, if there's such an image that's incongruent with assigned gender, it mustn't have been developed in that environmental way. In addition to possessing an internal perception of one's body, however, one is also affectively invested in one's body. That is, one takes an interest in it and has strong emotions about it. This provides a way to move beyond the limitations of socially-regulated environmental experience insofar as such affective attitudes are not subject to the same type of worldly-constraint.

The challenge, however, is to explain this investment in such a way that does not reduce to sexuality or forms of eroticism. Expressions such as Schilder's libinal investment have strong sexual connotations. And the worry is that an appeal to such notions will reduce trans experiences of bodily dsyphoria to sexual feelings. This is of particular concern in light of the long standing tendency as Salamon notes, , 45 to construe transsexuality in terms of sexual desire, to reduce cross-gender identification to a kind of sexual fetish, and to elide trans gender body dysphoria as a discrete phenomenon.

Unfortunately in her discussion of this issue, Salamon appeals to Butler's notion of the morphological imaginary which itself actually does appear to privilege the sexual. What remains to be explained - a serious lacuna - is the non-sexual affective investment in the gendered body that presumably must ground the disjunction between felt sense of gendered body and the visual body in cases of trans bodily dysphoria.

In her own account of sexual desire, however, Salamon is notably careful to avoid reducing transsexuality to eroticism. She is merely interested instead, in accommodating trans experiences of sexuality in a way that is not invalidating , Salamon draws on Merleau-Ponty's notions of the sexual schema and transposition. In experiencing sexual desire, one is oriented toward an object of desire. Salamon illustrates the point as follows.

In this way, Salamon's appeal to Merleau-Ponty is similar to Butler's notion of the morphological imaginary with respect to the role of the erotic in incorporating the part through a form of sexuality or, actually, the whole way of being toward another. For rather than talking merely about an internal feeling, we are talking about ways of being in the world, in interaction with others. Many trans women, because they are women , are well acquainted with mechanisms of sexism and sexual violence.

Moreover, sometimes sexism and transphobia can be blended together inseparably. For example, some trans women may sometimes find that they are stereotypically represented as prostitutes simply because they are seen as transgender women. With such considerations in mind, a trans feminist stance might involve taking the oppression of trans women as its starting point.

Some of the issues of transfeminist concern, for Koyama, include body image, violence against women, and health and reproductive choice. Koyama deepens the discussion of the tensions, identified by Heyes, between freedom of gender expression on the one hand and concerns about the political implications of gender understood as relational on the other.

She raises worries about the purist demand that a trans woman eradicate all gender stereotypes in a society in which such stereotypes pervade. She insists instead on the priority of larger scale coalitional politics, leaving individual women to make their own personal decisions about how to negotiate gender, free of judgments about who does and does not count as a feminist Jaco EG. Introduction: medicine and behavioral science. In: Jaco EG ed. New York: Russell Sage Foundation, Reeder LG. Social epidemiology: an appraisal. Revised version of a paper read at the annual meeting of the American Sociological Association, San Francisco, September, Patients, Physicians, and Illness.

New York: The Free Press, , pp. Syme SL. Contributions of social epidemiology to the study of medical care systems: the need for cross-cultural research. Med Care. Graham S, Schneiderman M. Social epidemiology and the prevention of cancer. Prev Med. Berkman L, Kawachi I eds. Oxford: Oxford University Press, Epidemiology and social sciences: towards a critical reengagement in the 21st century. Epidemiol Reviews. Greenwood M. Dubos RJ. New York: Doubleday, Frost WH. Some conceptions of epidemics in general Am J Epidemiol.

Gordon JE. The world, the flesh and the devil as environment, host, and agent of disease. In: Galdston I ed. The Epidemiology of Health.

Title: Transsexualism as an Intersex Condition

New York: Health Education Council, , pp. Cassel J. The contribution of the social environment to host resistance. Smythies JR. Perspectives in psychoneuroendocrinology. Past, present and future of psychoneuroimmunology. Engel GL. The biopsychosocial model and the education of health professionals. Sterling P, Eyer J. Allostasis: a new paradigm to explain arousal pathology. In: Fisher J, Reason J eds. Handbook of Life Stress, Cognition, and Health. McEwen BS. Protective and damaging effects of stress mediators: allostatis and allostatic load. N Engl J Med.

Kuh D, Ben-Shlomo Y eds. Portes, A. Social capital: its origins and applications in modern sociology. Annu Rev Sociol. Kawachi I, Berkman L. Social cohesion, social capital, and health. Oxford: Oxford University Press, , pp. Wilkinson RG. Unhealthy Societies: The Afflictions of Inequality. London: Routledge, Income inequality and mortality: importance to health of individual incomes, psychological environment, or material conditions. Br Med J. Baum F. Social capital: is it good for your health?

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