A Sympathy in Choice

‘As you are old and reverend, you should be wise.’ –so Shakespeare’s Goneril, King Lear’s evil daughter, advised her father. Her advice was deceptive -hostile, even- but there are times I feel that my judgement, too, has being unjustly impugned. Positions that I feel have been reasonably based and cogently argued, are attacked and maligned as if, because they dared to question the prevailing ethos, they are dangerous -or worse, should not even be heard. Should be retracted and the author forced to recant.

Some people are sensitive like that –so wrapped up in their own causes, they fear that anything similar, but more controversial, might detract from their not-yet successful endeavours. Understandable, perhaps, if they fail to thoroughly examine the merits and deficits of the other approach –refuse to consider how the one may complement the other, and vilify it to make those who would adopt it seem apostates.

Gender issues seem particularly vulnerable, maybe because they have recently been heavily exposed to public scrutiny. They are seen to be so fragile, that any attempts at critical analysis are often seen as foundational attacks, rather than efforts to better understand and underpin their framework. Comparisons are fraught, to be sure, but only when they can withstand the scrutiny of impartial examination, will they be accepted as mainstream -sufficiently natural to fade seamlessly into the Gestalt.

Of course, public confusion over terms (LGBTIQ, etc.), and the amalgamation of so many different communities of difference, makes easy and seamless acceptance perplexing for many who watch, bewildered from the edges, but progress is occurring nonetheless. Homosexuality, gay marriage, and adoption to gay couples are only the issues most recently being fast-tracked into conventional thinking. Not everybody agrees, of course, but then again what do we all agree on? Even religions and political parties still divide us.

But race (whatever that is) seems unduly stubborn. Despite the fact that DNA studies have consistently failed to demonstrate any genetic basis for racial categorizations, there seems to be an almost tribal requirement to allocate people into us and them –for othering, in sociology-speak. For seeking comfort and succour from those who most resemble us. Safety. Security. There is an assumed empathy in those who share the same assignation, an expected commonality of experience when compared with non-members. And there is not only an assumed history that unites, but also a presumed genealogy that ensures loyalty to whatever the group believes. Disavowal of what it does not.

And yet, it is a very social construct. What, for example, constitutes a valid pedigree? Any family membership in a group, no matter how far back in time, and whether or not it is inside the legal boundaries of wedlock? Or, suppose you do not look like your parents or their assumed grouping –or, conversely, you do, and yet were adopted? What if –more problematically, to be sure- you identify with another group, either because of outside influences, or a certainty within yourself, that you belong? What if you were mistakenly brought up as if you were a member, suffered along with it, saw the world through its eyes, but later discovered you had been adopted from another group? Does it make any difference? Are you somehow a less valuable member if you don’t carry the proper cards?

So, what if you decided you wanted to ‘be’ a member of another group –in the case in point, another ‘race’. Can one be transracial? And further, what might that mean? Does, ‘identifying’ with a ‘race’, qualify as anything? I have to say that I had never thought much about it until I came across an absolutely riveting article entitled In Defense of Transracialism, in the March 2017 edition of Hypatia, a journal of Feminist philosophy, written by Rebecca Tuvel, who teaches the philosophy of race and gender at Rhodes College.

I felt it was exceedingly well substantiated with cogent arguments, and compelling documentation, so I was dismayed when I discovered (in a piece from a different source: https://theconversation.com/i-wanna-be-white-can-we-change-race-78899?) that the article elicited ‘an open letter signed by hundreds of academics who demanded the journal retract the article.’ And further, that ‘the associate editors of the journal issued a long apology saying that the article should never have been published.’ I was only slightly mollified that the ‘Editorial Board responded with its own statement in support of the author’. The reaction of the academics merely underlined the unwillingness to entangle themselves in an equally scholastic attempt to explore the similarities between gender identification and the ability to racially identify. Tuvel suggests that there are many features in common, and although her argument is too long to easily summarize, I was willing to share her point of view by the end.

I suppose the most notorious case she discusses, is that of Rachel Dolezal, the former head of a local NAACP who was born to white parents but lived for many years as a black woman. ‘[…] Dolezal’s experience living with four adoptive black siblings since she was a young teenager coupled with her strong sense of dissociation from her biological parents, her later marriage to an African American man with whom she had a child, and her strong sense of familial connection to a black man named Albert Wilkerson, whom she calls “Dad,” all impacted her understanding of her own racial identity.’ That she did not officially qualify as ‘black’ and could therefore not possibly know what it meant to be black seemed unduly important to her detractors. Her duplicity alone disqualified her in many eyes and rendered her professed enthusiasm for her blackness a mockery. Invalid. White privilege…

Dolezal, became the unwilling focus of identity politics in which, perhaps understandably, the LGBTIQ community did not wish to become entwined. Any argument in her defense, it was suggested, does a disservice to the political context of transgender communities, and the violence of racism. And yet, in drawing parallels with those aspects of personal identity which are inherently fluid, Tuvel allows us to see that boundaries are also fickle, and over stretches of time, evanescent. Arbitrary. Even unstable.

