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:

‘[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…

Here’s ado to lock up honesty

Sometimes I think we want to simplify things too much; we crave bichromality: on or off, yes or no. We want certainty, not a spectrum. An answer, not another question -a decision, in other words. And yet if we stop to look around, it seems obvious that things are seldom black or white -there are colours everywhere.

Relationships are no different -how could they be when two unique individuals are involved? When evaluated over any period of time, they are in constant flux. Contingent. Their often turbulent waters involve negotiation -one might even say navigation. There are no reliable maps -and unless there is local knowledge, ‘Here be dragons’ like those drawn on medieval charts in areas where there was insufficient information to avoid dangers.

Even initial reassurance may require sudden modification depending upon the conditions -we cannot always know in advance how things will work out. Indeed, the very fragility of the substrate is one of the important reasons why we are so enamoured with fine porcelain, with delicate lacework, with Trust.

But relationships, except in a legal and sometimes transactional sense, are seldom maintained by official written contracts -it’s more of an understanding, verbal or otherwise. This is fine, of course, but susceptible to misunderstanding or deliberate deception. Vulnerable to sudden, unexpected changes in either partner. Difficulties in effective communication…

Words, words, words,’ says Hamlet to Polonius. It almost doesn’t need an explanation, does it? Similar to his ‘That one may smile, and smile, and be a villain’ -although admittedly in a different context. But the meaning is clear: one can hide behind a curtain of sound, or a reassuring appearance, so that what is being conveyed may be confusing -purposely, or accidentally.

The problem, I suppose, is in knowing the intent of either one of the participants and its effects on the other. This is especially important in sexual matters where effective communication often lags behind the actions, and frequently is restricted to vague, initial permission followed by hormonal dictates.

It is a subject that people often feel reluctant to talk much about beforehand. Meanings of words and actions can change in the heat of battle, making prior negotiation -setting ground rules, and such- important. Sexual dialogue is not something taught particularly well in School Health Classes, so I was pleased to find an article in Aeon that was willing to tackle it head on.

The author, Rebecca Kukla, is professor of philosophy at Georgetown University and senior research scholar at the Kennedy Institute of Ethics. She explores the language of sexual negotiation. ‘Philosophers who specialise in what is known as ‘speech act theory’ focus on what an act of speaking accomplishes, as opposed to what its words mean.’ She writes that, ‘all speech acts are governed by what philosophers call ‘felicity norms’ and ‘propriety norms’. Felicity norms are the norms that make a certain speech act a coherent possibility… I can’t name someone else’s baby just because I feel like it, by shouting a name at it. These would be infelicitous speech acts. ‘Propriety norms are norms that make a speech act situationally appropriate. So, although I have the authority to order my son to clean his room, it would be a massive norm violation for me to walk into his classroom at school and shout at him to clean his room in the middle of class.’

‘In public discussions about the ethics of sexual communication, we have tended to proceed as though requesting sex and consenting to it or refusing it are the only important things we can do with speech when it comes to ethical sex… Consenting typically involves letting someone else do something to you. Paradigmatically, consent (or refusal of consent) is a response to a request; it puts the requester in the active position and the one who consents in the passive position. And in practice, given cultural realities, our discussions of consent almost always position a man as the active requester and a woman as the one who agrees to or refuses him doing things to her.’

And yet, ‘Autonomous, willing participation is necessary for ethical sex, but it is not sufficient. We can autonomously consent to all sorts of bad sex, for terrible reasons. I might agree to do something that I find degrading or unpleasantly painful, for instance, perhaps because I would rather have bad sex than no sex at all, or because my partner isn’t interested in finding out what would give me pleasure.’

‘Usually, when all goes well, initiations of sex take the form of invitations, not requests… But when I’m trying to establish intimacy with someone as I am getting to know them, an invitation is more typical and likely more conducive to good, flourishing sex than a request… Invitations create a hospitable space for the invitee to enter.’ An invitation to dinner, for example. And ‘An interesting quirk of invitations is that, if they are accepted, gratitude is called for both from the inviter and the invitee. I thank you for coming to my dinner, and you thank me for having you.’

