I come to Gill-Peterson’s timely piece of trans scholarship as a teacher of medical humanities and disability studies. Histories of the Transgender Child makes a powerful case for how a trans bioethics needs to be historicized in order to do its urgent reparative work. As Gill-Peterson underscores in the book’s conclusion, one of the crucial ways we might reimagine pediatric medicine is surprisingly and frustratingly obvious. We need, more than ever, a trans-centered healthcare that
would revolve around actually listening to what trans children say about themselves, grounding medical care in their desires, and abandoning binary models of transition and dysphoria that continue to confine children to developmental teleologies ending in heterosexual masculinity or femininity.
Gill-Peterson attends to the lived experience of trans and intersex children who so often have to navigate a deeply homophobic and ableist medical-industrial complex. These accounts compose a rich archive of understudied, untold trans stories that preexist the medical discourses of transsexuality and the trans clinical narratives as we think we understand them now. Gill-Peterson’s work models the best of what the V21 Collective has called “strategic presentism,” which one of its organizers, Anna Kornbluh, describes as an “active listening to the past” that can inform new ways of imagining more just futures. Histories of the Transgender Child models how such listening can disrupt received narratives of trans pasts that have long been taken for granted at the expense of trans youth and specifically trans youth of color.
In so many ways, I wish I had had Histories of the Transgender Child when I was co-teaching a course on the science of sex and sexuality with my mentor, Lance Wahlert, at the University of Pennsylvania. Undergraduates interested in gender and sexuality studies as well as STEM majors enrolled in the class. We examined many of the same documents, particularly the work of twentieth-century sexologists like John Money, work that Gill-Peterson so deftly unpacks in her accessible, clear historical narrative. Like Gill-Peterson, we wanted to remind our students, or in some cases expose them to the fact, that trans people, children included, existed well before etiological narratives and conceits of newness became attached to them. As I have come to realize, few STEM majors get exposed to the histories of the fields and professions they aspire to join. My students, the pre-meds in particular, were shocked and appalled at the undue forms of scrutiny to which trans people were and continue to be subjected to in order to transition. They were also shocked by the violent surgeries done to intersex bodies without their consent purely on the basis of maintaining binary sex. Underpinning all of this, Gill-Peterson reveals, is a set of pernicious misunderstandings of trans life produced and perpetuated by medicine and media: that transness and trans childhood are novelties and that trans childhood is pathological because it deviates from teleological narratives of normative development that move from plasticity to the gender binary. Gill-Peterson’s reading of trans experience in the archive exposes these notions as not only ahistorical but also central to how medicine continues to affirm its “self-appointed authority and self-referential rationality.” In her account, Gill-Peterson demonstrates how trans people were always already actively involved in the process of making knowledge about themselves even despite those clinical professionals who would frame them as passive objects of that knowledge. Decentering the primacy of transsexuality as a medicalized discourse exposes the extent to which the situated knowledges of trans people have been dismissed and erased.
The history of transsexuality is also a history of a biopolitical apparatus advanced by biomedicine’s own shifting theories of the body. As Gill-Peterson argues most forcefully, trans pediatrics is
Only one example of how all Western biomedicine continues to be eugenicist in practice, hoarding resources, stratifying quality of care, and normalizing the individual and population through highly granular, racialized concepts of health that actively rely on a differential calculus of exhaustion, illness, and death for entire groups of people deemed undeserving.
Gill-Peterson’s calling out of Western biomedicine’s ongoing eugenic practices resonates with new work in disability studies. In “The Case for Conserving Disability,” Rosemarie Garland-Thomson advocates for what she terms “disability conservation,” or a bioethical revaluation of disability as an ethical, narrative, and epistemological resource worthy of life. This paradigm shift away from understanding disability as human lack, Garland-Thomson argues, disrupts the eugenic philosophies and practices framed by medical practitioners and entrepreneurs as social betterment and improvement. Such biotechnologies like CRISPR and genetic testing are really in service of what Anna Mollow aptly describes as “rehabilitative futurism:” a future entirely sanitized of disability. What would it mean to “conserve” transness as a category of identity and embodiment worthy of life? How might we theorize the unique resources that transness provides?
While trans people should never be expected to justify their existences, I find Garland-Thomson’s framework of “conservation” valuable for reimagining both trans and disabled life against dangerously reductive eugenic thinking. As opposed to a suspicion of trans life as a phenomenological oddity or anomaly that merits correction or elimination, a conservation framework understands trans childhood as valuable in and of itself, an already “happy and desired form—not a new form of life and experience but, rather, one that is richly, beautifully historical and multiple,” as Gill-Peterson puts it. To conserve these trans lives in their multiplicity means recognizing them as worthy of protection in their vulnerable processes of becoming.