But, loathe as I am to side with Shakespeare’s Claudius, and although taken out of context, there is something to his contention:

‘That we would do, we should do when we would, for this “would” changes and hath abatements and delays as many as there are tongues, are hands, are accidents. And then this “should” is like a spendthrift sigh that hurts by easing.

Thank you, Rebecca Tuvel; more than simply opening my eyes, you have opened my mind.


Oh, What Men Dare Do!

There seemed to be an inordinate amount of talk about polygamy last year –perhaps because of the long-awaited trial of two offenders from the town of Bountiful in British Columbia. In Canada, polygamy is a criminal offence under section 293 of the Criminal Code, but prosecutions have been rare. Polygamy must be differentiated from Bigamy, of course. With both of them, there are multiple partners (usually women) but with polygamy the marriage partners are presumably willing and knowledgeable about the other partners, whereas with bigamy, there is an attempt to deceive. Or, in a more legal framework, bigamy is the crime of marrying while one has a spouse still living, and from whom no valid divorce has been obtained.

I have to admit that I didn’t know that ‘polygamy’ was gender neutral –or, rather, it was nowhere near the apex of the pile of words I figured I’d look up some day. But, now that I mention it, I wonder if I’d stopped to think about the etymology, I would have known something was up –at least in our increasingly multi-gendered society… Although, in fairness to me, it’s roots are clear: gamos means something like ‘marry’ or ‘union’ in Greek. In fact, the term can be either ‘polygyny’ –many wives, or, I suppose, ‘polyandry’ –many husbands, but we don’t usually need to be so specific. As Claudio says in Shakespeare’s Much Ado About Nothing, ‘Oh, what men dare do! What men may do! What men daily do, not knowing what they do!’

The origins of polygyny –sorry, polygamy– are nested in the depths of time, but according to a 2010 article in the Independent, http://www.independent.co.uk/news/world/africa/the-big-question-whats-the-history-of-polygamy-and-how-serious-a-problem-is-it-in-africa-1858858.html, ‘It is most common in places where pre-colonial economic activity centred around subsistence farming […]Africa being a prime example. High levels of infant mortality may be a factor; when many children do not survive past the age of five a family needs more than one child-bearer to be economically viable. Then there is war. When a lot of men die, having more than one wife boosts the population most swiftly.’

But of course, times change, and so do economic and political pressures. Interestingly ‘Some anthropologists believe that polygamy has been the norm through human history. In 2003, New Scientist magazine suggested that, until 10,000 years ago, most children had been sired by comparatively few men. Variations in DNA, it said, showed that the distribution of X chromosomes suggested that a few men seem to have had greater input into the gene pool than the rest. By contrast most women seemed to get to pass on their genes. Humans, like their primate forefathers, it said, were at least “mildly polygynous”.’

It’s certainly not the norm nowadays, and often illegal. And yet, remember that in 2010, the president of South Africa, Jacob Zuma, ‘married his fifth wife in a traditional ceremony at his remote homestead in KwaZulu-Natal. His first wife, whom he married in 1973, was there to see him wed a woman 30 years his junior. His second wife stayed home to prepare the reception. He had two other wives but he divorced one in 1998 and another committed suicide in 2000.’ And the article went on to suggest that ‘he has not finished yet. The other day he paid the traditional dowry for his sixth fiancée [the article was published in 2010].’

‘In 1998 the University of Wisconsin surveyed more than a thousand societies. Of these just 186 were monogamous. Some 453 had occasional polygyny and in 588 more it was quite common. Just four featured polyandry.’ The study is obviously an older one, and societies and their mores evolve. According to an article in Wikipedia (last edited in July 2017), ‘Polygamy is [now] legal in 58 out of nearly 200 sovereign states, the vast majority of them being Muslim-majority countries situated in Africa and Asia. In most of these states, polygyny is allowed and legally sanctioned. Polyandry is illegal in virtually every state in the world. In India, Malaysia, Philippines, Singapore, and Sri Lanka polygamy is only legal for Muslims. In Nigeria and South Africa, polygamous marriages under customary law and for Muslims are legally recognized.’ That said, however, it is relatively common still in many Arab nations; among the Bedouin population of Israel it stands at about 30 per cent, according to the Independent.

I’m not sure what to make of all this. At the very least, it’s confusing -and not only for me, I suspect. What about at the state level for those countries in whom polygamy is illegal, like Canada and the U.S.A.? What are they to do with immigrants with two or more wives who seek asylum from persecution or war in their home countries? Should they be refused entry under all circumstances even if their needs are compelling and otherwise would have been candidates for acceptance?

