Excerpt of an article from 1982.
Dwight B. Billings and Thomas Urban. The Socio-Medical Construction of Transsexualism: An Interpretation and Critique. Social Problems, Vol. 29, No. 3 (Feb., 1982), pp. 266-282
IMPLICATIONS FOR CRITICAL THEORY
Forms of illness are always more than biological disease; they are also metaphors, bearing existential, moral and social meanings (Sontag, 1978). According to Taussig (1980:3), ‘the signs and symptoms of disease, as much as the technologies of healing, are not “things-in-themselves”, are not only biological and physical, but are also signs of social relations disguised as natural things, concealing their roots in human reciprocity’. Even with negotiated illnesses which often lack a basis in biology, the reified disease language of natural science obscures their social origins (Holzner and Marx,1979:137). Disease-talk is about things, not social interaction. Patients whose subjective histories are subsumed under the unifying rhetoric of transsexualism win operations but no language adequate to express the disparate and diverse desires which lead them to body mutilation. These remain private, inchoate, unspeakable.
Critical theorists describe the ideal therapy situation as a paradigm of non-distorted communication (Habermas, 1968:214). Rather than ‘treat human beings as the quasi-natural objects of description’, the goal of communication is patients’ self-reflection and emancipation from the reified pseudo-language of neurotic symptoms (Apel, 1977:310).
The real task of therapy calls for an archaeology of the implicit in such a way that the processes by which social relations are mapped into diseases are brought to light, de-reified, and in doing so liberate the potential for dealing with antagonistic contradictions and breaking the chains of oppression. (Taussig, 1980:7)
According to this view, therapy promises either to provide patients with sufficient self-understanding to criticise society and struggle politically against the crippling effects of social institutions or to provide new fetishes and easily commodifiable solutions to personal troubles (Kovel,1976–7). Transsexual therapy, legitimised by the terminology of disease, pushes patients towards an alluring world of artificial vaginas and penises rather than towards self-understanding and sexual politics. Sexual fulfillment and gender-role comfort are portrayed as commodities, available through medicine. Just as mass consumer culture, whose values are illusive, offers commodities whose ‘staged appearance’ are removed from the mundane world of their production (Schneider, 1975:213), surgically constructed vaginas are abstracted from the pain and trauma of operating rooms and recovery wards. Critical theorists claim that the illusions of consumerism can be as pathological for individuals as the neuroses and psychoses symptomatic of the earlier period of capitalist industrial production (Lasch, 1978).Today, in late-capitalist consumer culture, frenzied rituals of buying contradict the puritanical self-denial characteristic of the nineteenth century. We express our identity as much by the things we buy as the work we do. Commodities promise escape from alienation, and the fulfilment of our needs. Critics compare the temporary solace of consumer spending with the transitory euphoria of a drug-induced trance (Schneider, 1975:222).Similarly, transsexuals are in danger of becoming surgical junkies as they strive for an idealised sexuality via surgical commodities. This is what physicians refer to as a ‘poly-surgical attitude’ among post-operative patients (Pauly, 1969a). Male-to-female patients especially are caught up in an escalating series of cosmetic operations—including genital amputation—to more closely approximate ideal female form. They routinely demand breast implants and operations to reduce the size of the Adam’s apple. Edgerton (1974) reports that 30 per cent of his patients also sought rhinoplasty (nose reconstruction); others demand injections of Teflon to modulate vocal pitch and silicon to alter the contours of face, lips, hips and thighs. Surgeons reduce the thickness of ankles and calves and shorten limbs. In their desperation to pass, male-to-female patients try to effect a commodified image of femininity seen in television advertising. In so doing, many patients are themselves transformed into commodities, resorting to prostitution to pay their medical bills.
While it is difficult to assess the ultimate worth of consumer products, we can try to discern the false promises implicit in their appeal. In the absence of adequate follow-up research, it is impossible to assess the lasting value of sex-change surgery, though recent studies suggest an almost invariable erosion of the transsexual fantasy following an initial ‘phase of elation’ lasting two to five years after surgery (Meyer and Hoopes, 1974). Johns Hopkins University physicians stopped performing sex-change operations in 1979 on the grounds that the patients they operated on were no better off than a sample of transsexual patients who received psychotherapy but not surgery (Meyer and Reter, 1979). Other prominent clinics, however, continue to perform surgery (Hunt and Hampson, 1980).The following excerpt from a letter written by one transsexual who underwent surgery expresses the disappointment and anguish of some patients:
No surgery can possibly produce anything that resembles a female vagina. The operation is a theft. [The surgically remodelled tissue] is nothing but an open wound. It needs dilation to keep it open and if dilated too much become useless for intercourse. Such an open wound lacks protective membranes and bleeds under pressure… Apiece of phallus with an open wound below and a ring of scrotum hanging is all it is…Who calls that an artificial vagina is nothing but a bandit looking for ignorant and credulous people to exploit them. (quoted in Socarides, 1975:130)
The evidence suggests that Meyer and Hoopes were correct when they wrote that, in a thousand subtle ways, the reassignee has the bitter experience that he is not—and never will be—a real girl but is, at best, a convincing simulated female. Such an adjustment cannot compensate for the tragedy of having lost all chance to be male and of having, in the final analysis, no way to be really female.(Meyer and Hoopes, 1974:450)
THE POLITICS OF SEX-REASSIGNMENT
Taussig (1980:7) shows that ‘behind every disease theory in our society lurks an organising realm of moral concerns’. In this paper we have examined both physicians’ and patients’ motives for sex-change surgery. We conclude that at the level of ideology, sex-change surgery not only reflects and extends late-capitalist logics of reification and commodification, but simultaneously plays an implicit role in contemporary sexual politics. The recognition that, in this day and age, the fulfilment of human desires is less a matter of public discussion than a technical accomplishment of social administration (Habermas, 1973:253) applies equally to sex-changes. Medicine brushes aside the politics of gender to welcome suffering patients —many fleeing harassment for sexual deviance—into pseudo-tolerant gender identity clinics. Yet these clinics are implicitly political and, indirectly, intolerant. With reproduction and sexual functioning falling under medical jurisdiction, physicians have played crucial roles in maintaining gender organisation (Ehrenreich and English, 1973). In providing a rite of passage between sexual identities, sex-change surgery implicitly reaffirms traditional male and female roles. Despite the mute testimony of confused and ambivalent patients to the range of gender experience, individuals unable or unwilling to confirm to the sex-roles ascribed to them at birth are carved up on the operating table to gain acceptance to the opposite sex-role.
Critical theorists contend that, in the United States, hegemonic ideology absorbs and domesticates conflicting definitions of reality (Gitlin, 1979:263). But rather than support contemporary movements aimed at reorganizing gender and parenting roles and repudiating the either/or logic of gender development (Chodorow, 1978:1979; Ehrensaft, 1980), sex-change proponents support sex-reassignment surgery.