Sexual sanism permeates the ways our culture talks about and treats the “mentally ill,” “queer” people, and, more broadly, anyone who relates or reacts “inappropriately” to the world and people around them. As a discourse of oppression, it links the oppressions of queer and Mad people together, in a way that requires us to work towards our mutual liberation.
What do I mean by this? “Sexual sanism” is a label I’ve used to describe the ways in which sexuality and sanism are co-constructed in our society. In essence, an underlying assumption of the “insane” or the mentally ill is that they are, in some way, shape, or form, also sexually deviant, and this sexual deviance is a signal to their troubled minds; in turn, the sexually deviant are deemed to be “mentally ill,” with all their behavioral issues being an expression of a sexual identity thrown askew in their development. How can you tell if someone is insane? They are sexually deviant (which can mean a number of things—maybe they wear the “wrong” clothes, sleep with the “wrong” people, or don’t sleep with any people, or sleep with too many people). How can you tell if someone is sexually deviant? They have some kind of underlying mental illness condition. The dominant norm of behavior, then, determines what “normal” sexuality and “normal” neurosis is, and uses deviations from one of these norms as evidence of deviance in the other.
I came to this understanding of sexuality, sanism, and behavioral norms while doing historical research for my Master’s thesis in Sociology at the University of Alberta. Historically, “sexual sanism” was used in many ways, but its main use, by psychiatrists and psychiatrically-aligned laypersons, was to demonize and delegitimize lesbian, gay, bisexual, transgender, or otherwise “queer” people. (Technically, the definitions of a “mentally ill person” under Canadian legislation would have included anyone who related to other people “inappropriately” and reacted to other people “inappropriately,” two norms which are highly culturally-contextual but, nonetheless, made “queer” and “insane” people practically one and the same.)
The effects of this kind of logic—which was generated by psychiatric policy—meant that queer people often lost their rights despite Canada’s supposed “decriminalization” of homosexuality in the 1960s (though gender-expansive expression was still criminalized for decades after that).[1] Several stories from my archival research support this statement.
Testimonies from the Psych Wards
There were many “treatments” I found in these archives, including electroshock therapy and widespread aversion therapy in Canadian hospitals. Layperson publications included many stories and testimonies of queer peoples’ experiences in Canadian psychiatric institutions. Gemini, a newsletter for a Waterloo Gay Liberation movement (which can be found in Archives of Sexuality and Gender), asserted in 1971 that aversion therapy techniques—specifically, to condition homosexuals into heterosexuals—were widespread in Canadian psychiatric institutions, even after the general public began to condemn it.
Individual testimonies go into this in more detail. Susan White, a self-described “‘ex-crazy’ and currently unemployed therapist” in Winnipeg, wrote of her experiences in an article for The Body Politic, found in Archives of Sexuality and Gender. Her friends in the ward—both those she was treated alongside of, and those she helped to treat as a nurse years later—lost all memory of her after experiencing shock treatment. She described her own electro-convulsive therapy as feeling like “being hit with a sledgehammer.” White was also an outspoken lesbian. Her doctor, upon discovering that her questioning (but closeted) roommate was rooming with a lesbian, screamed “She’s rooming with a what?!!” and demanded the whole hall be reorganised to prevent such an arrangement. Simply talking to this woman was enough to cause conflicts with the nursing staff, with her deviant relating (lesbianism) becoming a problem for the entire ward staff to handle.
Sheila Gilhooly, an outspoken ex-mental patient activist in Vancouver in the 1970s-‘80s, frequently wrote of the ways in which ward staff attempted to “cure” her lesbianism, something she resisted through 19 shock treatments. She would only escape the psychiatric ward after pretending to be a “normal” woman. She did this by never presenting a “problem” for staff, not talking about her desire for women, and always acting cheerful, in essence, relating as a heterosexual, “sane” woman.
Even outside of the psych ward, psychiatry influenced the lives of queer/trans people in Canada to oppressive effects. Authors writing from clinical experience in the Gender Identity Clinic of the Clarke Institute, for instance, wrote that only a small minority tend to pass well as women, while “the more transvestitic males often appear very unfeminine, wearing obvious wigs and heavy pancake makeup in an attempt to cover their beard.” This kind of writing highlights the disgust and contempt psychiatrists held for their patients, even as they attempted to help them transition.