There have been attempts to work around this dilemma, of course. Until recently at least, the U.S. has denied immigration to polygynists (either the man or any of his wives) but under some circumstances, ‘a refugee who was practicing polygamy before he immigrated will be required by U.S. immigration law to designate one wife as his legal wife to accompany him to the United States. Years later, after becoming a U.S. citizen, he might divorce that wife, and marry the woman who was formerly his second wife, in order to petition for her to immigrate to the United States.’ (nolo.com -legal encyclopedia)

Okay, so there are ways around it, but in an already overcrowded world and especially in modern societies with safety nets for its more vulnerable citizens, it seems to me that whatever use polygamy once had –marrying widows to ensure orphans are taken care of, or maybe a way of quickly increasing a specific population, or even, of course, lessening the burden of work for a solo wife- is no longer necessary. One gets the distinct impression, however much disguised, that polygyny is merely an excuse for male sexual gratification dressed up as a tradition –another not so covert way of diminishing female authority and power.

I fail to see any way in which polygyny fosters gender equality, let alone female autonomy. And I would challenge any male who purports to believe that parity is possible under those circumstances, to argue as strenuously for polyandry. To accept that he would be as equal a partner as his wife and her other husbands… But of course, he could argue that polyandry is extremely uncommon and also illegal almost everywhere. That there must be a reason for that.

Gosh, I wonder what that would be…






Frailty -Thy Name is Woman?

There seems to be no end in the struggle to differentiate men from women. You’d have thought that by now, we would have settled the boundary disputes, agreed on who owns what, and set up market stalls on anything remaining. It’s all shared territory anyway. Of course, maybe that’s naive. Maybe there are fundamental discrepancies that admit to only superficial comparisons. Relativities…We are, when all is said and done, different from each other not in terms of value, or worth, or intelligence -or anything like that- but physiologically. And there’s the wonder.

That we complement each other seems so adaptive, so perfect… And yet, do others that interact with us -microorganisms, for example- see it the same way? Are infections as unbiased, fair and equal as we are striving for in our societal evolution? Human laws be damned -do they see us as the same, or do their rules change depending on our sex? Do they discriminate?

We’ve all sniggered about the unequal fury of ‘man colds’ and the like, but whatever evidence supported or rejected this contention has always been subject to the confirmation bias of those studying it. An article in the BBC News seems to have uncovered yet another layer of the Matryoshka doll: http://www.bbc.com/news/health-38304071

They have reported on a 2016 article in Nature Communications by Ubeda and Jansen which suggests that ‘Viruses can evolve to become more aggressive in men than in women’. This has usually been attributed to hormonal differences, and the effects these might have on the immune response, and no doubt this does play an important role. But suppose one were to examine this from a different perspective?

‘Viruses have ways of spreading that are unique to women – such as to a child in the womb, during birth or breastfeeding.’ From the invading organism’s point of view, this is important. ‘Scientists at Royal Holloway University in London used mathematics to model whether this altered the way viruses behaved. Their findings suggest there may be an advantage to infections being less aggressive in women as reducing the risk of killing the mother increases the chance of infecting the child.’

They’re not meaning to suggest some form of microbial intelligence of course -other than that those who happen upon a better way to survive and more successfully propagate their kind will be able to continue passing on their genes. ‘”Viruses may be evolving to be less dangerous to women, looking to preserve the female population, the virus wants to be passed from mother to child, either through breastfeeding, or just through giving birth.”’ The Selfish Gene kind of thing -survival of the most adaptive.

All this is very interesting, but for me, it also raises the question of the nature of intelligence, and whether we have truly cornered the market. Without becoming unduly tautologically entangled, how should we define intelligence -and therefore decide who, or what, possesses it?

I suspect it is no longer sufficient to equate mentality (to use an obviously autological word) with brain size, and neuronal density… Or maybe even neurons –trees, for example, have interconnecting root systems, often associated with fungal networks, that are able to communicate after a fashion. Trees and plants are also often able to signal to each other about threatening insect infestations, allowing the production of defensive chemicals. But they live in a different Magisterium almost -they cannot run or hide, so another mechanism was required for survival in an ever-changing environment.

Humans, with our recently evolved Weltanschauung, tend to frame the capacity of other organisms in terms of our own, and their intelligence by what we judge they have accomplished in their own environment. The fact that they have been successful at survival has often been seen as irrelevant to the discussion. Whether an organism can reason –if we can ever peel away the inbuilt hubris implied by the word- is surely another way of saying, ‘learns from its mistakes and adapts appropriately’ -even if that is only in terms of the next generation enabled by the survivor. We have adjusted in our fashion, and they in theirs.

