Eenie Meenie Miney

I’ll be the first to admit that I have been left far behind in the vocabularic peculiarities that are now used to describe non-normative sexuality. Perhaps it’s Age, but more likely naïveté, that has led to this deficiency rather than lack of exposure.

I entered medical school in the mid-sixties when the youth were beginning to out themselves, and when some of the gloves were starting to come off -or maybe there was a growing awareness that a few of them had actually been wearing gloves. At the time -at least in my  school- Medicine seemed bicameral and only accepted two genders, male and female, with perhaps the door held slightly ajar for babies born with ambiguous genitalia or other genetic syndromes that made classification difficult.

For some of us, at least, it was a simpler time. Gender and sexual assignation were one and the same; preference as to which was really which was non-negotiable. But times and self-designation began to change; Medicine and the Law limped behind until the rift started to expose the consequences of their inaction.

I’d like to pretend that I saw these coming but, alas, I had no idea of the scope of the issue. In fact, in my mind, this straying from the norms was at best a marginal fashion. Anatomically, at least, we were what we had been assigned, and I assumed that perhaps the fullness of time and the machinations of society would iron any deviations into the acceptable crease. I had not reckoned with the discontent that enforced conformity might produce. When one has not experienced qualms, when one accepts the way the chromosomal dice have landed, it is not easy to grasp the uneasy restlessness of those few who will not play the game… or were not willing to join either team.

I say ‘few’ because I did not know; I did not understand. In time, of course, the discrepancies became too obvious to ignore in practice. At least in my gynaecological practice…

At first, there was confusion, I suppose -mine at first, perhaps- but theirs too. Not about their role, but mine. Initially, my lack of training forced me merely to listen, to empathize and then to help when and where I could. And, naïvely, I thought that was likely all that was required -and maybe all that they could reasonably expect. There was much psychological turmoil and disbelief that there was so little I could do, and yet I was relieved that I had heard them without disparaging their distress, or trivializing their problems.

But it soon became apparent that the eventual ramifications of their choices had the potential for far deeper consequences than either side had anticipated. And I’m not sure that I even appreciated the extent of the consequences of this disparity until after I retired. Only then, for example, did I come across an essay in the BBC Future series that touched upon some of the problematic issues. In an essay, Zaria Gorvett, a freelance science journalist for BBC, addressed the problem of why transgender people are ignored by modern medicine and what that might mean for their health: https://www.bbc.com/future/article/20200814-why-our-medical-systems-are-ignoring-transgender-people

‘[T]here are thought to be nearly a million transgender people living in the US… Rather than devising new ways to cope with changing social norms, transgender people are often shoehorned into inappropriate boxes instead.’

And the example she starts with is ‘a transgender man – he identifies as male but his biological sex is female. He has been living as a man for around 20 years… he is registered as a man on all his legal documents, from his passport to his medical records.’ All along, he had been taking small doses of the male hormone testosterone, but he suffered kidney failure and his condition deteriorated, therefore necessitating a kidney transplant. The criteria, for consideration of transplantation, however, differ between men and women and he lost valuable time in sorting out what criteria would apply to him.

As Gorvett points out, ‘When you factor in the large data gaps in everything from the average life expectancy of transgender people to the right dosages of medications for their bodies, along with the widespread lack of knowledge among doctors about how to address them – let alone treat them – and the high chance of them being refused treatment outright, it soon becomes clear that transgender medicine is in crisis.’

Indeed, in the UK, ‘“You can register as male or female, but you can still only choose between these two options – you can’t say if you are transgender or non-binary,” explains Kamilla Kamaruddin, a doctor who works for the National Health Service (NHS) and transgender woman. “So that’s quite difficult.” Or, if gender issues seem irrelevant to the visit, the patient may choose not to mention it, because of perceived stigma.