‘A sexual invitation opens up the possibility of sex, and makes clear that sex would be welcome. Invitations are welcoming without being demanding… Notice that if I invite you, appropriately, to have sex with me, then consent and refusal are not even the right categories of speech acts when it comes to your uptake. It is not felicitous to consent to an invitation; rather, one accepts it or turns it down. So the consent model distorts our understanding of how a great deal of sex is initiated, including in particular pleasurable, ethical sex.’

Kukla goes on to talk about when and if invitations are appropriate, and then about such issues as ‘gifts’ of sex in long-term relationships, as well as the sociology of gifting. But her discussion of ‘safe words’ I think is one of the most important topics she covers. So, ‘Even if we freely consent to a sexual encounter, or otherwise enter it autonomously (for instance, by accepting an invitation), we also need to be able to exit that activity easily and freely. Entering autonomously is not enough; sexual activity is autonomous only when everyone understands the exit conditions and can stop at will, and knows and trusts that they can do this. This requires shared linguistic norms for exiting any activity. Safe words, properly employed, provide a framework that allows everyone to understand when someone wants to exit a sexual activity.’

‘Part of what is interesting about safe words is that they let someone exit an activity at any time without having to explain themselves, or accuse anyone of transgression or any other kind of wrongdoing (although they can also be used when there has been a transgression)… One reason they are important is that inside a sexual encounter, speech is frequently nonliteral… We need very clear ways to be able to tell when someone wants to leave this nonliteral discursive context.’

And, as she suggests, ‘Safe words are powerful discursive tools for enabling sexual autonomy, pleasure and safety, in at least two senses. Most straightforwardly, they offer a tool for exiting an activity cleanly and clearly, with almost no room for miscommunication. But even more interesting to me is the fact that safe words allow people to engage in activities, explore desires and experience pleasures that would be too risky otherwise. When we want to experiment with something that might give us pleasure, but also might make us uncomfortable or put us at risk, we need to be especially sure that we can exit the activity easily.’ But, of course, ‘safe words should never become the only way that someone can exit a scene or activity – all participants need to remain flexibly responsive to other discursive cues as well.’

Unfortunately, the ‘strong social tendency to focus our discussions of sexual negotiation on consent and refusal has resulted in a narrowed and distorted view of the pragmatics of sexual communication. Correspondingly, we have tended to focus on rape and assault, understood as nonconsensual sexual activity, as the only sexual harm we need to worry about. In fact there are many ways in which sex can go ethically wrong, other than by violating consent.’ Kukla feels that ‘sexual autonomy also requires the ability to engage in clear, pragmatically complex, fine-grained sexual communication – including uses of language that go well beyond consenting to and refusing requests for sex.’

There is so much more to communication than words, isn’t there -and so much more to words than meets the ear?  Hamlet again: ‘There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy…’

Let Virtue be as Wax

We are all products of our era, and often unbeknownced to us, our language is to blame. Words become signposts that reassure us that we know where we are headed. Where we came from. And yet they can be as lost as us –especially in the domain of sexuality. Even the word ‘sex’ itself –a seemingly self-defining concept- can be misleading. It’s origin, commonly attributed to the Latin verb secare –to divide, or cut- presumably to explain the physical difference between men and women, does not necessarily entrain the psychological divisions. Or behaviour.