I also wonder about how the intersections between trans and disabled people both in history as well as in lived experiences might better enable forms of solidarity between both groups, especially given how many trans people also identify as disabled and vice versa. I am greatly influenced by trans and disabled activists like Eli Clare who have advocated for trans-crip approaches to the archive and narratives of cure, as well as by disability scholars like Robert McRuer and Jason Farr who link queerness and disability in their crip theoretical method. Queerness entails a resistance to norms of gender and sexuality (what Adrienne Rich has famously termed “compulsory heterosexuality”), and so, too, does disability resist cultural imperatives to be and remain able-bodied (what Robert McRuer has similarly called “compulsory able-bodiedness”). What shores up both of these “compulsory” ideologies is medicalization and, consequently, stigma. The medical model figures trans and intersex people precisely as bodies to be fixed while simultaneously requiring both to claim medical diagnosis in order to access resources and services. This double-bind, as Ashley Mog and Amanda Lock Swarr describe in their “Threads of Commonality in Transgender and Disability Studies,” characterizes an “organic relationship” between these groups.
To be clear, I do not mean to suggest that trans and disability experiences are interchangeable or should be conflated; rather, their overlaps, particularly in their interlocking histories of medicalization stigma, offer us a way of thinking critically about how disability or, to use Jasbir Puar’s preferred term, “debility” is foundational to the “differential calculus” that Gill-Peterson so rightly identifies as integral to the management of marginalized populations. Central to disability activism has been a move from the medical model of disability to the social model. Instead of framing disability as human lack or individual pathology, the social model emphasizes how environments, institutions, and cultures disable people. A social model approach to both disability and transness offers a way to depathologize disabled and trans individuals by challenging the medical establishment to consider how their practices and spaces exclude certain bodies and minds. Gill-Peterson ultimately extends the social model’s critique of medicalization toward more radical ends: that developmental etiologies and curative paradigms should not mediate the social life of gender and sexuality at all. Instead, clinicians and medical researchers should abandon conceits of panic and emergency in favor of “actually asking trans children what they want and truly basing care on that knowledge.” This necessitates a reformation of pediatric healthcare. Trans children must be empowered agents in their medical encounters.
In light of Gill-Peterson’s focus on the fantasies surrounding trans childhood, I want to conclude with a reflection on figuration and its particular form of cultural work. I arrive at Gill-Peterson’s book as a scholar invested in the history of childhood, particularly as it connects to the history of anti-vaccination and its contemporary mutations. The anti-autistic bent of recent anti-vaccination rhetoric is actually a redeployment of centuries-old propaganda that attempted to frame vaccination as a medical practice that deliberately infected and corrupted those it purported to protect. According to late eighteenth-century anti-vaccination activists, if vaccination used cowpox fluid to produce smallpox immunity, it risked blurring the species line between man and animal, resulting in debilitating diseases like “cow mania.” By the mid-nineteenth century, anti-vaccination propagandists repeatedly decried what they argued was the state’s authorization of physicians to harm children under the guise of preventative medicine. From the pro-vaccination perspective, children represented a population of extreme vulnerability and thus specific targets for public health initiatives like compulsory vaccination. Both sides of the vaccination debates mobilized the figure of the child as representative of a healthy nation and its healthy future. The “strangely living figure” of the child in these histories and the trans histories that Gill-Peterson excavates underscores the extent to which children have been at the center of Western cultural anxieties about medicine’s authority and its relationship to the state.
I find Gill-Peterson’s assessment of how the figure of the child comes “to serve as a metaphorical representation of other concepts, often ones that are too inhuman to stand on their own,” particularly useful for considering how scholars in the humanities intervene in these larger debates by interrogating the foundational metaphors that animate medicine and science. By revealing medicine’s ongoing dependency on unruly figures like the child, humanists challenge the presumed objectivity and authority of biomedicine that so often disavows this reliance on metaphor. Contrary to Susan Sontag’s infamous polemic against metaphor, I ultimately agree with Gill-Peterson that “rather than opposing metaphors entirely, the task is to imagine different ones that would reshape the practice of science and the production of biological knowledge from the situated perspective of the long-presumed passive object.” The only way to begin this much-needed reimagining, she rightly suggests, is by carefully listening to the past and the present, if only to discover who we have failed to listen to all along.
Travis Chi Wing Lau received his PhD in English at the University of Pennsylvania and is a postdoctoral teaching fellow at the University of Texas at Austin. He specializes in eighteenth- and nineteenth-century British literature, the history of medicine, medical humanities, and disability studies.