Still, I don’t mean to attribute our characteristics to microorganisms who could care less what we think. Sometimes, it is enough to survive and create the next generation; sometimes adaptation-whether over time and generations, or in one lifetime- can be seen as a goal achieved. So, is it too much to believe that there may be an effective strategy that is gender-modifiable? And is it too much to call it a strategy? Is this such stuff as dreams are made on…?

However much we hesitate to anthropomorphize an issue, a change of perspective is often heuristic. It may well lead to a new understanding and hence a novel approach to a hitherto unsolvable problem. Although this is purely speculative at this stage, the researchers in that article suggest ‘that eventually it may be possible to use drugs to trick viruses into thinking they were infecting women in order to make them less aggressive.’

What an exciting prospect that we may no longer feel a need to completely ignore gender in our dealings with the world -that we may finally be able to shed the guilt of being unable to meld the two into a seamless fabric, and feel embarrassed that, like a poorly executed pentimento, traces of the discrepancy continue to persist.

Recognition and concession of difference does not imply censure or stigmatization -rather, it invites a celebration of the unique patterns each can offer. A realization that a recipe with only one ingredient is uninteresting and bland. And, given the conjecture in the Nature and Communication paper, it’s an awareness of something suspected since antiquity: that our remedies oft in ourselves do lie.

Sometimes, like Robert Frost we just have to take the road not taken:

I shall be telling this with a sigh

Somewhere ages and ages hence:

Two roads diverged in a wood, and I—

I took the one less traveled by,

And that has made all the difference.

Trippingly on the Tongue

I’ve always liked the poetry of metaphor with its imagery revealing nuances hiding shyly in the background. Words alone sometimes convey their meanings too narrowly, whereas metaphors allow imagination to roam more freely, only loosely tethered to definitions. After all, depending on the context of its use, meaning is often reliant on Weltanschauung. Such is communication; language is only the messenger.

Usually one can imprison meaning, of course -confine it in a cramped little box from which, should it ever escape, it would cease to be useful. Indeed, it would be a Pandora’s box from which it escaped. And yet, even there, what remained inside after all the mischief and malevolence had escaped, was Hope. Maybe that’s what metaphors are: unexpected colours leaking from behind the bars… Liberations.

Of course, metaphor is value-laden as well as culture-dependent. One society’s metaphors do not always translate into that of another -hence the difficulty of truly understanding and appreciating the poetry of another nation, especially if it must be converted into a different language. It made me wonder whether there may be similar disparities with gendered interpretations of metaphor.

There was an interesting article in BBC Future a while ago that caught my eye: http://www.bbc.com/future/story/20170718-the-metaphors-that-shape-womens-lives It made me realize that there are many ways the genders differ. Of course, it may be that when we hear an unusual expression for the first time, we (either sex) cling too firmly to denotative -definitional- aspects of the words for interpretational safety, when the more imaginative and unexpected connotative sense is what was intended all along. And it’s in the connotation -the metaphoric significance- where we differ…

For example, what is a ‘glass ceiling’? ‘Originally popularised by Gay Bryant at the height of the feminist movement in the 1980s, it’s a widely used term today that describes an invisible barrier that keeps women from occupying executive positions. The metaphor suggests that women should aspire to ‘break through’ the ceiling – but the problem is that it describes only the women reaching up, rather than, say, the men that are peering down from the top. This arguably places unfair responsibility on women to smash the ceiling, rather than focusing on the role of men in creating and maintaining it.’

There are other metaphors in use of course, often involving glass -presumably to convey the idea of invisible barriers to movement for women. So, the ‘glass cliff’ which depicts the idea of  ‘how senior women are often hired for risky and precarious roles at times of crises’ and therefore making them look bad if they fail to succeed. Or, the non-glass example of the ‘sticky floor’, which describes how women often feel stuck in low-wage jobs where career ascension is unlikely.’ 

But, handy as they are in explaining often complex topics, metaphors -in these contexts anyway- tend to oversimplify the problems ‘offering only a specific angle or viewpoint that isn’t the full picture.’ They confine us to viewing the world through a narrow aperture -a spotlight that illuminates only one small part of the stage. ‘“Women are the effect to be explained,” says Michelle Ryan, a psychology professor at the University of Exeter. “We never talk about men being overconfident, we always talk about women being underconfident. And we never talk about men having privilege or finding it easy; we always talk about women finding it difficult.” Ryan believes that the metaphors we’re using to describe women at work reflect the world’s androcentricism [sic] – our insistence that, even in 2017, we consider the male experience as “the norm”’

The issue is not entirely one-gendered, though. There is the concept of the ‘glass escalator’, a term occasionally applied to men in female-dominated industries that ascend to upper ranks more quickly than women. And yet, as Caren Goldberg of Bowie State University in Maryland points out, metaphors are employed when there is an “exception” to the rule or gender stereotype.’ So in the example she cites, it was applied to a male nurse (in a predominantly female dominated profession at the time) and implied that he probably chose nursing because he wasn’t able to get in to medical school.

