Gender is a socially produced category that derives from the essentialization of bodily difference located in chromosomes, hormones, and genitals. These “sex differences,” while not completely dimorphic, are often treated as such—in science, law, and public realms. Gender binaries function within many communities, nations, and cultures to govern individual expression and comportment, roles, and life trajectory. An individual assigned the sex “male” at birth is presumed not only to claim the gender identity of “man” but to also be masculine in expression and presentation; the same is true of “female,” “woman,” and femininity.

Scholars in gender, queer, and trans studies have critiqued the role Western biomedicine has played in reinforcing sex and gender structures and pathologizing the gender identities of nonbinary and trans communities. Medical doctors categorize infants according to genital size (used as the basis for assigning sex at birth) and routinely surgically alter infants who do not fall neatly into the binary (Dreger 2000; Fausto-Sterling 2000). US clinicians and researchers have used the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (through its five iterations) to render trans people as suffering from “gender identity disorder” (fourth edition) and, in the fifth edition, the somewhat less stigmatizing “gender dysphoria.” These diagnoses have made medical treatment related to gender transition as well as access to trans-specific medical care dependent on trans people fitting into prescribed narratives of, for example, being in the wrong body or desiring the “opposite sex.” This decenters the self-determination of trans people over their own identities as well as diminishes their medical access (Fink 2019; S. Hsu 2019).

The field of health humanities brings critical insights to issues of gender in medicine and health, questioning medical categories and centering the experiences of marginalized genders as they navigate the medical field. Marty Fink (2019) analyzes the trans coming-of-age novel Choir Boy (2005) by Charlie Anders and highlights how the main character in the novel, at the cusp of puberty and facing vocal changes, rejects both “male” and “female” in favor of “choirboy.” The main character continues to challenge the medicalization of trans identity when he refuses to perform the “wrong body” narrative to his psychologist to obtain hormones, opting to sing instead. Fink argues that the fictional narrative models the aims of queer and feminist disability theory—by positing that patients’ relationship to medical care should be one of self-definition and self-advocacy and, moreover, that reliance on medical providers need not come with acceptance of the hegemonic framing of trans bodies as something to be fixed or cured.

Health humanities scholars also expose how hegemonic Western medical systems regulate women’s bodies. The social subordination of women and femmes (feminine-presenting individuals) in Western culture has shaped the post-Enlightenment dominance of biomedicine, which conceptualized reproductive organs associated with womanhood, such as the uterus, as abnormal and categorized processes like menstruation and pregnancy as illnesses. Cultural myths about the predisposition of white, upper-class women to domesticity and frailty in nineteenth-century Europe and the United States led to outlandish biomedical diagnoses: women who complained of a range of symptoms from headache to indigestion as well as a variety of mental states (such as high libido) were diagnosed with the imagined condition known as “hysteria,” which at its worst subjected them to unnecessary hysterectomies as purported treatments (Ehrenreich and English [1973] 2011; Lupton 2012; Wertz and Wertz 1981). Rosemarie Garland-Thomson (2005, 1564) has described the medical construction of femaleness as a natural form of physical and mental deficiency as both the “disabling of gender” and the “gendering of disability.”

Marginalized women have in particular been pathologized by cultural ideas about fertility, desire, mothering, and ability. Modern gynecology was founded on the famed Dr. J. Marion Sims’s experimentation on enslaved Black women in the United States, which he rationalized with the notion of their inability to feel pain, among other cultural myths rendering Black bodies vulnerable (Holloway 2011; Snorton 2017; Washington 2006). Dorothy Roberts (1999) discusses how, in contrast to the chastity attributed to white women, Black women have been negatively constructed: historically, as sexually promiscuous and hyperfertile Jezebels or asexual and maternal mammies devoted to nurturing their white masters’ children in lieu of caring about their own children and, in the mid- to late twentieth century, as domineering Black mothers and lazy welfare queens. Roberts describes how this devaluing of Black mothers has served as a technology of social control subsequent to the abolition of slavery: the US medical establishment curtailed Black women’s reproduction and policed their sexuality through birth control measures—in its worst form ending in compulsory sterilization. Native, Latina, and Asian American women as well as women who are poor, are queer, and live with disabilities have also been the targets of sterilization abuse—buttressed by eugenic beliefs of their purported unfitness (Garland-Thomson 2005; Tajima-Peña 2015; Stern 2005). In the twenty-first century, women continue to face limitations on their sexual and reproductive health and autonomy.

