Andrea James

Gender Medicine

A defining moment in our history: Examining disease models of gender identity

Originally published 10 September 2004 online

Published December 2006 in Gender Medicine

doi: 10.1016/S1550-8579(06)80121-X

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Abstract (via Gender Medicine)

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Gender identity and expression take on different meanings within different systems of thought. Because medical technologies are available to assist in the somatic expression of these identities, several medicalized disease models of the phenomena have developed. This article examines three disease models as typically applied to those who seek feminization:

Psychosexual pathology (Bailey-Blanchard-Lawrence [BBL] model)

The BBL model is the least scientific and most stigmatizing, with roots in the eugenics movement of the 19th century.

Psychopathology (“gender identity disorder” [GID] model)

The GID model is currently considered legitimate within psychological literature and is a required diagnosis to receive access to trans health services in many places. The author reviews several problems with mental illness models, including “childhood gender nonconformity” and “transvestic fetishism,” two other “mental disorders” currently considered legitimate diagnoses. The article makes several analogies, asking readers to consider whether “racial nonconformity” or “religious identity disorder” seem legitimate as well.

Pathology (“birth defect” model)

This third metaphor of impairment describes a physical disorder rather than a mental one. The “order” implied by positioning these traits and behaviors as diseases reinforces heteronormative hierarchies. These models use scientific-sounding terminology to reinforce the social belief that the “purpose” or “function” of sex and sexuality is procreation. This leads to an examination of historic problems with anatomical thresholds for determining sex. The author then draws parallels with other bioethical debates about technologies that disrupt the “natural” order of procreative sexuality. Interest in feminization is stigmatized in many cultures, and the article concludes with some suggestions for ways to consider it independently from models of sin or disease.

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