‘The obvious upside of any these metaphors, however, is that they highlight social phenomena that might otherwise remain invisible and therefore impossible to resolve. But in order to address the circumstances that lead to women being held back, and men rising seamlessly, it shouldn’t be forgotten that metaphors simplify complexity.’

In an admittedly convoluted way, it reminds me of a woman I met the other day at a bus stop. I suppose I only met her by default, really -nobody would stand beside her because she was exhibiting a rather odd behaviour -probably Tourette’s syndrome, I’d thought at the time. She would be standing quietly at the curb, and then suddenly bend forward and seem to be vigorously cleaning and polishing something above her. This would last for a few seconds, often becoming more and more frantic, and then subside, leaving her once again peaceful, although by the look on her face, perhaps not content.

She was in her thirties, I would guess, and dressed quite respectably in a blue pant-suit, with a spotless white blouse and short stubby earrings that would be unlikely to achieve any unwanted momentum during her seemingly randomly timed tics. Her auburn hair was sensibly short and her makeup intact as far as I could tell. Apart from her odd movements, she seemed like a typical business woman on her way home from work.

And, when she moved beside me in the now-disrupted line up, she smiled apologetically. “I’m sorry, sir,” she said -hurriedly, I thought, in order to explain herself before she was once again overcome by the movement. “It’s just my latest tic…”

At that point and without any obvious warning, she launched into another bout of scrubbing something invisible over her head. I tried to pretend I didn’t notice, but she wasn’t fooled.

“I think stuff at work must have kicked this one off,” she said and then blushed.

“What do you mean?” I asked, genuinely interested.

She stared at me for a moment, perhaps wondering if it was something appropriate to confess to a stranger at a bus stop. Then her smile returned briefly before the tic arrived again.

“They’re all used to me at work,” she explained when she was able to. “But the boss isn’t.” She risked a sigh to indicate her frustration. “I mostly just repeat words to myself so they’re not as disruptive. But occasionally a movement takes over, and that’s what he doesn’t understand… Or like. I think he wonders if I’m actually mentally handicapped, or something.

“Anyway, even though I’ve been working there as an accountant for almost ten years, he’s never promoted me. I’m well regarded by my colleagues, and they’re almost all men…but…”

I could see a sudden change in her face as she leaned over the curb and the tic began again.

“But my friend Amrita thinks it’s just the glass ceiling that’s holding me back,” she said, once again in temporary control. “And yet, I’m not certain that reassures me…”

Her bus pulled up suddenly, and she stepped onto it like any other passenger, and was gone. I saw her smile at me through the window when she found a seat though, and I nodded in a friendly recognition of what she’d shared with me. But, like her, I’m not sure her friend was right -ceilings are not the only battles.

When the wheel has come full circle…

What’s it like to live on the other side? As far as I can tell, I’m neither trans nor bi; I do not have any genderqueer feelings or aspirations, and for as many years as I’ve been in this body, I’ve been happy with my gender assignation. I’m merely curious about things I have not experienced –about things that I am not, I suppose. Is a rose by another name really the same -really a rose as we have come to experience it? Or would it be more appropriate to phrase it as the converse: does calling something else a rose, make it a rose? Even if it feels it is? It begs the question ‘what is a rose’, doesn’t it? And is the answer –even culturally contextualized- relative, temporal, or in fact, meaningless? Perhaps for someone invested in linguistic definitional stability, the idea of reassigning nouns is more confusing than helpful –notwithstanding the in-your-face examples of homophones and homographs… But I think it is worth exploring.

Jiddu Krishnamurti, the Indian philosopher, argued that naming the Divine -and therefore essentially defining­ it- confined what that concept meant, limited it. I can see parallels with gender appreciation and denotation. But this is certainly problematic for many of my generation who seem to be invested in the immutability of anatomically assigned gender –or perhaps merely question the wisdom of reallocating something that already is, to something it does not appear to be…

Confusing? An interregnum usually is. When those things to which we have become accustomed are swept aside –or, more disturbingly, simply ignored as if their validity had always been in question- there is often a feeling that some moral law has been violated. An ethical boundary crossed. No matter that the boundaries were themselves arbitrary, templates from a different paradigm, to borrow from Kuhn –a different time. It’s not so much that they were wrong, as that they saw the world from a different perspective –much like we might view the customs of another country as being quaint, if not inimical. But, hopefully, when analyzed carefully, there are usually negotiable commonalities. Values which transcend differences, attitudes which, on reflection, are not that hard to accept. Not that different from those we had come to trust.

