Blogging for HONS 201: Feminism, New Media, and Health at Hunter College.

Medicalization, Trans* Discourse, and Michelle Kosilek

In class this past week, we learned the definition of medicalization as “the conversion of natural human behavior into a medical condition.” We looked at examples such as alcoholism, drapetomania, and post-partum depression, and after lengthy discussion on Twitter arrived at a few questions. What do we describe as a “natural” human behavior? When does something “natural” get to a point that it needs treatment? Is the idea of “treatment” itself inherently problematic because it implies that there is an “unnatural” problem? Do the positives of medicalization outweigh the negatives (or vice versa)?

Michelle Kosilek, 1993, via LGBTnation, Fair Use

I considered these questions again as I read about Michelle Kosilek’s government-granted approval for sex-reassignment surgery this morning. Kosilek is currently serving a life sentence for the murder of her spouse, Cheryl, in 1990. In 1993, she changed her name from Robert to Michelle, and has been officially diagnosed with gender identity disorder (GID). In 2000, she successfully sued the government for the right to undergo female hormone therapy on the grounds of the Eight Amendment. She appealed to the Massachusetts Department of Corrections  for electrolysis for the eighth time in 2009.

Just a few days ago, on September 4, District Judge Mark Wolf ruled that the DOC was mandated to pay for Kosilek’s sex reassignment surgery because she had demonstrated a serious “medical need” for it. She has been serving her incarceration as a woman while in an all-male prison, and has attempted to castrate herself and kill herself from her GID-related anguish. Wolf wrote in his report that he believed her to be a “transsexual – a man who truly believes that he is a female cruelly trapped in a male body” and that this is a mental disorder that requires treatment. This is the first ruling of its kind, and has brought up a lot of questions as related to the rights of the incarcerated and trans* rights.* While there is no express Constitutional mandate for healthcare, the Eight Amendment does prohibit cruel and unusual punishment, and it would be cruel to deny “medical care for a serious medical need.”

There has been an intense public outcry to the ruling – most of it in opposition to Wolf’s decision. To some of those opposed, GID isn’t a real medical condition that doesn’t require treatment; Kosilek’s organs and body would, on the most basic level, function without the reassignment surgery. From that perspective, sex reassignment surgery is viewed as purely cosmetic – and something the state should not have to pay for. Others opposed (like Elizabeth Warren) are angry at the cost of the surgery – sex reassignment surgery is expensive, and the average middle-class taxpayer probably couldn’t easily afford one, so why should they have to pay for one? And lastly, some just want to deny Kosilek her surgery because she is a convicted murderer, and that’s the price you pay when you murder someone.

I honestly don’t know where I stand on this issue. It ties back to the intial questions of medicalization: what constitutes a medical disorder? And when does is mandate treatment? In the end, I think Wolf’s ruling was fair one. Kosilek has every right to feel safe in her own body, without the anguish and depression that could eventually lead to suicide. I have to wonder, though, what that says about how we as a society talk about sex, gender, identity, and transgression – that somehow not being comfortable with what we are born with or assigned somehow make us “ill” or “disordered.” I think it’s also troubling in the way we as a society deal with the incarcerated; it would seem, from reactions to Kosilek’s situation, that people couldn’t care less what happen to the populations that are behind bars.

*As well as the problematic (and ignorant) discourse as related to trans* people. A good majority of sources reporting on Kosilek’s case repeatedly mis-assigned her gender pronouns, referring to her as “him.”


One comment on “Medicalization, Trans* Discourse, and Michelle Kosilek

  1. parrhesia
    September 12, 2012

    The problem with GID is that it stigmatizes those who desire to live according to the gender they choose in contrary to the one they were given, and this doesn’t have to be necessarily so. We don’t have to think of transgression of a given gender as a “disease”, and I like to argue that society is diseased as it forbids a variety of gender expressions across the spectrum to healthily flourish. Ideally, people should have the autonomy to decorate and/or modify their bodies in such a way that is congruent with their ideal gender expression, whatever that might be, without resorting to medical authorities and taking on the language of illness or disorder. However, at the moment it is only through the language of GID that trans people are able to gain access to what they need, thereby a lot of trans people have to adopt this medical language and rehearse a certain script to convince their doctors (such as “I was born in the wrong body”) in order to live their lives fully, comfortably, and in many cases, safely. The language of “medical disorder” is pragmatically important because it is, at the moment, the only way to persuade the rest of society that it is an essential need, and it is an essential need for many trans people who will otherwise suffer immensely without it. At the same time, the stigma and the constraints this language medical disorder brings is unnecessary and often harmful. This is how I view the issue, and sadly I’m not really sure what could be done about it. There definitely needs to be more conversation about what gender is in order to change attitudes towards trans people, but this is a difficult dialogue given how deeply ingrained the dominant essentialist binary gender ideology is in our society.

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This entry was posted on September 8, 2012 by in Uncategorized and tagged , , , , , .

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