To paraphrase Socrates at his trial, the unexamined word is not worth using. That ‘sex’ and ‘sexuality’ were so inconsonant I had not suspected. Sex, quite obviously, is a physical assignation; sexuality on the other hand, is the more psychologically -the more erotically- imbued preference. Indeed, the concept of heterosexuality did not exist as such in the past. Nor did homosexuality as an article by Brandon Ambrosino in the BBC News pointed out:  ‘One hundred years ago, people had a very different idea of what it means to be heterosexual.’ In fact, ‘The 1901 Dorland’s Medical Dictionary defined heterosexuality as an “abnormal or perverted appetite toward the opposite sex.” More than two decades later, in 1923, Merriam Webster’s dictionary similarly defined it as “morbid sexual passion for one of the opposite sex.” It wasn’t until 1934 that heterosexuality was graced with the meaning we’re familiar with today: “manifestation of sexual passion for one of the opposite sex; normal sexuality.”’ It would seem that ‘all of our sexualities are “just there”; that we don’t need an explanation for homosexuality just as we don’t need one for heterosexuality.’

‘“Sex has no history,” writes queer theorist David Halperin at the University of Michigan, because it’s “grounded in the functioning of the body.” Sexuality, on the other hand, precisely because it’s a “cultural production,” does have a history. In other words, while sex is something that appears hardwired into most species, the naming and categorizing of those acts, and those who practice those acts, is a historical phenomenon.’ Or, to put it another way, ‘[…]there have always been sexual instincts throughout the animal world (sex). But at a specific point on in time, humans attached meaning to these instincts (sexuality). When humans talk about heterosexuality, we’re talking about the second thing.’

And as well, ‘[…] sexual desire was situated within a larger context of procreative utility, an idea that was in keeping with the dominant sexual theories of the West. In the Western world, long before sex acts were separated into the categories hetero/homo, there was a different ruling binary: procreative or non-procreative.’ So sexuality is the desire and although the act may be categorized as procreative (different-genital intercourse), or non-procreative (it doesn’t matter), with erotic desire -in the past at least- the intention was not further categorized. It was the act that was noticed. The act that was labelled. ‘Something […] happened with heterosexuals, who, at the end of the 19th Century, went from merely being there to being known. “Prior to 1868, there were no heterosexuals,” writes Blank [the author of Straight: The Surprisingly Short History of Heterosexuality]Neither were there homosexuals. It hadn’t yet occurred to humans that they might be “differentiated from one another by the kinds of love or sexual desire they experienced.” Sexual behaviours, of course, were identified and catalogued, and often times, forbidden. But the emphasis was always on the act, not the agent.’

And yet nowadays, we seem to require labels –as if the words were themselves expositors and not mere descriptors. ‘Debates about sexual orientation have tended to focus on a badly defined concept of “nature.” Because different sex intercourse generally results in the propagation of the species, we award it a special moral status. But “nature” doesn’t reveal to us our moral obligations – we are responsible for determining those, even when we aren’t aware we’re doing so.’

The difficulty of negotiating this landscape had occurred to me long before I read the article, however. A few years ago I walked over to a downtown bus stop, tired after having a rather long day at work. I’d left the office early, and I thought I was the only one there until I noticed two teenaged girls sitting on the little bench in the bus shelter in passionate embrace. I didn’t want to embarrass them, but I did feel the need of sitting down. Unfortunately they had both put their backpacks onto what little remained of the seat on either side, so I thought I’d wait until they’d finished, as it were. I kept glancing at them, but their fervour seemed unending and I eventually resigned myself to standing.

Suddenly a head disentangled itself from the osculatory machinations and stared at me accusingly.

“Got a problem, mister?” it asked, while a hand deftly extricated a piece of overly-chewed gum from its mouth.

I blushed, but did manage a conciliatory smile hoping to defuse the tension. “Sorry,” I said, when I could find the words, “I didn’t mean to disturb you, but I was hoping I could sit down…”

The other head opened its eyes at the sound of my voice and managed an embarrassed smile while convincing its hands to leave her friend and move the pack from the seat. “We didn’t mean… We didn’t know anybody was standing there…”

The first head dropped its eyes to the pavement in obeisance. “Yeah, I didn’t mean to be rude…” She picked her eyes up again and sent them softly to my face before she looked at her friend. “It’s just that, like, some people get… You know, like, upset when they see us kissing.”