So, in time, the misgivings fade, and it becomes not only uncomfortable to deviate from the new norm, but to wonder how we had ever thought otherwise –the subtle memory readjustment that neuroscientists tell us occur with time and circumstance.

Many years ago when I first opened my specialist practice in gynaecology, attitudes were different from today. I was asked to consult on conditions that would now be referred to sub-specialists –doctors who have gained added expertise in specific fields. But in those distant times, we were left to deal with things we had never seen in our training as best we could.

It’s when I first met Jo. There were few computers then; my day sheet was typed and the name seemed to have been left purposely vague. But Jo sat straight and proud in the chair, anything but vague -beautiful, in fact. Dressed in a full-length light blue dress, and large, dangling earrings, I wondered how she avoided getting the slowly swaying waves of her long black hair entangled. I could see her bright brown eyes following a little diapered baby crawling erratically across the rug, both of them smiling at each other, both of them obviously delighting in the moment, however fleeting. Another newly pregnant mother, I thought, although in those days, my day sheet was just a list of names and times of appointment –no other details.

Her eyes lit up when she saw me coming across the floor to greet her, and a warm smile surfaced on her face as if it had been carefully wrapped and stored for just this occasion. For me.

I led her into my office down the hall and showed her a seat across from my desk. I have to admit I was smiling broadly by that stage as well –her face was contagious. “So what can I do for you today, Jo?” I started. I hadn’t yet learned the value of the small-talk that often helps to dispel the initial anxiety before having to confront the reason for the visit.

For a brief moment, her smile disappeared, and her eyes examined the window beside her. “I guess my doctor’s note didn’t arrive…” She summoned her eyes and promptly dropped them in her lap. The smile tried to reassume it’s command of her lips, but I could see it was having some difficulty. “It’s a bit complicated,” she said, shooing her eyes from her lap.

I smiled, picked up a pen from the desk and opened her chart to show that I didn’t mind. That I would judge just how complicated it was. It was then that I saw the note from her GP.

But before I could read it, I could feel her gaze leaning heavily on me so I looked up. I remember her expression was almost pleading with me to listen –not write.  Begging me to understand. I put the pen down and leaned forward in my seat.

“I…” she hesitated, clearly wondering how to begin. Wondering if the explanation she had memorized would suffice. “…I’m not what I seem, doctor,” she said, her voice trembling slightly.

I said nothing; I sensed it was a time for silence, even though I had not yet learned its value.

“I don’t think I’ve ever been what I seemed… But I’m 23 now, and I realize that I can’t live like this.”

I watched her face slowly dissolve into tears, so I reached for the tissues I kept on the desk, and handed her one.

She accepted it with a wrinkled smile she found somewhere and wiped her cheeks. “Sorry,” she said, the smile disappearing again despite her efforts to pin it to her lips. “It’s just that my GP didn’t know what to do with me. He said he didn’t know anybody who could help –apparently there’s nobody here in Vancouver…” She took a deep stertorous breath and grabbed another tissue from my desk. “Anyway he said you might know more about it.” Her eyes suddenly perched on my cheeks and stared at me. Through me, as if my eyes were only guardians of the doors into my head. “I’m a man, doctor…”

She –he– waited to see how I would react. She –I couldn’t help but regard Jo as a ‘she’- had obviously had uncomfortable reactions to the revelation in the past. And I couldn’t disguise my expression, I’m afraid –this was not a time of social media or tolerance of any egregious flaunting of norms. Homosexuality was beginning to evince some token acceptance in many circles, perhaps, but transsexuality was still felt to be beyond the pale. Cross-dressing was a deviance that needed to be closeted away.

Jo shrugged and sank further into her seat, as if my reaction had somehow punctured her only hope. “You know, I’m only Jo, doctor. I’m really no different from the person you met in the waiting room… I want to be that woman you greeted so innocently.” Her eyes sought mine again, like supplicants before a judge.

But in that moment, I could not judge. She was the Jo I had first met moments before –the delightful woman in the waiting room engaging with the trusting toddler. “I know,” I said with a reassuring smile, my heart taking over my words. “Let me see what I can do to help.”

And with that simple acknowledgement, Jo straightened in her chair again, her eyes alive as she adjusted an errant strand of hair that had wandered onto her now hopeful face.

Sometimes, there are surprises in all of us just waiting to be discovered.

Gender and Stress

Even the most ardent proponents of gender parity will admit that equality of opportunity does not imply equality of physiology. ‘The worst form of inequality is to try to make unequal things equal,’ as Aristotle said. Homogeneous –likeness, if you will- is not necessarily homogenous (a biological term meaning structurally similar due to common ancestry). Admittedly a semantically fraught distinction, it nonetheless suggests that there may well be differences that do not transcend gender.

