Author: Former Student

Book Report: “Trans Medicine: The Emergence and Practice of Treating Gender”

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In “Trans Medicine: The Emergence and Practice of Treating Gender,” stef m. shuster evaluates the medical and scientific communities’ “treatment” of gender, as well as the development of trans medicine as a field. This book was written in an effort to understand what has been normalized in the practice of trans medicine that has unintentionally perpetuated healthcare inequalities. It dives into issues the medical and scientific community face in regards to experience, skill, knowledge, and uncertainty in trans medicine, such as lack of experience, guidance, and scientific evidence. It addresses social constructs, such as the medical and scientific community holding ultimate authority over patients despite individual needs with respect to identity. It also acknowledges the uncertainty medical providers face with respect to providing gender affirming care to non-binary individuals and how the providers often operate under the normalization of a gender binary. While providers have difficulty keeping up with social changes as their practices become standardized, it is important that they strive to break from traditional ways of thinking about specific groups of people. This book makes an important intervention in how we understand the field of trans medicine. 

 The author of this book is stef shuster, an Assistant Professor at Michigan State University and the Lyman Briggs College and the Department of Sociology. They received their M.A. and Ph.D. in sociology from the University of Iowa with a certificate in Gender Studies. stef Shuster’s research and interests involve topics of medical sociology, gender, inequality, and social movements. Their main point of interest is on the social, culture, and historical lens through which scientific evidence is constituted and utilized by the scientific and medical communities.

This book was constructed using research from interviews as well as archival and ethnographic research dating back to the mid 20th century. A wide variety of medical providers were interviewed about their experiences treating trans people, as well as their sentiments on the development and future of the field. Letters of correspondence between providers were also utilized as the basis of information for the book, and were cited heavily throughout it. Providers were also observed and recorded during their presentations at conferences discussing trans-specific healthcare.

The first part of the book addresses the historical context of trans medicine, specifically the uncertainty and suspicion surrounding trans patients and potential gender-affirming interventions or procedures during the mid-20th century. It begins by acknowledging the “doctor knows best” paternalistic model of medicine present at this time, and the strong sense of authority associated with medical providers. New scientific and medical advancements introduced a sense of excitement in exploration. The trans community and trans medicine, while viewed as abnormal, became the target for exploration by the medical and scientific communities. While the medical community viewed trans people as deeply troubled, it was excited to “be on the forefront of medical information and knowledge.” However, when seeking gender affirming care, trans patients were pressured to prove their “credibility” to providers, as they “sought assurances that trans people would be able to successfully live in their target gender.” However, “successful” was defined so rigidly that many trans patients were set up for denial of care if they were unable to fulfill expectations for “gender conformity, heterosexual desire, stable jobs, and no interest in raising children.” A knowledge base formed within the medical and scientific communities was established to filter out trans people who did not meet the expectations for a model citizen; these people were perceived as unworthy of gender affirming medical treatment. The sense of power and authority in medical professionalism also coincided with a need for the reliance on empirical evidence; many providers practicing trans medicine fought uncertainty due to such lack of scientific evidence. As many providers sought credibility in their work with trans patients, they “began to frame their work within the spirit of scientific research.” In an effort to avert questions of morality and distract people from their uncertainty, providers “instituted the trope of the ‘trickster’ trans person, deflecting professional critiques by focusing attention on the moral character of trans people.” This gave providers the authority to set boundaries and requirements for deeming a trans patient “credible” for gender-affirming treatment, and to establish these under the name of science. There was an overarching idea that transness should be diagnosed or proven before being able to undergo gender affirming medical interventions. Due to the lack of information to “verify” someone as trans, providers were keen to refuse to treat people who they suspected were lying about being trans. Noncompliance with the rigid expectations placed on trans people to prove their trans identities resulted in denial of care. Such expectations included matching the standard narrative of a trans person’s life: one feeling disgusted with one’s genitals from an early age and wanting to dress in the clothing of the “opposite” gender. Trans people were also required to tell providers everything about their lives in order to have the possibility of accessing medical care. Gender affirming operations were also only granted to those who showed most promise in conforming to gender norms and expectations, and being able to move through society in their “target gender.” 

