I was recently asked to give a talk at the Eastern division of the American Philosophical Association’s annual conference, on a panel with the wonderful Liz Dietz, Bella-Rose Kelly, and Perry Zurn. The result is not enough to be publishable, and too much to let evaporate, so: it’s here.
Thank you very much for joining us. Before we get started, I do want to riff on something Liz mentioned – the government complaints about people trying to access womens’ bathrooms. There are many good reasons to dispute this fear, this complaint, this site of panic, but, I want to mention an ethical one that I think should be taken up more, and that is that – having been in mens’ bathrooms – I don’t think anyone should be expected to endure that kind of, shall we say, sensory experience.
I am going to begin my talk in perhaps the most obnoxious way possible, by paraphrasing Foucault. He once opened a talk by specifying that he was not an analytic philosopher, because nobody is perfect. My paraphrase is that I am not, by training, a philosopher at all – so I beg for your indulgence if I ignorantly tread on speaking or argument conventions.
Rather than being a philosopher, I am a…mess, intellectually. But I’m a mess whose work centers on the sociology, history and (sometimes) philosophy of trans medicine – I’ve just submitted (last week) the manuscript for my first book, Trans Science, which is a history of scientific work surrounding trans care based on around 30 archives, two of which I created, and interviews with historic practitioners, policymakers and patients involved in trans care from the 1950s to the 1980s. Specifically, over 200 interviews. I am very tired.
So, with that scene-setting, you’ll be unsurprised to know that the focus of this talk is trans medicine. Specifically, it’s about how the current moment in culture surrounding trans medicine relates to eugenics.
There are a lot of definitions of eugenics; conventionally, it might be summarised as techniques and technologies that promote and pursue a particular vision of what forms of human life are desirable/undesirable – and seek to ensure their perpetuation or elimination. I would add to that by pointing to the work of Rua Williams, who notes that, in ideology and execution, eugenics often moves “past optimized physical prowess, and even beyond psychological fitness, and into the realm of moral purity”. While eugenic practices are often interpreted as focusing on disability, they are just as frequently about gender and race – motivated by that mentioned idea of moral purity, and how it interacts with ideas of racial supremacy. Ladelle McWhorter makes an important point, I think, by emphasising that while white supremacy is often interpreted as starting from the idea that whiteness is supreme, it is instead an active process – it requires that whiteness, and white populations, be made and maintained as supreme through the purification of whiteness and the repetition of a particular idea of what is “best”. This means that eugenics is essential to a white supremacist project – it is one of the mechanisms by which whiteness is, to return to Williams, “purified”.
Eugenics and the history of trans medicine
So how does eugenics appear in trans medicine? Historically-speaking, it appears in a very strange way. One might expect that eugenicists would be opposed to gender-affirming care – that they would be opposed to trans lives altogether. But in fact, many of the early pioneers of such care were also ardent eugenicists. Through my archival work, I have uncovered strong links between those who ran, for example, early Gender Identity Clinics in the United States, and the anxiety around population control and management in the 1950s.
This did not (and does not) mean that trans people constituted an exception to eugenic thought: instead, eugenic thought strongly shaped both the rhetorics used to justify trans medicine, and the form that the provision of medical care took.
Trans medicine was justified, in part, by arguing that it made sense from a eugenicist basis. This was on two grounds. The first, most directly, was that trans people – seen as imperfect and impure – could be put to use as a disposable population, from a population management perspective. Harry Benjamin, the pioneering physician whose book The Transsexual Phenomenon influenced so much of the narratives and practices surrounding trans people and care, explicitly wrote that while the taboo surrounding gender-affirming care was often motivated by the concern that procreation was prevented in patients, it could be countered by pointing to “the only too well justified fear of overpopulation”.
Simultaneously, trans medicine constituted a “rehabilitative” practice, as John Money put it. Through gender-affirming care, trans people could be made more useful – could be made, if not normal, then to simulate normalcy in a societally productive fashion. By providing treatment, doctors could take a population and render them capable of employment, marriage, and at least the fostering or adoption or children.
None of this changed the fact that, while seeking to rehabilitate existing trans people, doctors simultaneously saw transness and the desire for medical transition as an imperfection that could (and should) be eliminated. Early clinics explicitly articulated their provision of treatment as motivated by a desire to discover the causes of trans identity, with the hopes that it could be snuffed out. And in structuring that care, the clinics simultaneously put rules and regulations in place to ensure, for example, that patients received divorce, and were separated from their children – in order to avoid “confusing” those children and risking the further spread of trans desires.