For example, there seems to be a sexual discrepancy in the acquisition of post-traumatic stress disorder (PTSD)  http://www.bbc.com/news/health-37936514 -women tend to be more vulnerable to its development than men. A research team from Stanford University published a study in Depression and Anxiety (the official journal of the Anxiety and Depression Association of America) and it suggests that ‘[…] girls who develop PTSD may actually be suffering from a faster than normal ageing of one part of the insula – an area of the brain which processes feelings and pain. […]the insula, was found to be particularly small in girls who had suffered trauma. But in traumatized boys, the insula was larger than usual. This could explain why girls are more likely than boys to develop post-traumatic stress disorder (PTSD), the researchers said. The insula, or insular cortex, is a diverse and complex area, located deep within the brain which has many connections. As well as processing emotions, it plays an important role in detecting cues from other parts of the body. […]This shows that the insula is changed by exposure to acute or long-term stress and plays a key role in the development of PTSD.’ And as I quoted, the changes seem to be different in the two sexes.

The point of all this somewhat detailed background, is to submit that, as the study suggests, ‘it is possible that boys and girls could exhibit different trauma symptoms and that they might benefit from different approaches to treatment.’ Perhaps a sensitive counsellor would recognize this as the sessions continued, but it’s helpful to have some corroboratory evidence to justify any proposed changes.

I have to say that I was woefully ignorant of any sex difference in the development of PTSD. I’m embarrassed to admit that, if anything, I thought of it as largely a male condition –perhaps because of its association with war, and combat -traditionally at least, arenas of male predominance. But of course that is naïve. PTSD is not something confined to combat; it can be equally prevalent in other situations of distress or upheaval. Trauma is trauma, and long term issues can result from such things as natural disasters, car crashes, and certainly sexual or physical assaults, to name only a few. Because the symptoms can be confusing or even disguised, the diagnosis is best left to qualified practitioners, and yet I can’t help but wonder if a greater and more sensitive awareness of the possibility of the condition might encourage more sufferers to seek professional help.

As a gynaecologist, I feel uncomfortable and indeed far out of my depth in discussing most issues pertaining to PTSD, and yet thinking back over my years in practice, it seems to me that I may have suspected something of the sort, but lacked both the vocabulary and training to assign it a label –especially in those women I saw for conditions they suspected may have been attributable to previous sexual abuse: fears that they occasionally admitted to re-experiencing in unrelated events; things about which they still had nightmares; situations that led to unprovoked irritability and anger.

PTSD, by whatever name, has no doubt afflicted humans from time immemorial. Male hubris dictated that it be disguised or denied no doubt –it was a sign of weakness- and therefore unlikely to be mentioned in contemporary accounts. But signs of its presence occasionally snuck into mainstream literature -Shakespeare’s Henry IV being a likely candidate, for example. Perhaps more germane to my specialty, however, was the recognition of the lasting effects of trauma on people other than those involved in traditional conflict: women. The US Department of Veteran’s Affairs in its National Center for PTSD pamphlet states: ‘Most early information on trauma and PTSD came from studies of male Veterans, mostly Vietnam Veterans. Researchers began to study the effects of sexual assault and found that women’s reactions were similar to male combat Veterans. Women’s experiences of trauma can also cause PTSD.’ In fact they maintain that ‘The most common trauma for women is sexual assault or child sexual abuse.’ http://www.ptsd.va.gov/public/PTSD-overview/women/women-trauma-and-ptsd.asp

For too long have the lasting effects of sexual assault been ignored, or at best, trivialized and examined through male eyes in a still-male world. I don’t mean to sound like an overzealous feminist who pins all problems on male dominance, but I think age and a career spent in women’s health grants me a unique –if still masculine- perspective. As with all things, specialists run the risk of deconstruction, overanalyzing the events often with the consequent subversion of their apparent significance -almost a form of historical revisionism, an unintentionally biased and often contextually barren interpretation. One bridge, when crossed by a thousand people, becomes a thousand bridges –we all see the world through our own experiences, our own expectations, our own prejudices.

I think the fact that we can now demonstrate that there are valid reasons to question those often unconscious assumptions is a cause for hope. Much as we have finally realized that the results of many studies carried out only using men cannot necessarily be mindlessly extrapolated to women, so it is becoming increasingly apparent that trauma and its effects may also be non-generalizable. Although not its prisoners, we are after all, creatures of a chromosomal lottery, divergent physiologies, and certainly of different past experiences, so why wouldn’t there be a spectrum of responses to stress?

So, is there a ‘man-cold’? Well, maybe… I know that’s the kind I get, anyway.












Folk wisdom sometimes gets it right: there is a man-cold… Well, maybe.