In the second part of the book, shuster elucidates the contemporary practices and stigma surrounding trans medicine. This part discusses the rise in reliance on evidence based medicine and how this has impacted trans medicine and trans access to gender-affirming interventions. As technology becomes more advanced and more information on trans medicine is collected, providers have established professional documents to serve as guidelines and diagnostic criteria. This was motivated by the evidence-based medicine movement that emerged in the 1980s to make medicine more objective and standardized. Many believed that using the EBM approach would solve problems in trans medicine. With the increase in reliance on scientific evidence and trust in medical diagnoses, many providers have worked under the assumption that diagnoses are “anchored in science and therefore devoid of social values regarding proper bodily expression or behaviors.” However, shuster also highlights that the existence of diagnoses in trans medicine insinuates that being trans is an illness. This reinforces the harmful idea that being trans means that one is biologically deviant. In the tenth version of the International Classification of Diseases, “‘transexualism’ was one of several subcodes within a broader diagnostic category of ‘gender identity disorder.’” This conveys “broader implications in defining realt rans people as those individuals who understand their bodies as simply needing to be changed to fix a problem.” shuster then evaluates the unintended consequences of constructing evidence that can be used to form these diagnoses. They highlight the idea that evidence is never morally or ethically neutral, and that it relies heavily upon who has the control over the definition and qualification of evidence. As evidence-based medicine is constructed within a medical model that implies that a patient carries a “problem,” this reinforces providers’ power to control trans patients and their lives. Also, shuster adds that the lack of scientific evidence existing in trans medicine in the first place makes procedures and guidelines extremely uncertain and up to interpretation, which may lead to the unintended consequences. shuster argues that in using medical guidelines, providers “use strategies in trans medicine that raise broader questions about how the rhetoric of EBM and interpretations of clinical guidelines for medical decision-making may unintentionally perpetuate healthcare inequalities.” 

The main strength reflected in this book is the amount of detail displayed from the research, and the well organized structure of such information within each chapter. Each chapter dives into a wide range of information that include results from studies, interviews of providers, or the personal experiences of trans patients. All of this information is very well integrated within shuster’s own analysis of it. Upon bringing up a new point, shuster then shifts to cite entire letters written by medical providers or long personal accounts of medical providers to back up his argument. 

“Trans Medicine: The Emergence and Practice of Treating Gender” demonstrates how medical providers are very uncertain in their work with trans people. Through their analysis of ethnographic and archival research as well as other personal accounts from medical providers, shuster shows how providers lack the scientific research and clinical experience to interact with trans patients and create treatment plans. This has resulted in providers relying on social and cultural norms or their intuition to inform their decisions in terms of care. This book offers a glimpse into the uncertainty surrounding trans medicine as well as an opportunity to understand the challenges to their expertise which providers face. It shows how in the process of navigating how to create an evidence based system of treatment for trans individuals while dealing with uncertainty, providers have acquired power of gender itself. 

Feminist Mixtape: “Better Than Revenge” by Taylor Swift

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Taylor Swift is a feminist! That is, until another woman gets between her and her boyfriend. While Taylor Swift, singing and song-writing icon, is commonly known for writing songs that blatantly call out misogynist and sexist stereotypes, Better Than Revenge employs a narrative that engages in slut-shaming and the reinforcement of sexist ideas. 

Better Than Revenge is Swift’s confrontation with a woman she blames for her messy breakup. In the song, Swift viciously attacks this woman’s character, dignity, and sense of self-respect, painting her as sex-obsessed and superficial. She accuses her of “stealing” her boyfriend from her and paints a narrative in which As a white, cis, heterosexual celebrity, Swift maintains a very strong sense of superiority. Although she speaks from an incredibly privileged perspective, she victimizes herself and continuously slut-shames the woman. She utilizes a sanctimonious tone, asserting that she is above the other woman, who she describes as malicious, disgraceful, and ugly for her actions. The tone and lyrics of Better Than Revenge make for an incredibly condescending and bitter outburst of blame and accusations against the other woman in the situation. Never during the song does Taylor attack her ex boyfriend, whose fault is not recognized. 

Swift’s lyrics slut-shame and degrade the woman she believes stole her boyfriend. The song begins with a recording of Swift saying, “now go sit in the corner and think about what you did.” Swift refers to the other woman as a little girl, and that she views her as childish and immature for her actions. Other lyrics like “she came along got him alone and let’s hear the applause, she took him faster than you could say ‘sabotage’” reinforces the idea that women’s desire for men is so crazed and uncontrollable that women devote all of their energy toward attaining men, even by malicious means. Swift shifts to shaming the woman, claiming that “she’s not a saint, she’s not what you think, she’s an actress.”  This insinuates that women should remain pure, as phallocentric mainstream ideas promote the desirable innocence of such purity. With her reference to being an “actress,” Swift includes the idea that many women feel pressure to act in ways that appeal to the male gaze, whether it be through sexualizing oneself or maintaining a “wholesome” image. Swift’s lowest blow comes next, as she claims that “she’s better known for the things that she does on the mattress.” By objectifying the woman, Swift reinforces the common idea that women are only good for sex. She also shames her for being very sexually active, reinforcing the stigma around sex. 

Overall, Better Than Revenge strengthens mainstream ideas about women needing men to feel fulfilled, women needing to maintain innocence to be desirable, and women disgracing themselves and their image by engaging in sexual behaviors. Swift, who is rarely called out for her degrading lyrics, released this petty anthem probably unaware of the stereotypes this song reinforces. 

Grey’s Anatomy: Challenging or Reinforcing Stereotypes?

