Sufficient Scruples

Bioethics, healthcare policy, and related issues.

October 20, 2011

Patriarchal Progressives

by @ 5:09 PM. Filed under Autonomy, General, LGBTQ Issues, Personhood, Sex, Theory, Women's Issues

Jill Filipovic, at Feministe, has a great post up on objectification of women within liberal activist circles. It was prompted by the much-commented assholery of one Steven Greenstreet, who took video footage of female demonstrators at OWS protests and put it up on Tumblr, out of context and with no purpose other than inviting leering at the “Hot Chicks of Occupy Wall Street”.

Jill righteously calls him out for it (as did many others):

The deflecting from legitimate concerns, and the fact that the OWS “public” includes a lot of men who think it’s ok to treat women at a protest like we’re there for their visual fulfillment, troubles me. No one is saying, “Don’t find women attractive.” . . . No one is objecting to the fact that straight men are attracted to some women (fun fact: straight women are also attracted to some men! So really, no one is pissed about attraction, I promise). What people are pissed about is what Rebecca Traister says:

“The larger, simpler argument, outside of consent or permission, is: This video is sexist. It’s an example of women participating in public life — political, professional, social — and having their participation reduced to sexual objectification. That’s what happened here, nothing more, nothing less.” . . .

Emphasis mine. . . . [C]reating a blog and a video dedicated to showing women at a protest with the sole purpose of reminding dudes that women at the protest are hot? That does reduce women to objects of male attention. It’s another reminder, for women, that how seriously we’re taken and how valuable we are depends on how sexually attractive we’re deemed.

Read the whole thing; she’s got good things to say. But the part that really triggered something for me was this:

Frankly, the kinds of dudes who would come to the OWS protests because they heard there are hot chicks there? Are not the kinds of dudes I want to be protesting with. I would hope they’re not the kinds of dudes that most progressives would want to be protesting with — but judging by the lefty-dude reaction to Steven Greenstreet (hi Matt Zoller Seitz, looking at you!), that’s not the case. It’s disappointing.

To say the least. And far too common, from way back. It’s no secret that supposedly “progressive” groups have always been rife with sexism and sexual pressuring, and it doesn’t seem to be getting better. Progressives have never been immune to human failings, including stereotyping and bigotry of the kind that they supposedly abhor but sometimes don’t recognize in themselves; the long fight for acceptance in progressive movements of gays and transexuals is one case in point, and the difficulty many white (and especially male heterosexual) liberals have in recognizing and acknowledging their own privilege is another. But the LGBTQ community, people of color, and other marginalized groups, though still embattled, have by now to a considerable degree been granted by progressives the one thing many persist in denying to women: recognition of the fact that they have real interests, problems, and worth that must be taken seriously. The situation is far from perfect, and not everybody agrees on how the tensions between different progressive constituencies should be resolved, but in most cases they are acknowledged, and the human pain and human interests that lie at their heart are given due deference. Except in the case of women.

To be sure, progressives are not right-wingers. They don’t overtly hate women. They don’t gleefully consign them to death by deliberate neglect at the hands of sniffy sex-negative religious bigots. They don’t dishonestly and cynically strain moral concepts – often ones introduced and championed by progressives – such as “informed consent” to create barriers to the very autonomy they are intended to protect. They don’t penalize the fact of women’s having sexual natures – just the opposite! But in too many cases they don’t grant them the respect and freedom needed to act on their own natures and seek their own good. Just as with conservatives, women exist for far too many progressive men for the purpose of their gratification – an impersonal usage that erases those women as persons themselves.

Which leads me, finally, to the question that came up for me on surveying this latest stupid and distasteful incident: how, exactly, are these dipshit “progressive” men progressives? What goes through their heads, what process takes place in their heads, such that they wind up thinking things like “let’s go to the OWS protest and photograph women’s breasts!”? How, when they are called out for that, do they expend so much energy defending their childishness and sexism? Why do they not care about offending or humiliating their supposed fellow activists – about derailing or undermining the movement they claim to support – about embarrassing that movement by acting in a regressive manner and then elevating their own bad behavior into the limelight? More particularly, what is it that allows progressives to empathize with everyone but women, even women in their own movement? What allows them to hear everyone else’s protests at mistreatment, and dismiss those of women out of hand?