Eeny Meeny

I have always been fascinated by the idea of choice –the philosophy of choice. What does it mean to choose? Does the act of embracing one thing necessarily exclude the other, or merely prejudice it? Blemish it? Dishonour it? Alternatively, given an either/or situation, is it possible to throw the pair into a box and merely choose the box? After all, that’s (sort of) what Set Theory allows mathematicians to do –group together unlike things with common properties for analysis.

It seems to me there are several types of choice that range from necessary to frivolous, each with its own particular reason for being made, and each with its own particular set of consequences. Some choices are imposed from without, and some from within; some have to be made, while some are voluntary. Personal. The most compelling ones –for me, anyway- are those in that box –that set

The issue surfaced again for me after reading another BBC news article on non-binary gendering: http://www.bbc.com/news/magazine-37383914  I published another essay on this topic in July, but there I was more concerned with managing its language eccentricities: (https://musingsonwomenshealth.com/2016/07/13/non-binary-gynaecology/ ) I realized even then that there was much more to it than language, but the more recent BBC article really brought that home. How can you choose between two things when you are both? It would be like choosing between your son and your daughter –a Sophie’s Choice.

And yet, it would seem that Society feels more comfortable with identifiable categories –in this case, they’re usually anatomically assigned, so from that perspective, they’re not exactly arbitrary… Just unfair. Insensitive. Closed…

Perhaps my long career as an obstetrician/gynaecologist has blurred the gender boundaries as thoroughly as it has the social, economic and ethnic ones. When you get right down to it, we’re all more alike than we might like to think, and categories eventually leak like unwaxed paper cups.

I take the bus a lot nowadays –I’m not sure why, really, except that I enjoy watching those around me. And listening. Sometimes I feel a little like Jane Goodall, only my country is the bus, and my subjects, are people, not chimpanzees in deepest Africa. The other day, I happened to be on a rather crowded vehicle just after the local public schools had opened their gates. Standing next to me in the aisle were two young girls, both around eleven or twelve years old judging by their looks. Each was wearing jeans, sneakers, and coloured ski jackets, and both were hugging their backpacks to their chests, for some reason. One, a rather tall girl with short, brown hair and horn-rimmed glasses, was rummaging in her pack for something while her friend –a blond with hair that she had tied into a rather messy ponytail, watched with interest.

“Do you have any gum in there, Cindy?” the blond said, peering into the caverns of her own pack.

“No… I was just looking for some lipstick,” she said proudly, glancing at me as she said it.

“What! Your mom lets you wear lipstick?”

The tall girl blushed at the response. “Well it’s just reddish Chapstick, but it, like, reddens my lips, too…”

The blond nodded collegially, and then pointed at the two seats in front of me that had just been vacated. After that, only scattered bits of their conversation filtered back to me.

“Yeah… sometimes, I do Cindy,” the blond said, nudging her friend.

“But you said…”

“I said sometimes!”

Then Cindy elbowed her softly, as if she understood completely. “I’ve sometimes wondered what it would be like…”

“It’s kinda confusing -every so often, anyway…”

“You mean choosing which…?” Cindy seemed puzzled.

I could tell that the blond had to think about that. Then she shook her head thoughtfully. “No, more like who I am when I try to think about it…”

Cindy looked at her for a moment and then straight ahead, as if she was suddenly embarrassed. “Aren’t you just ‘Connie’? I mean no matter what you feel like, aren’t you still a Connie?”

Connie was quiet for a moment. “I guess…” They were both silent for a bit. “I don’t think names really matter though, do you Cindy?”

Cindy shrugged and looked at her. “I suppose as long as you answer…”

I could hear Connie giggle at that. “I’m still Connie… But whatever you call me, it’s still me inside.

Cindy nodded slowly but I could tell she was still perplexed about her friend. “Have you…Have you told Father Simms?”

Connie immediately shook her head vigorously and the little ponytail almost came undone. “No way! He’d just tell my parents.”

“How about your mom and dad then?”

“Mommy thinks it’s just a phase –hormones kicking in or something…”


“Cindy I’ve always felt like this; I just didn’t say anything.” She glanced out the window and nudged Cindy again. “Better pull the cord. It’s the next stop.”

Cindy looked up and then obliged. But as they passed me, I could hear Cindy’s concerned whisper -as if it wasn’t something she dared to say it in a normal voice. “But how come you don’t think like the rest of us in the church?”

“How do you know I don’t?” Connie said with a laugh, and they both stepped off the bus, giggling.

I thought about it for a while before my stop came. If I hadn’t just read the BBC article on non-binary gender, I would have assumed they were simply talking about God. But now that I’ve had more time to replay the conversation in my mind… I’m not so sure. Maybe I was granted a privileged audience with someone very special.