Comments on: Responding To Nikki Sullivan’s Questions

By: Nikki

Nikki — Wed, 26 Aug 2009 02:01:37 +0000

Hey Zoe, Thanks for your comments. Perhaps you’re right about the fact that what I’m really interested in is the ethics of embodiment (in all its diversity), but as I understand ethics its not really separate from politics. I’d love to see Sean start a discussion ethics and/or bioethics, in particular the kind of postconventional bioethics that people like Margrit Shildrick have theorised. There is a fair bit of mnaterial out there that evaluates elective amputation via a consideration of conventional bioethical principles, but most of it seems to me to be problematic for all sorts of reasons – most particularly the fact that the principles themselves are so debatable.
One last thing, I realise that there has been work done which presumes to have ‘proven’ that ‘homosexuality’ is biologically determined, but as far as I’m concerned, both from a theoretical perspective and a personal (lived experience)one, its totally unconvincing and potentially dangerous! I realise though, that historically it was a useful argument to make in the push for decriminalisation. Still, I so don’t want to go there ;{
Oh, and BTW, I’m at Macquarie. I did hang out a bit at UWS in the early 1990s, but have never worked there.

By: Zoe

Zoe — Sat, 22 Aug 2009 15:05:59 +0000

I think Peter makes an interesting point regarding homosexuality – from my (admitedly limited) understanding, recent research has concluded that homosexuality is something which is hardwired into the brain from birth – be it a gene or an excess of testosterone or other hormone (im)balance in the womb.

I’m not saying that BIID tendancies are necessarily related, just that it seems to me that there is a lot about the brain that we dont know – and maybe BIID tendancies are formed in the womb just as homosexual tendancies appear to be.

Nikki, you seem very familiar, were you at UWS around 2001 or SCU subsequently. I’m leaning towards SCU. In any case, i’m grateful to see an Aussie leading the way with a BIID research interest.

I really dont have much to add to this very intelligent conversation on the issues, save for i would say that i’m not adverse to the GID/BIID comparison if it helps the medical profession understand the complexities and intracies of our needs.

I had not considered that the impact of that would be that GID needs were considered normative whilst BIID needs were not. Of course, i see the distinction, but i also think that not so long ago a MtF transformation would also have been considered, for want of a better term, ‘a step backwards’.

I would completely agree that its purely a social construct, until our society learns to accept ‘differently abled’ people as people ready, willing and able to contribute to society then our society will not accept us.

But, by the same token, can’t we be a positive force to help our society understand the contribution that all ‘differently abled’ people can make? And why would we, as a society, degrade that possibility?

Nikki, in answer to your most recent question, I tend to think that history has proven that the attempted elimination of ‘non-normative’ desires has been unsuccessful, and i dont see any reason why it would be successful in this instance. So any so called ‘politics’ of this would only be a discussion of an uninformed, and largely scared body politic – people are always afraid of what they do not understand. But an open discussion of these topics would pave the way for future generations to reap the benefits of our struggles.

As a society, we either have to redefine the norm, as we’ve done over and over again over the past 30 years or so (and yes i realise the feminist movement started long before, but really only achieved relative equality recently (if at all) – with the gay and lesbian community making inroads later.

The other option is that we just stand still and pretend that this doesnt exist. But it does – and more and more of my contemporaries are willing to speak out and ‘stand up’ and be counted (excuse the pun!).

I’ve struggled for so long with the idea that i was ‘abhorrent’ because i felt something that my society told me i shouldnt feel. But i’ve slowly come to the conclusion that i just am what i am, and if people dont like it, then that’s their prejudices or assumptions and they are the one’s lacking or missing out because they aren’t willing to open their minds to other possibilities.

I think perhaps your question might have been one of ethics rather than politics (and perhaps that’s what you had intended), but that is a very different discussion, and one which would ultimately influence the politics (or possibly vice versa!).

If its an ethical discussion you were looking for, perhaps Sean could start us off with a new topic so we can get in depth with the nitty gritty of the medical ethics of BIID.

By: Nikki

Nikki — Fri, 21 Aug 2009 07:37:11 +0000

Thanks for the info Sean, but what do you really think of the politics of this, especially in cases where treatment is focused on the elimination or ‘non-normative’ desires/experiences?

By: Sean

Sean — Fri, 21 Aug 2009 06:25:41 +0000

Deep brain stimulation involves an open brain surgery, wherein they place electrodes deep in the brain. These electrodes are attached to a pacemaker-like device that is implanted in the chest.

