Our Bodies Our Selves?

A recent article in the New York Times reported on transgender women, born male, who couldn’t afford the surgery they so desperately desired. They paid “pumpers” to inject silicone into their cheeks, buttocks, and chests so that they would look more like women. The injections might cost up to $20,000.  The pumpers, of course, were not licensed medical professionals. The equipment wasn’t always sterile. The silicone was sometimes industrial rather than medical grade, and because it was not encased in an elastomer shell it began to migrate throughout the body. (Even medically-approved breast implants can rupture and the silicone can migrate.) Some of these people died. Others were left disfigured, permanently disabled, or in constant pain.

Although the Times didn’t mention it, I’m fairly sure that transgender advocates would say that health insurance should cover the surgery as it is a medical necessity and should be available to everyone who needs it, not just the wealthy. In other articles appearing around the country, transgender prisoners are suing their states for this purpose.

In Portland, Oregon, where I live, an FTM is suing his insurance company. He has undergone some medical procedures and self-injects with testosterone, but still has ovaries. As a result, he is at high risk for ovarian cancer—the deadliest of gynecological cancers—and wants the insurer to pay for removal of those organs. Portland's mayor is backing a proposal to have the city pay for sex reassignment surgery for its employees.

The last article I’d like to mention appeared in Just Out, Portland’s LGBT newspaper. The story is about a little girl who started calling herself a boy and played only with boys. When she was ten, the mother took her to a “trans therapist", who said, “You have a little boy there.” As a result, the child was given a boy’s name and allowed to use the boys’ bathroom at school.

I don’t want to see desperate people dying at the hands of pumpers or from ovarian cancer. I believe we all have the right to decide what to do with our own bodies. However, I also believe that “transgender” is a cultural issue, not a medical one, and calls for cultural change, not a medical solution. Even with the best medical care, there are long-term consequences to removing healthy organs and injecting yourself with estrogen or testosterone.

In my youth, in the 1950s, I rebelled against a society that valued women only insofar as we measured up to the standard of beauty set by Hollywood and the advertising industry. We were expected to torture ourselves with extreme diets, girdles, nylons, spike heels, hair curlers that you had to wear throughout the night, eyebrow tweezers, razors, and deodorants. The ideal was to look and smell like a Barbie doll.

Women who could afford it tried to match their bodies to the cultural standard via plastic surgery. Jewish women of my generation were pressured to mutilate our noses so that we would look more like gentile women. Most of those who had nose jobs said they felt much better about themselves afterward.

Even more important than her appearance, a woman had to behave in certain ways:  don’t be too assertive, don’t be better at math than your brother, and don’t apply for an executive position.

In the 1950s, the concepts of male and female were grounded in a philosophical notion called essentialism. (I always hated philosophy in college, and I expect that some of you readers will, too. But please be patient with me here, because this turns out to be important.) Essentialism meant that you born with certain characteristics. A woman, for example, was naturally endowed with psychological passivity, and a preference for frilly pink blouses and secretarial work. If you didn’t express those characteristics in your behavior, you weren’t a real woman.

In the 1950s and for most of the 1960s, anyone who didn’t dress and behave in a gender-appropriate manner risked social ostracism, loss of employment, imprisonment, electroshock therapy, rape, and even murder. These days, people aren’t imprisoned or committed to psychiatric institutions for their sexuality, but gays are still vulnerable to all the other consequences. Transgender people suffer more than any other group from the cultural fear and hatred of sexual difference.

A generation ago, the child who was taken to the trans therapist might have turned out to be a butch lesbian. Now I expect that when she hits puberty, she will be considered for surgery and hormones. (I can’t bring myself to use the pronoun he in this situation.)

As a parent, I am frightened by this kind of early pigeonholing, and even more frightened by the medical consequences of early intervention. But I also remember the child that I was—a little girl who liked science. There were times when I wanted to be a boy, because I didn’t fit in with the girls, and because the options for women were so limited back then. Female relatives often said, “You should have been a boy.” If I were growing up now, I might feel pressured to accept a transgender designation. Instead, with the support of the women’s movement, I helped create space for women like me.

The feminist rebellion of the 60s and 70s was grounded in an opposing philosophical notion called constructionism. That is, all the characteristics society has attributed to women are constructed by the culture we live in. In plain English, feminist ideology said that someone born with a female body is a real woman no matter how she presents herself, who she does or doesn’t have sex with, or what she does for a living. The same is true for someone born in a male body.

The popular culture, though, is still wedded to essentialism. Liberal columnists—including female ones—went after the first female presidential candidate in language that reeked of sexism. For example, Maureen Dowd of the New York Times said that Hillary Clinton’s “message is unapologetically emasculating” and the Times news staff spent some time analyzing the “Clinton cackle.”

Despite the economic downturn, women are still paying doctors to “improve” their looks, whether by implanting silicone packets in their breasts or paralyzing their facial muscles with Botox. (Men also pay for cosmetic surgery, but in much smaller numbers.) Per the American Society for Aesthetic Plastic Surgery, 9.5 million cosmetic procedures were performed in 2010. This is down from 11.7 million in 2007, but the Society expects these numbers to rebound if the economy improves. Please note that this does not include plastic surgery for birth defects or deformities resulting from accidents.

I have met transgender people who were much happier after surgery. From a psychological standpoint, they were better adjusted. Like the women who had nose jobs and breast augmentations, they felt better about themselves afterwards. Each of them has only one life, and I would not want to deny them their chance at happiness. The question remains, though: what kind of society are they adjusting to? An essentialist society—one that says some dress and behavior is inherently male and other dress and behavior is inherently female—is profoundly anti-feminist. And that’s the society we have, despite some superficial changes in the last forty years.

Essentialism says that if your personality doesn’t conform to the cultural norm for someone with genitals like yours, change your body.

Constructionism/feminism tells us to learn to be at home in the bodies we have, and demand the right to be the kind of persons we are. It means that we throw our energy into changing the cultural norms. And since nobody can accomplish these tasks alone, feminism also tells us we must organize to transform society rather than seek individual medical solutions to our discomfort in the world.