Abstract
This article begins with an ethnographically documented incident whereby nursing students dissected a medical human simulator model and rearranged it so that the “male” head and torso was attached to the “female” lower half. They then joked about the embodiment of the model, thus staging a scene of anti-trans ridicule. The students’ lack of ability, or purposeful refusal, to recognize morphological biodiversity in medical settings indicates a lacuna in clinical imaginaries. Even as trans-identified and gender nonconforming people increasingly access care in the clinic, the lacuna of transsex—as a proxy term for non-binary embodiment—persists at the heart of clinical practice. This article concludes that we might engage in more ethical clinical practice if we recognize and affirm the trace of multiple forms of human being in the non-human simulator.
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Notes
An example of a Simulated Learning Lab (not referenced in this paper) can be found at the website for the Department of Nursing, Bloomsburg University: http://departments.bloomu.edu/nursing/programs/learningLab/NEW%20Learning%20Lab%20Page%201.12.10.htm (site last visited 19 August 2012).
Much of the literature justifying the use of simulators in medical education stresses that the potential harm to patients is reduced if clinical trainees are first allowed to practice on models. See “Patient simulation for training basic and advanced clinical skills” (Good 2003).
I place “male” and “female” in quotes to indicate that bodies and their parts do not need to be gendered or sexed. This follows Dean Spade’s 2011 critique in “About Purportedly Gendered Body Parts,” (last viewed 19 August 2012 at: http://www.deanspade.net/2011/02/03/about-purportedly-gendered-body-parts/). Spade argues that instead of ascribing sex or gender to body parts clinicians could, for example, reference “people with breasts, or ovaries or testes” instead.
While the figure of the monster appears in literary and medical discourses alike as a fearsome aberration, it has also been re-appropriated to counter such negative associations. See Susan Stryker’s “My Words to Victor Frankenstein Above the Village Chamounix: Performing Transgender Rage” (1994).
Among other possibilities for similarly embodied patients could be someone who has lost a penis as a casualty of war or in an accident or a person born with a visible intersex condition.
Cisnormativity perpetuates cissexism as a form of bias that maligns people with bodies and gender expressions that do not replicate culturally standard sex/gender norms. The prefix “cis” means to be in alignment with, instead of moving across (“trans”), sex/gender categories. While it is contestable whether anyone can fully align with idealized sex/gender norms and standard forms of embodiment, my intention is to name a type of bias that otherwise remains unspoken. Transphobia, as the irrational fear of and sometimes hatred of trans-identified and gender nonconforming people, does not encompass the more insidious manifestation of normative bias enacted in this particular Lab situation.
“Resusci Anne,” Wikipedia, accessed August 7, 2012. en.wikipedia.org/wiki/Resusci_Anne.
Laerdal Company’s history page, accessed August 19, 2012. http://www.laerdal.com/us/doc/367/History.
Ericka Johnson, “The ghost of anatomies past: Simulating the one-sex body in modern medical training,” Feminist Theory 2005:6: 141–159. Johnson draws upon Thomas Laqueur’s history of the one-sex body model found in pre-Enlightenment anatomies and medical discourses. Elsewhere in her article she argues that simulators do not even approximate a live human body. They instead create a standardized environment for practicing—and receiving feedback—on medical procedures. The feedback received via computer is reductive knowledge in that it does not include additional information from eye contact, touch, or even verbal interchange with live professional patients who are sometimes used in clinical training environments. So it is that in studying different types of simulators (i.e., a “male anesthesiology training mannequin” and a “female pelvic exam simulator”), Johnson draws the conclusion that “the patient-body which is reified in each […] simulator reflects a specific understanding of the patient in the[ir] respective fields, and that the patient-body varies between them” (149–150).
As social anthropologist Mark Johnson claims: “there is nothing ambiguous about ambiguity, sexual or otherwise. Rather, ambiguity is the specific product or effect of different historical relations of power and resistance through which various cultural subjects are created and re-create themselves” (Johnson 1997, 13–14).
See Donna Haraway’s Modest_Witness@Second_Millennium. FemaleMan©_Meets_OncoMouse™ (1997); Myra Hird’s “Feminist Matters: New Materialist Considerations of Sexual Difference” (2004); Eva Hayward’s “Lessons from a Starfish” (2008).
See Joan Roughgarden’s Evolutions Rainbow: Diversity, Gender, and Sexuality in Nature and People (2004).
Roughgarden defines “sex” solely as gamete-driven (egg and sperm) reproduction.
See Judith Butler’s Bodies That Matter: On the Discursive Limits of Sex (1993) and Anne Fausto-Sterling’s Sexing the Body: Gender Politics and the Construction of Sexuality (2000).
In “Beyond the Standard Human?” (2009), Steven Epstein argues that critiques of the standard human based on white, middle-class and normatively gendered non-trans males, has led to an attempt to create a “single, more representative standard.” His work argues that biomedicine is moving toward “niche standardization—the development of multiple standard subtypes distinguished by sex, race, ethnicity, and age” (36). The result of this move is not less standardization, however, but rather a standardization that operates according to ever more articulated and refined principles.
To develop their theory, Deleuze and Guattari draw from 17th-century philosopher Spinoza’s famous dictum, “We don’t even know what a body can do,” (1955 81).
I do not intend to imply that all students perceive their bodies similarly in these training environments. During my ethnographic research I was told stories by trans-identified and gender nonconforming medical students, as well as allies, who reported feeling traumatized by their peers’ jokes about and derision of non-standard bodies—both simulated and live. The joking perpetuated an assumption that nobody in the room could be non-normatively gendered and/or embodied. Although I speculate about the motives behind these microaggressions exercised by some students, such behavior does not hold true for all people engaged in clinical training.
See Diana Fuss’s “Introduction: Human, All Too Human” (1996).
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Singer, B. The Human Simulation Lab—Dissecting Sex in the Simulator Lab: The Clinical Lacuna of Transsexed Embodiment. J Med Humanit 34, 249–254 (2013). https://doi.org/10.1007/s10912-013-9229-5
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DOI: https://doi.org/10.1007/s10912-013-9229-5