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Throughout Grey’s Anatomy’s , Shonda Rhimes seems eager to write and direct episodes that highlight pressing social justice issues and challenge gender and racial stereotypes. While many of her episodes tackle social issues regarding race, gender, sexuality, mental health, drug use, she also includes a lot of representation of marginalized groups. Many of her episodes showcase people across all marginalized groups taking on the empowering and glorified profession of surgery. 

Specifically, an episode in the 14th season highlights stereotypes about women in relation to mental health issues such as anxiety and depression. This episode mostly features Miranda Bailey, an African American woman who is also Chief of Surgery at Grey Sloan Memorial Hospital. Dr. Bailey is an inspiring figure not only for her admirable work ethic and striking leadership abilities, but also for representing groups particularly marginalized in society: she is black, fat, and a woman. 

In this episode, Dr. Bailey confidently claims that she is suffering a heart attack, seeking medical attention at Seattle Presbyterian Hospital. Despite providing her professional opinion and self-diagnosis to the medical staff treating her, her suspicion of a heart attack is relentlessly shut down by doctors who are white, cis-men. Bailey stays loyal to her own professional judgment and requests that she speak to the Seattle Presbyterian’s Chief of Surgery, Dr. Maxwell. Maxwell immediately dismisses Bailey’s belief that she is suffering from a heart attack. He looks at her with sympathy, places a comforting hand on her shoulder, and assures her that his medical opinion is correct. This effectively portrays the harmful stereotype that women are inherently less intelligent than men. It reinforces the idea that women don’t belong in professions where many urgent, important, and high-pressure decisions must be made with utmost skill and knowledge. Maxwell, who actually holds the same position as Bailey in hospital authority, quickly assumes invalidity in her opinion and overlooks her judgment confidently. As a white, cis-man with an intensely glorified job, he feels he holds authority over Bailey, whose blackness, fatness, and identification as a woman devalues her skill and judgment as a highly qualified surgeon.

To make matters worse, Maxwell then suggests she consider mental-health related factors that could be the cause of her physical discomfort. “Do not go down that road with me,” she says. Maxwell continues to ask Bailey about “big stressors” and her history of mental illness. Bailey quickly recognizes that Maxwell’s inference is based solely on stereotypes that women are unable to handle their emotions and anxiety. Bailey asserts her confidence as a black woman who deals with OCD, claiming that she views it as a piece of her story rather than a disadvantage.  Refusing his inference, she requests a new doctor. This scene shows Bailey resisting the socially ingrained idea that women are more mentally and emotionally immature and unstable compared to men. Too often, women’s heart disease is overlooked as merely a manifestation of anxiety or stress. This emerges in relation to the overarching idea that white men are inherently stronger, smarter, and better prepared for success than women of color.

Unfortunately, rather than upholding Bailey’s request for a new cardiologist, Maxwell refers Bailey to a psychiatrist, who is also a white cis-man. He speaks to Bailey in a condescending tone, insisting that he help “treat” the mental issues he believes are causing her physical pain. He describes her as a woman “who has a big job with a lot of responsibilities,” who “manages life and death scenarios on the daily,” “has a history of mental illness,” and has “limited coping skills.” His assumption that someone like Bailey could not possibly handle the stress that comes with such a highly respected and important job feeds into the belief that such positions belong to white men. It reinforces the stereotype that only white men could ever qualify for such an intense, emotionally strenuous, extraordinary profession; this is because society has held the idea that only they have the mental capacity and qualities to handle and deserve such a responsibility. 

The title of the episode, “Don’t Fear the Reaper,” contradicts the episode’s message in an abstract and interesting way. The title originates from a song written by Buck Dharma, a member of a band called Blue Oyster Cult. The song is basically about the inevitability of death and how it shouldn’t be feared. It’s less of a comment on the gender and racial stereotypes of the episode and more of one on the humanity of the situation she is in. The “death” aspect reflects Bailey’s grueling work life and stressful home life. The title insinuates that Bailey should surrender to the forces weighing her down, such as the inevitable stress of her job and as an individual part of intersecting marginalized communities. It implies that despite how secure and empowered she is in herself, she must allow herself to succumb to the natural struggles of life. While this episode title represents the humanization of Bailey, it also places greater emphasis on her struggle, which reinforces negative stereotypes about people like her. This tainted message takes away from the episode’s message on gender and racial stereotypes. Although this message does tie into Grey’s Anatomy’s overarching theme of the imperfectness of humanity, it dulls the episode’s commentary on more pressing social issues.  

Overall, the writers successfully tackle stereotypes about women regarding anxiety and heart disease. Miranda Bailey, a fierce and resilient black woman who is Chief of Surgery at Grey Sloan Memorial Hospital, is known for speaking on issues concerning gender, race or sexuality stereotypes. The writers of Grey’s Anatomy utilized such admirable qualities of her character to effectively comment on the harmful gender and racial stereotypes that are ingrained in our society.