Patient narratives receive considerable focus in health humanities scholarship as a means to challenge oppressive cultural norms and reconfigure the relationship of socially marginalized groups to medicine and health care. Noted poet Audre Lorde (1980) mobilized biography, poetry, and analysis to center her experience navigating breast cancer and mastectomy in The Cancer Journals. She shared her experience of the isolation of bearing the illness and the physical pain of amputation and also the strength of women-loving support. She also spoke back to the patriarchal and medical gaze, underscoring the pressure on postmastectomy patients to get breast prosthesis in order to maintain norms of femininity. Lorde described her encounter with proponents of breast implants: their investment in implants to secure male companionship and maintain a normalcy of appearance for the comfort of others. Lorde juxtaposed her focus—as a Black lesbian—on survival and productivity to these heteronormative, Eurocentric pressures and also pointed out the lucrative political economy of breast prosthetics. Lorde’s far-reaching influence can be seen in, for example, literary theorist Diane Price Herndl’s (2002) narrative of her own personal history navigating breast cancer and feminized illness by embracing a posthuman perspective and, consequently, implants.

Health humanities scholars also use patient narratives to interrogate the highly gendered doctor-patient dynamic—where the doctor presumedly embodies an authoritative source and the patient is expected to be compliant and obey the doctor’s orders without question. In both The Cancer Journals and A Burst of Light, Lorde (1980, 1988) describes how doctors were affronted by her asserting her say and control over her body and medical decisions. Scholars have documented extensively the way medical systems in Europe and the US attained the male professional mode of today—most notably, male obstetric physicians usurped midwives’ authority over pregnancy and birth in the early twentieth century (Ehrenreich 1972; Wajcman 1991; Wertz and Wertz 1981). In “Three Generations of Native American Women’s Birth Experience,” poet, musician, and teacher Joy Harjo-Sapulpa (2008) highlights the way US hospitals create an alienating experience for individuals giving birth—their cold, unfeeling sterility and the detrimental effects of the medicalization of birth that results in, for example, immediate postbirth isolation of babies from their parent(s). Physician and essayist Rafael Campo (2014) offers a critical doctor’s perspective in “I Am Gula, Hear Me Roar: On Gender and Medicine,” critiquing the omission of women’s contributions to the profession in medical textbooks as well as the stoic, authoritative air of manliness associated with the doctor profession. Lorde’s, Harjo-Sapulpa’s, and Campo’s narratives, much like the radical achievements of feminist health movements (the 1971 publication of Our Bodies, Ourselves and the 1997 founding of SisterSong Women of Color Reproductive Justice Collective are but two manifestations), carve out space for the voices and contributions of women, queer people, and trans people.

Scholars have also transformed established medicine by intervening in education. Like its sister field of medical humanities, health humanities has focused on mining the expressive and reflective strengths of arts and humanities approaches—that is, theater, poetry, music—to improve existing biomedical education and practice, albeit with health humanities’ greater focus on unsettling biomedical expertise (rather than bettering health-care providers’ communication skills with the tools of the humanities). Health humanities approaches aim to reframe how doctors view patients and their authority as well as the role—and limitations—of medicine in patients’ lives. Susan M. Squier (2020) argues for the utility of comics and graphic narratives in medical education—that their spatial aspect proffers “a zone where one can play with ideas not yet accessible to linear thinking, draw together concepts, communities, and practices conventionally kept separate, and enjoy the fireworks that result” (60). Elsewhere Squier (2014) emphasizes comics as a medium for sex education—that they decenter medical expertise and center embodied experience by encouraging “a broader, more accepting, and distinctly non-normative understand of human sexuality” (228).

Attempts to transform medicine from within have also prioritized incorporating interdisciplinary humanities texts informed by critical theories of power and difference. Gutierrez and DasGupta’s (2016) “The Space That Difference Makes: On Marginality, Social Justice and the Future of the Health Humanities” argues for engaging health-care providers in robust methodologies such as feminist philosophy, queer of color studies, postcolonial theory, critical theory, and cultural studies. Drawing on these fields to overhaul health humanities education and textbooks, they argue, pushes the health humanities curricular canon beyond traditional foci on illness, death, and health and toward exploration of social justice praxis outside of the classroom-to-clinic model (e.g., in community spaces or legislative actions). We might query, for example, what future psychiatrists would learn from Stephanie Hsu’s (2019) reading—through trans of color critique—of Fanon’s footnote on transgender performance in his revolutionary anti-colonial, anti-racist treatise on interracial desire in Black Skin, White Masks. These paradigm-shifting frameworks engage future health-care providers in reevaluating existing medical practices and dominant views of health care.

Indisputably, gender forms a site where medical intervention and regulation frequently result in the abuse and loss of autonomy for women, femmes, trans people, and nonbinary people. The field of health humanities, as it continues to center feminist and critical approaches to gender, offers indispensable tools for rethinking notions of illness and health, uplifting patient narratives and expertise, transforming medical education, and ultimately, achieving a reality where people are free from medical abuse and can maintain autonomy over their bodies and self-determine their health-care access.

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