Notably, “The [Clarke Institute] tends to take a conservative view and requires a minimum period of cross-living of 1 year before commencing hormone therapy.” Patients were expected to navigate this trial-living themselves, and those who “require much support and demand assistance in. . . establishing their cross-gender role” are portrayed as emotionally immature and unstable. Any transgender woman who re/acted “inappropriately” in this way, or related inappropriately (by being improperly feminine, or by being attracted to women, or by not being attracted to men), was sorted into the category of “transvestite”—a clinical label which was used to delegitimize transgender women’s gender identities- while the transgender women who could relate and react “normally” (as defined by psychiatry, which included not having another clinical label like “schizophrenia” attached to them) would be deemed “proper transsexuals.”
One will notice that most of these stories are about women. Though I gathered no statistical information on the presence of women vs. men in psychiatric wards, what I will say is that, likely, sexism played a major role in queer and transgender women’s psychiatric oppression, which requires thorough feminist analysis. Though I was able to glean a few stories of queer men’s experiences in psychiatric wards, the majority of queer men who encountered psychiatric oppression were “sorted” into prisons and “psychiatrized” there, under “Dangerous Sexual Offender” legislation. The National Gay Rights Coalition, for instance, alleged that federal penitentiaries would refuse parole to gay prisoners who refused homosexual aversion therapy.
I outline these stories not only to discuss an historical process, however. What I hope to illustrate is that sexual sanism still permeates our discussions of queerness, Madness, or anything/anyone else who relates/reacts “inappropriately” to this day.
Back to the Present
Little has changed since the timeframe my study is based in.
In these earlier discourses, a deviant, hypersexual sexual instinct was used as “proof” of a transvestic identity which could, in turn, “prove” the trans person was inherently insane and criminal; in today’s day and age, sexualization continues to be used as a tool for delegitimizing trans women’s identities and ways-of-being. Politicians have called those who denounce the school censorship of trans-centred curriculum, as well as the outing of transgender kids to their parents, “groomers,” and their schools are grooming centres for “gender identity radicals.” Seemingly, this sexual sanist assumption has moved beyond separating trans people from each other to lumping ALL trans people into the “sexual predator” category. Julia Serano argues in her book Whipping Girl that this hypersexualization of transgender people—transwomen in particular—serves not only to delegitimize (which results in bans on hormone therapy, surgeries, or other forms of gender-affirming care), but also to demonize, to turn trans people into monsters and societal scapegoats.
This kind of discourse has clear precedent in Canadian history. Bill C-83, for instance, was labeled by gay liberation activists as “excessively punitive,” using the “gross indecency” charge to confine queer people to psychiatric treatment in prison indefinitely after one offence. When activists brought their critiques to court, Liberal legislators attacked them with the very same “grooming” language being used today. It was not until an academic stepped in and presented his research into DSO legislation and its failures that legislators even began to reconsider the bill. (Notably, he said many of the same things the activists had said, including that psychiatrists were more likely to label homosexuals as “psychologically damaged” than heterosexuals, and to use this label to support conviction decisions.)
More recently, bills have been introduced to restrict gender-affirming care for people with autism and other “mental health conditions,” mimicking the way in which schizophrenia was used to differentiate mentally ill people from “true” transsexuals. In Canada, the Million March for Children has risen in prominence to protest the inclusion of sexual orientation and gender identity (SOGI) education in school curriculums, in the name of protecting “vulnerable children” from harmful language and “crazed” agendas. Danielle Smith, the premier of Alberta, along with the United Conservative Party, has introduced bills which would forcibly out trans children to their parents should they decide they want to use different pronouns at school—a procedure which is not at all medical, and yet, still poses a threat, because the UCP has decided trans people are “insane” and sexually deviant.
Conclusion: Our Response?
There is no easy way to respond to this moment. Right-wing movements and actors continue to see both Mad and queer people as monsters, less than human. While there is no easy solution, I would argue that we can start by knowing our history and being able to name it; to see where our oppressions overlap, where they diverge, and where they parallel; and how our communities can see and support each other through it all. Angela Davis once said that “You have to develop organizing strategies so that people identify with the particular issue as their issue” (emphasis added).