In a way, I suppose it has something in common with the denial and self-absorption that allowed Southern slave-holders to rationalize their own crimes. Patriarchy is its own form of slavery, more complex and less overt, but very real, and it is very hard to acknowledge you are doing wrong when your entire lifestyle, all its comforts and conveniences and pleasures, derives so much from others’ service to your needs. It is easy to protest obvious wrongs that don’t require you to change your own life to amend. But progressive men, in many cases, are no better than the privileged classes of the Confederacy, of apartheid South Africa, of Wall Street itself, at admitting that their own satisfaction depends on bending others to their desires, against their will and at the denial of their basic human personhood.

You can’t be progressive just for causes you aren’t invested in, at the expense of people you don’t like. Being progressive means wanting to live in a better world – not just wanting to take down the most guilty in this one and then carry on regardless. Being progressive means checking your privilege, living the dream you envision, being part of the solution – all slogans that have at their heart the basic truth that you have to be as critical of yourself as you are of others, or more so, since you can only really change yourself.

You aren’t a progressive if you mistreat women. You aren’t a progressive if you think progressivism is defined as rallies, protests, and events, rather than a mindset that is grounded on a world in which people are treated with respect, by everyone, starting with yourself. You aren’t a progressive if you go to events but don’t treat the people there with regard. You aren’t a progressive if you revel in your own privileges at the expense of the pain and diminishment of others, then feel hurt because you’ve decided that whatever superficial support you feel for “the cause” entitles you to use others for your pleasure and then resent it when they object.

If you’re not a progressive for any of these reasons, you’re little better than a reactionary even if you vote the right way. You’re pro-choice? Great. You don’t think being pro-choice encompasses the choice to control, and present, your own sexuality on your own terms? You’re not a progressive, and you’re a pain and an embarrassment to those who sincerely try to be.

October 1, 2011

Complexities of Transexual Procedures, and of Progressive Healthcare

by @ 7:35 PM. Filed under Access to Healthcare, Autonomy, Biotechnology, General, Healthcare Politics, LGBTQ Issues, Medical Science, Provider Roles, Theory, Women's Issues

There’s a great post up at Skepchick, discussing a supposed regimen for “natural” transexual procedures for female-to-male transitioning. Debbie Goddard (@DebGod) responded to a question from a writer who was approaching the FTM transition but was uncertain about surgery and hormone therapy, and had heard about a program of exercise and “natural” supplements similar to that used by “natural bodybuilders”. DebGod’s response and the discussion that ensued fascinated me. I encourage people to read it; then I’ll have some comments to make.

What got me onto this is that there’s just so much cool stuff in this post and the comments thread. I don’t have anything to say about the basic question of natural transitioning, but I want to point out several things that come up in the discussion.

First, it’s interesting that this post arose on a skeptic (i.e., atheist, anti-paranormal) site in the first place. Transexuality isn’t inherently an issue for skeptics, but the questioner identified as a skeptic and was apparently feeling vulnerable as both a transexual and a skeptic, so sought out a welcoming community. He found the right place: DebGod happens to be gender-queer, and is knowledgeable about transexuality and a former bodybuilder, and the community of readers was supportive. From some of the comments, it appears that many perceive the skeptical community as not uniformly welcoming for LGBTQ people – something I hadn’t known or expected. This post included some interesting discussion of LGBTQ issues among skeptics, and raises questions that – especially in light of the recent conflict over misogyny among skeptics (notably involving another prominent Skepchick poster) – I hope the skeptical community will take the opportunity to address.

More importantly, DebGod’s response is a model of careful and helpful analysis. She gives her own background, with appropriate disclaimers, then lays out the issues clearly and concisely. She notes red flags with the claims being made (no professional credentials, buzzwords, trademarked terminology, skeptical responses from people directly affected). She then reviews the suggested procedure, notes that it relies heavily on biochemical supplements, comments intelligently on their purity and efficacy, and discusses the vague distinction between “natural” and “non-natural” that the promoters take advantage of. She seeks information from a more knowledgeable source. Shen then concludes by running down all the issues this analysis raises, categorically, giving pros and cons for each and pointing out dangers. This is a really well-done, intelligent, well-argued analysis, at least as good as that commonly seen from Quackwatch or prominent skeptics like PZ Myers.