It is apparently quite effective on extreme cases of depression that don’t respond to other forms of regular therapy.

By: nikki

nikki — Fri, 21 Aug 2009 06:06:37 +0000

Peter, I guess my point is, that in the past procedures that were seen to be equally medically beneficial (and harmless!) were carried out on people regaded as psychologically ill or aberrant (ie people whose desires differed somewhat from the so-called mainstream). I certainly don’t regard same-sex desire as a brain disorder or as a psychopathology, but it has been conceived this way : it was, as I’m sure you’re aware, included in the DSM, and ‘homosexuals’ were, as a result of the medicalisation of their desires and thus of their persons, subjected to procedures thought to be revolutionary but which were in fact were incredibly damaging. As I said, I am not a neurologist, and I do not know exactly what “transcranial magnetic stimulation” or “deep brain stimulation” might entail – nor do I know anything about ‘naughty neurons’- but given that we know so very little about the brain and how it functions. I’m personally disturbed at the idea of these kinds of procedures (given past history). I guess I’m also not confortable with the idea that desires perceived as aberrant by the mainstream would be better off eliminated. Mose people I know who are same-sex attracted, or who identify as gender-queer or trans would not choose to have their desires normalised via medical means, which is not to say that they don’t desire the suffering associated with the pathologisation and/or disqualification of their desires be alleviated.

By: Peter

Peter — Fri, 21 Aug 2009 04:47:05 +0000

Nikki

I don’t consider homosexuals to have a brain disorder and I’m sure you don’t either so why should deep brain stimulation conjure up that image?

The process of placing electrodes in the brain has been found to be very efficacious for youths who have, as I call them, naughty neurons. Kids whose conditions resulted in them not being able to walk or talk have shown incredible improvements. It’s nothing to do with sexuality although it does conjure up a Dr. Frankenstein scenario!

By: nikki

nikki — Thu, 20 Aug 2009 23:47:43 +0000

Yes, I totally agree Chloe, the term ‘disorder’ does carry with it all sorts of worrying conotations. I know that to some people arguing about naming might seem peurile, or like something that only those allegedly not suffering have the luxury of doing. But I guess that as I see it, there are very real material ramifications/effects of conceiving difference in terms of normal/abnormal, healthy/sick, ordered/disordered etc. Clinical nomenclature tends not just to name different modes of bodily-being, but also to classify people as certain ‘types’ – and being classified in this way can, for example, have the effect of discrediting those who are perceived in this way, silencing them etc. I was particularly struck by this yesterday when I was reading a recently published article by Tracey Elliott called “Body Dysmorphic Disorder, RAdical Surgery, and the Limits of Consent”, in which she writes (summarising the claims of others) “any surgeon or hospital who becomes known for conducting healthy limb amptuations is likely to attract, in addition to a good deal of unwanted publicity, considerable attention from ‘wannabes’ all over the world, not all of whom would be considered to be appropriate candidates for surgery. … Would-be amputees may go to great lengths in an attempt to force hospitals to treat them, and hospitals will need to consider carefully how they are to deal with such people” (168). What we see here – and I’m sure this is not intentional – is an homogenising image of people who desire amputation, that basically discredits them, sets them up as obsessive, compulsive, and difficult to deal with. In an article that critiques mainstream media representations of ‘body modifiers’ Victoria Pitts argues that the voices of bod moders are silenced or ‘disqualified’ through the depiction of them as compulsive (ie irrational) and therefore as unable to be relied upon, taken at their word, trusted – in much the same way that ‘addicts’ are not to be trusted. The idea of a person being ‘disordered’ inevitably – it seems to me – carries these kinds of connotations, at least in the popular imaginary. For this, and a whole host of other reasons, I think that it is crucial that diagnostic nomenclature not simply be accepted on the assumption that it will result in access. There is no guarantee that this will be the case. Indeed, the idea that a person has, for example a brain disorder that might be cured through, for example, some sort of deep brain stimulation (and not being a neurologist I have to admit I really don’t know what that would entail) conjures up the image of ‘homoseuxals’ undergoing electro-shock therapy and/or even lobotomies. In saying this, I’m not discrediting the work of neurologists or the contributions they might make in this area, I’m simply suggesting that caution, coupled with knowledge of the struggles of other individuals/groups might prove crucial.