And, ‘The gender you’re registered as also dictates which screening tests you are invited to, meaning that thousands of transgender men could be missing out on potentially life-saving cervical (Pap) smears and breast exams, while transgender women could be missing out on abdominal aortic aneurism check-ups (or prostate cancer screenings, if they live in the US).’

Male and female physiology are different and many medications behave differently in each. ‘Females also have more sites for certain drugs to bind to, and are therefore more sensitive to them. They tend to clear them more slowly, so they are more susceptible to overdoses.’

Perhaps because of the stigma and subsequent lifestyle, ‘The group has higher rates of heart disease, certain cancers, mental health problems, suicide, smoking, and substance abuse than the general population – as well as an HIV prevalence which is  up to 42 times the national average. Transgender people are not only more likely to get sick, but less likely to seek treatment when they do.’

Still, I think we’re beginning to understand the problems they face. This gender dysphoria is an ancient condition, though, and actually gender fluidity may go back farther still. Gorvett writes about more enlightened recent attempts at assisting both with surgery and with hormonal replacement. The problem, however, is in the continuing stigmatization of those who are not mainstream. Those who do not fit neatly into societally condoned roles.

Maybe my age is tempering my reaction, or clouding my judgment, but I do wonder why there continues to be such marked antipathy to those who do not look like us, behave like us, or (gasp) think like us. Are we so insecure in who we are that we are threatened? And is it redress for the difference that we seek, an expectation of contrition? Do we really demand repentance, or is it homogenization?

I, for one, have come to think that the world would be a poorer place if we -the cis creatures- and we alone, were all that was on offer…

The raven himself is hoarse

There was a time when I thought I finally had a handle on gender: it’s a spectrum, right? It’s not defined by biology or chromosomes -it’s how you think, how you feel, who you are. It should not merely be assigned, it should be assumed. And just when I thought I was escaping from the biases of another era, and beginning to see the wisdom in Bell Curve thinking, I found myself wandering in yet another labyrinth. It was only a matter of time before I met the Minotaur, I suppose.

But it all made sense: we are what we feel inside, no matter our outward assignation. And, let’s face it, none of us is always the same person -we evolve both in time and place; who we are at work, or in public, may not be the same as who we are at home and with friends. I am large, I contain multitudes, as Walt Whitman confesses in his Leaves of Grass.

I am old now, and have never felt the urge to leave my tent; I do not feel imprisoned, nor deprived, and yet I can understand that others may wish to leave the flap unfastened. My own multitudes are those of ideas, not identities -sexual or otherwise- but as I say, we are all different and I have no problem with that.

Still, I enjoy opinions and ideas that trespass on Shibboleths, so I was intrigued when I came across an essay about the gender spectrum by the philosopher Rebecca Reilly-Cooper, from the University of Warwick: ‘https://aeon.co/essays/the-idea-that-gender-is-a-spectrum-is-a-new-gender-prison

As she writes, ‘The word ‘gender’ originally had a purely grammatical meaning in languages that classify their nouns as masculine, feminine or neuter. But since at least the 1960s, the word has taken on another meaning, allowing us to make a distinction between sex and gender. For feminists, this distinction has been important, because it enables us to acknowledge that some of the differences between women and men are traceable to biology, while others have their roots in environment, culture, upbringing and education – what feminists call ‘gendered socialisation’.’

And, in what Reilly-Cooper sees as the radical feminist view, ‘[G]ender refers to the externally imposed set of norms that prescribe and proscribe desirable behaviour to individuals in accordance with morally arbitrary characteristics.’ That view, by the way -although I have difficulty with it- is the one which I had finally come to understand: imposed gender is a caste system, a hierarchical one in which males occupy the highest rank, and socialization proceeds accordingly. ‘So, for the radical feminist, the aim is to abolish gender altogether.’

The author, however discusses another view of gender -the queer feminist view- that  ‘what makes the operation of gender oppressive is not that it is socially constructed and coercively imposed: rather, the problem is the prevalence of the belief that there are only two genders.’ The choice isn’t simply a binary one -gender is a spectrum.