I want to emphasise that although these examples are from the 1970s and 1980s, the mentality behind them – that trans medicine is rehabilitative, that trans lives are less-than “the ideal” – still undergird a lot of medical mentalities surrounding care. That the status quo within the field is not too far divorced from where it was back then in outlook, only in the intensity with which that outlook is made explicit.
Eugenics and trans medicine in the present moment
These days, of course, political narratives around trans medicine look…well, different. As people in this room have definitely noticed, we’re in the midst of a good old-fashioned moral panic surrounding gender-affirming care. There are state-level bans, federal-level bans, and active scrutiny of and, frankly, administrative harassment, of both providers and patients. What motivates these actions and this panic is…well, a lot of things. Part of it is a pragmatic and cynical political calculation; the realisation by socially conservative forces that gay marriage no longer serves as an effective rallying cry for right-wing voters, and the need for something new.
But part of it – both rhetorically and motivationally – is a different kind of eugenic and reproductive anxiety. In the 1960s, the fear was overpopulation – a fear that was deeply racially charged. Too many of the “wrong people” (specifically and particularly, people of colour in developing nations) were having children. This fear is still present: see the popularity of the “great replacement theory” on the right – but has been expanded to include the fear that “the right people” (specifically, western, white populations) are not having enough children. We see increasing attention by both the right and neoliberal center on “demographic collapse” and on “pronatalism”; on efforts to popularise the right people reproducing (in the right way).
The fear at the heart of this effort functions not only because it plays on direct racial tropes, but also because it plays on anxieties about the collapse of the “proper” (read: heterosexual, white, middle-class) family unit, and the collapse of the gender roles that supported that same structure. As Elizabeth Corredor has convincingly argued, the current right-wing movement against “gender ideology” targets gender precisely because gender, as a concept, opens up opportunities and imaginaries beyond the inevitability of such a structure. It is part of a backlash against not only trans lives and care, but abortion rights, divorce rights, and equal access to employment or social services. All of these things have one thing in common: they are seen as destabilising that traditional, and always-racialised, ideal of a monogamous, heterosexual couple reproducing within marriage. This current moment of pushback is an attempt to re-cement that ideal, and perpetuate cultures centered around it.
Given all of that, it is no surprise to see those reproductive anxieties (and the ideals of purity and racial and cultural reproduction that backstop it) at play in many of the efforts to constrain gender-affirming care. Most prominently, I would point to the Executive Order issued by Donald Trump titled “Protecting Children from Chemical and Surgical Mutilation”, which seeks to prohibit gender-affirming care for adolescents.
The executive order’s rhetoric says a lot about the fears that motivate it, or that those who wrote it seek to stir in the reader. It focuses almost exclusively on adolescent transmasculine people – on people assigned female at birth – and does so through a reproductive lens. Gender-affirming care, the EO states, produces in patients “the horrifying tragedy that they will never be able to conceive children of their own or nurture their children through breastfeeding”. This is not an aside: it is the very second paragraph. And that is not a coincidence: it is ultimately about the fear that gender-affirming care, or transition more generally, will reduce the population capable of that idealised form of social and biological reproduction. That it will constrain us in reaching physical, social, and moral purity – these forms of purity inherently intertwined with white supremacy.
Responding to the present moment
So what am I trying to communicate here? Other, perhaps, than that I am not a philosopher. And what on earth is the connection to disability? Why are we all here?
Well, on the first: I have a concern about the current political moment. And that is not that the people seeking to prohibit trans care and demonise trans people will win – it is that they will lose only through the restoration of the previous status quo. And in a sense, this will be a win for them, because as I have tried to demonstrate, the moral impetus underpinning many of the current restrictions is based on a value framework shared by practitioners on both sides of the aisle: that trans-lives are subnormal lives, that trans people are subnormal people, and that trans medicine should be viewed as a site to constrain the existence of those lives. While switching from practices that seek to eliminate us to practices that seek to minimise us is an improvement, it is not enough of one.
This leads us to the connection to disability, because – and I say this as someone both disabled and trans – disabled communities have a long history with everything going on here. Having to pick between paternalistic tolerance and outright elimination – and knowing that they are ultimately the same urge expressed in different forms. Disability theorists’ responses have been all over the map, but one common theme is simply refusal of this dichotomy: a refusal to accept assistance that is premised on also accepting the right of those outside disabled spaces to assess which of us are worth allowing to live, and a refusal to accept the premise of that: the premise that it is a judgment for them to make, recognition they have the power to offer or withold.
In the present moment – when trans people are asked to choose between outright elimination, and allies who are the bearers of the legacy of doctors with their own eugenicist mindsets – we should learn from disability theory. We should learn that this dichotomy is a false one, and that empowerment that conserves the enactor’s authority to determine who receives it is no empowerment at all.