What I really like about DebGod’s analysis is that she is carefully value-neutral in all of this. Though it’s clear that there is much to be worried about in this suggested regimen, she never takes it on herself to make other people’s decisions for them. Her final statement is a clear and balanced sketch of the relationship between all the competing factors – health, personal goals, available support, and insurance or income – that influence a decision among the many different options for transitioning; she doesn’t declare any of them right or wrong for any individual, but makes it clear that each may be better or worse under different conditions. She includes just a single sentence offering her opinion that the “natural” process is too risky and low-benefit, but clearly identifies it as her own perspective and doesn’t insist that anyone else has to adopt it. She really gets her role as guide and analyst, as opposed to parent, judge, or dictator – something that so many culture-critic blowhards, and even many licensed professionals, can’t accept.

As she notes:

When it comes to gender identity and transsexualism, where you want to go, who you want to be, and how you want to do it is up to you, of course.

- a message that needs to be heard more widely, and not just regarding transexualism.

That leads to another issue that comes up obliquely, but importantly, in the comments. The medical community’s response to transexualism has been mixed, in ways that have generated a lot of resentment in the T/Q community even when the doctors and psychologists thought they were being helpful. For many years, transexuals seeking medical treatment in the US were commonly required to conform to the so-called “Harry Benjamin Standards of Care” (now the “World Professional Association for Transgender Health Standards of Care”), requiring extensive counseling and explicit authorization from multiple psychologists, and a set period of pre-treatment life in the transitioned gender, before professionals would agree to provide the requested treatment. Those standards have been eased but still exist. Many critics have pointed out that this is not only paternalistic but unnecessary – transexual patients have a higher level of success and satisfaction with their treatment than patients of many other conditions, including cosmetic procedures, that do not involve such heavy-handed gatekeeping. The professional societies – starting in the 1950s, when this work was extremely controversial – saw themselves as protecting patients and preventing harmful mistakes, while also going to lengths to provide treatments that more conservative caregivers would have prohibited in the first place. Patients, however, saw it as condescending, offensive, and wasteful of time and money. (Note that in other parts of the world, clinical standards for transexual therapy are much looser or non-existent; there is no known epidemic of regretful genderflippers.)

There are some very interesting comments from “natalie1984″ noting that the sex-reassignment gatekeeping system has been eroded in recent years, and along with it the stereotyped view of what it means to “really” be transexual or gender-dysphoric in the first place. Not only has therapy become more accessible, but what kind of therapy and what therapeutic endpoint the patient seeks have also been thrown open. As she notes: “Now we’re all able to simply work out for ourselves who we are and what we want from transition, and what will make us feel happiest”. She speaks with understanding of why many healthcare professionals are not current on T/Q issues, and simply encourages patients to find caregivers they are comfortable with. There’s also an interesting exchange further down the thread between her and one of the promoters of the natural therapy. She comes across as uncompromising but smart, thoughtful, and understanding.

There’s more, including the politics of gendered pronouns, but even just this adds up to a rich and complex discussion, with intersections between skepticism, healthcare autonomy, gender issues, and, vaguely, perhaps some philosophy-of-science stuff. What this post brings up for me is the deeply connected ways in which such issues always do surface in any similar debates over the proper application of facts to values – that is, the use of science or medicine to achieve chosen goals in human lives, and the conflicts that arise between those who control the science and those whose goals are at stake. It is common in ethics and philosophy of science to emphasize the “fact/value distinction”, but real cases often dredge up facts – and perceived facts – from many aspects of our lives, and competing values that arise from very different lived perspectives.

In this one issue, the skeptical community provides a useful mindset for analyzing clinical claims, but has also been charged with hostility to the LGBTQ community in whose interests those questions are asked. The “natural health” community offers the autonomy and self-direction that many patients want, but also harbors liars and scammers. The doctors who invented the sex-assignment gatekeeping system that so many transexual people hate did so as a way to make it possible for those patients to get care than had never previously been available. It is impossible for anyone to assert an exclusive claim to the moral or epistemological high ground here.

This stuff is hard, and, like so many progressive programs, requires a dedication to working through all the implications of a given position, and to striving to make one’s positions more defensible, more responsive, and more accepting. Every one of these communities – the skeptics, the healthcare professionals, the alternative-health promoters, and to some degree the LGBTQ population as well – have work to do in that way. Some of it has been done, though, and some of it is being done now, over at Skepchick. Good start.

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