“Yeah, as if we were, like, tards, or something,” the second girl said as they both moved over on the bench to make room for me.

The word  tards seemed to offend the first girl. “She just means that, like, some people go strange when they see us being so… involved, I guess.” She looked at her friend and whispered something I couldn’t hear. “Like we’re pervs, or whatever,” she continued, after elbowing her gently.

“Yeah, the other day, one old guy walking by even, like, spat on the sidewalk when he saw us cuddling.”

“Yeah, as if he never cuddled with his partner…” the first girl giggled.

“He probably never had a partner, Joni!”

Joni shook her head. “Maybe not, but I don’t think he was, like, jealous or anything, do you?”

Her friend smiled. “He was just looking for a label, sweetheart. Some are easier to find, I guess.”














The Yang of Yin

We are, it would seem, a binary species and we live in a binary world where opposites define each other. Think, for example, of up and down –the one depends on the other for its very existence: there is obviously no up without a down with which to contrast it. Good/bad, in/out, light/dark, near/far… even the code written into our computers -the list of inter-dependent binaries is endless.

Perhaps the most famous –and arguably the earliest- recognition of this interdependence is the Chinese concept of Yin and Yang. Without pretending an esoteric knowledge of historical linguistics or an abstruse Sinological background, the meanings of Yin and Yang can be superficially understood as ‘shady’ and ‘sunny’ respectively, and seem to date from sometime in the fourth century BCE.

I suppose the reason this complementarity is so fascinating to me is the implied rejection of the rule of the Absolute. One would seem to need, say, a seller for the concept of ‘buyer’ to exist. And by extension, perhaps, the presence of evil for good to become manifest –although I recognize that to be a bit of semantic trickery. But at any rate, it is an interesting idea to play with.

Binarity –to neologize- has its limits, however. Or at least its two components can be seen as bookends that confine an entire shelf of not-quites. The concept, as we often find after sufficient investigation, can be that of a spectrum, with intermediates melding imperceptibly into their shelf-mates.

Labels, while they help us to identify things, can also lead us astray. I will cover this idea more fully in a later essay, but suffice it to say that a label can be merely a societal/cultural attempt at categorization –a name that simplifies the issue of what to make of the entity. Where to put it. How to interact with it.

For now, however, I would like to touch briefly on whether or not the hitherto necessary binary assignation of gender is anachronistic. There was a helpful BBC News article that brought this to my attention:  and while I have certainly touched on gender issues in past essays,  and for example, the idea that gender is a labile concept is one that my generation, at least, often finds challenging.

And yet, if one can step back from the anatomical signposts that have directed us for millennia, is the binary assignation of male or female really all that important a predictor of who, or for that matter, what a person is? We’ve always known that different people manifest different characteristics and we even apply societally accepted terms to allow them to maintain their positions within the otherwise ordained sexual designations. We use such terms as ‘effeminate’ for a man who seems at odds with the perceived norms for masculinity, or ‘tomboy’ for a young girl who seems to run with the other team –although I admit I haven’t heard that word applied since I was young myself (perhaps the term is now ‘butch’ although I find it offensive and somehow demeaning). My point, though, is not what words we use, but that we have always found ways to describe someone who does not quite fit into normative –or what the majority may describe as normative- assignations. In other words, a tacit realization –and acceptance- that gender cannot be captured by genitalia alone.

It is not a new concept in any society as the BBC article attempted to illustrate. Sexuality and, indeed, sexual orientation has always been a fluid concept –and both an intriguing and compelling one, as the recent and untimely death of David Bowie has served to remind us. Maybe the time has come to reconsider things. I wonder why it has taken us so long to realize that what we treasure in people and what we find so important is not their gender, not their sexual orientation, and certainly not their appearance, but their energy. Their spirit, I suppose.

We can never agree on everything, perhaps, but as with Shakespeare in The Winter’s Tale, I say, ‘When you do dance, I wish you a wave o’ th’ sea, that you might ever do nothing but that.’