But now Reilly-Cooper’s training as a philosopher enters. ‘If’, she posits, ‘gender really is a spectrum, doesn’t this mean that every individual alive is non-binary, by definition? If so, then the label ‘non-binary’ to describe a specific gender identity would become redundant, because it would fail to pick out a special category of people.’ Even the binary of Tall/Short is relative, because nobody is absolutely tall -it is merely a comparison between that individual and the average height in whatever population we are considering.

And, ‘If gender, like height, is to be understood as comparative or relative, this would fly in the face of the insistence that individuals are the sole arbiters of their gender. Your gender would be defined by reference to the distribution of gender identities present in the group in which you find yourself, and not by your own individual self-determination.’

An interesting conclusion, especially if you expand the concept. If gender is a spectrum, that means it’s a continuum between two extremes, and everyone is located somewhere along that continuum. I think of myself as a man, and yet someone is likely to be further along the spectrum towards manhood, and would therefore be more of a man than me… Whoaa.

The author takes it further, of course: ‘In reality, everybody is non-binary. We all actively participate in some gender norms, passively acquiesce with others, and positively rail against others still. So to call oneself non-binary is in fact to create a new false binary.’ Or, if you want to ‘identify as pangender, is the claim that you represent every possible point on the spectrum? All at the same time?’ And if you don’t ‘accept that masculinity should be defined in terms of dominance while femininity should be described in terms of submission… whatever you come up with, they are going to represent opposites of one another.’

I love the way philosophers approach things, don’t you? The next question she asks is ‘how many genders would we have to recognise in order not to be oppressive? Just how many possible gender identities are there?’ Her answer: ‘7 billion, give or take. There are as many possible gender identities as there are humans on the planet… But if this is so, it’s not clear how it makes sense or adds anything to our understanding to call any of this stuff ‘gender’, as opposed to just ‘human personality’… The word gender is not just a fancy word for your personality or your tastes or preferences. It is not simply a label to adopt so that you now have a unique way to describe just how large and multitudinous and interesting you are. Gender is the value system that ties desirable (and sometimes undesirable?) behaviours and characteristics to reproductive function.  Once we’ve decoupled those behaviours and characteristics from reproductive function – which we should – and once we’ve rejected the idea that there are just two types of personality and that one is superior to the other – which we should – what can it possibly mean to continue to call this stuff ‘gender’? What meaning does the word ‘gender’ have here, that the word ‘personality’ cannot capture?’ Bravo!

So, should the default then, be ‘cis’ (i.e. personal identity conforms with birth sex)? She has an answer to that one, too: A ‘desire not to be cis is rational and makes perfect sense, especially if you are female. I too believe my thoughts, feelings, aptitudes and dispositions are far too interesting, well-rounded and complex to simply be a ‘cis woman’… Once we recognise that the number of gender identities is potentially infinite, we are forced to concede that nobody is deep down cisgender.’

And remember, ‘To call yourself non-binary or genderfluid while demanding that others call themselves cisgender is to insist that the vast majority of humans must stay in their boxes, because you identify as boxless… The solution is not to reify gender by insisting on ever more gender categories that define the complexity of human personality in rigid and essentialist ways. The solution is to abolish gender altogether… You do not need to have a deep, internal, essential experience of gender to be free to dress how you like, behave how you like, work how you like, love who you like. You do not need to show that your personality is feminine for it to be acceptable for you to enjoy cosmetics, cookery and crafting.’ Amen.

Somehow, I feel that Reilly-Cooper has allowed me to peek under the canvass just a little -sort of like what I used to do when I was a kid and the circus came to town. I’m sure it did not go unnoticed, but nobody seemed to mind that I was fascinated with what was going on, and that I wanted to know how it all worked -and maybe even be invited in to ask some questions.

After all, curiosity is what leads to understanding -and isn’t it better to be interested than indifferent? Or worse, intolerant?