By: Chloe

Chloe — Thu, 20 Aug 2009 02:32:53 +0000

Thank you for all this food for thought, Nikki. What you said about the word “disorder” jumped out at me. A year or so ago my psychotherapist pointed out that my thoughts about needing to be paralysed do not seem disordered. To the contrary, his perception was that for the most part my thoughts are quite orderly and rational given the situation in which I find myself. However, I would accept any label necessary to gain access to surgery.

I am also reminded of the nomenclature “Disorders of Sexual Development” as applied to people with intersex conditions. I absolutely do not consider myself to have a disorder just because I am intersexed. The implication is that there is something inherently “wrong” with being intersexed.

By: Nikki

Nikki — Thu, 20 Aug 2009 01:32:14 +0000

Thanks Sean, Your comments have got me thinking all over again. Yours too Chloe. I should begin by acknowledging that the term “disability assignment surgery” is not my own. I used it in response to a comment from Nobody which included the term.
Like you both, I think that language – in particular ‘naming’ – really matters, and its for this reason that I’ve been doing a whole lot of reading re debates that have taken place regarding nomenclature surrounding ‘trans’ and ‘intersex’. I guess I’m troubled by the idea of naming (even for strategic purposes) the experience of dyshphoria, the experience of profound suffering, a ‘disorder’. And I’ve been thinking about whether and how it might be possible to argue for access to procedures that would alleviate that experience/suffering without conceding to a model that implies (explicitly or implictly) that people who have that experience are ‘sick’, ‘abnormal’ etc and therefore need to be ‘cured’. It could be that a consideration of the debates etc that have shaped other experiences of ‘dysphoria’, other forms of profound suffering re a disjunction between self and bodily-being, might help to shape arguments for access in positive and productive ways – and I guess that’s the kind of contribution I would hope to be able to make.
On that note, I’m really grateful for your comments re the ‘GID’, BIID relationship. As an explanatory tool I can see how it works. And to be honest, I was not aware that the analogy wasn’t being drawn in order to argue for access to surgery. I now wonder whether what is in fact happening is that the analogy is being deployed in different ways, in different contexts, and for different purposes. Why, for example, might a medical practitioner like Michael First use it?

I’ve also been doing some reading about the DSM, and thinking about what some of the considerations might be about the *form* inclusion would/could/should take (should it happen). Just read a great article by Nicholas Matte, Aaron H Devor, and Therese Vladicka entitled “Nomenclature in the World Professional Association for Transger Health’s Standards of Care: BAckground and Recommendations” (in the International Journal of Transgenderism, 2009, 11:1, pp.42-53) which I think raises a whole range of really important questions that those arguing for inclusion of BIID in the DSM-V might want to consider.
Also, given your comments Sean re the desire for HIV+ what imput might activists and academics have on the formulation of ‘diagnostic criteria’ etc?
OK< I’ve probably asked more than enough questions, but I hope we can continue this conversation – there is so much more that I want to ask and/or put out there for consideration and response.

By: Chloe

Chloe — Wed, 19 Aug 2009 19:33:24 +0000

There are so many well thought out and interesting points made here by both Sean and Nikki that I’m only going to address a tiny fraction of the issues.

Firstly, there’s the idea of normality. It’s all in the eyes of the beholder. In this first month of wheeling full time at work I have felt more normal than at any other time of my life. My sense of normality is in proportion to the degree with which I conform my presentation to my self-image. For me it is normal to be in a wheelchair. Others may see wheelchair use as abnormal, but then so is having red hair. It is a matter of societal convention as to what is labeled normal. As such it is subject to change.

I am not convinced that the world at large sees post-operative transsexual bodies as being normal. To be sure, MtF surgery is sufficiently advanced that few would be able to tell the difference. However, several of my post-op MtF friends have been dumped by boyfriends after divulging their TS status. One might assert that this is not because of anatomical considerations, but I would argue otherwise.

Secondly, I agree that the analogy between BIID and GID is not per se sufficient argument for surgical treatment of BIID. However, it is indeed a powerful explanatory tool. For myself it is in addition a road map. Although I am technically excluded from a diagnosis of GID, I have gone through a similar process of addressing gender identity, gender presentation, and corrective genital surgery. The BIID path that I now tread is amazingly familiar.

Finally, I happen to very much like the term “ability reassignment surgery”. To me it does not imply connotations of providing more, or less, ability. Likewise “sex reassignment surgery” does not imply having more, or less, sex. One can change one’s ability, just as one can change one’s sex, without there being “more” or “less” about it.