Psychiatric oppression must become a queer issue; 2SLGBTQIA+ oppression must become a Mad issue; and our mutual liberation must become a shared goal. We can do this by resisting the carceral arms of psychiatry, where we can; resisting involuntary “treatment” practices (which would be levied against queer people disproportionately, as a group who relates and reacts inappropriately to cis-heteronormative norms); and honoring diverse ways of living, being, and acting in the world. It also means planning to refuse to comply with the waves of oppressive policies we are seeing across both Canada and the United States. This includes at the university level. On-the-ground activists protested Bill C-83 in Canada, but it took Professor C. Greenland of McMaster University saying what they were saying (albeit, backed by years of research into DSO legislation) for legislators to listen.
We can see that sanism and anti-queer rhetoric continue to go hand-in-hand, and our best response to this moment should come with an understanding of our shared queer/Mad history and a solidarity across lines of oppression.
[1] Gary Kinsman, a leading scholar of sexual regulation by the Canadian government, goes into more detail on how the “decriminalization” of homosexuality led to a host of “dangerous sexual offender” or “perversity” laws as a way to continue the oppression of non-heterosexual people in his book The Regulation of Desire: Queer Histories, Queer Struggles.
We need to be able to have a nuanced conversation about the medicalization of gender distress. If there is to be a union between the LGBT/queer movement and the Mad in America/anti-psychiatry movement, I think we need to be willing to acknowledge that the very thing that the anti-psychiatry movement rallies against- over-medicalization and over-prescription for individual distress- is in fact flourishing in the medical treatment of transgender individuals.
As a former therapist, I think the medical model we use to treat individuals who are suffering from gender identity related distress, or who identify as transgender, has very poignant similarities to the way psychiatry historically treated individuals suffering from extreme emotional distress or labeled ‘mentally ill’. In both cases, the person’s feelings of distress are placed as existing only INSIDE of that individual person, de-contextualizing them from the culture and environment in which they live. This is taken even further when psychiatry and the medical establishment escalates this to the medicalization of someone’s suffering or of ‘being different’, to diagnose the person with a medical condition, causing a cascade of medical interventions to begin, such as life-altering medications and surgeries with sometimes debilitating side effects.
The range of beliefs and approaches to ‘how to be transgender’ within the transgender movement itself speaks to the inconsistencies of it being a ‘medical’ issue and somewhat of an acknowledgement that this doesn’t need to be ‘medical’ at all. Many people will say that they are transgender but feel no need to engage in any medical interventions at all- no hormone pills, no surgeries. Some of this group may ‘socially transition’- adopt a different name and pronouns, and start dressing in ways associated with the opposite sex. Others, however, will say that they need the pills and surgeries and are unable to live without them. Why can’t we examine this vast discrepancy? Isn’t this the heart of the issue?
The concept of ‘gender’ is very much social, environmental, and cultural, yet the left is not willing to acknowledge that this current medical model approach to being transgender abandons the idea that someone’s gender distress may be informed by our culturally enforced oppressive norms of gender and sex. Rather, for anyone seeking help from either the psychiatric/mental health treatment/therapeutic/medical establishment, it is a problem existing in the brain/mind/body of the individual experiencing the distress, which can be treated with medical interventions. Sound familiar? This is the very approach that psychiatry uses, the one many psychiatric survivors (including myself) have found to be so harmful and negatively life-altering.
In my Mental Health Counseling graduate program to become a therapist, and in various treatment facilities I worked at after, we were taught to practice from a ‘bio-psycho-social’ model- that we had to use a unified model in treating people that keeps in mind how these various factors inform a person’s experience. To my dismay, this is not actually used. People are medicalized and medicated instead of actually understanding them and helping them. Someone’s ‘culture’ becomes a box to check about their religious or ethnic background, rather than an examination of all the external influences on their beliefs about themselves, their worth as a person, their identities.
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Thank you for saying that, how you said it. I completely agree. As a lesbian and psychiatric survivor, it always feels like this topic must be off limits. I support every trans individual’s right to access the medical interventions they want to pursue, but I am deeply skeptical of the medical and pharmaceutical industries’ co-opting of being transgender. The biomedical model of being trans has harmed people; it harms people who pursue these interventions and come to regret them and now live with permanent medical problems, and it harms trans people who have to jump through hoops. I am especially cautious of these interventions being used on children and teenagers, and of course, on mental patients.
Many trans people have a psychiatric history/record. Conversations about this topic have to be compassionate and balanced. It seems that most people entering this arena from whatever perspective or opinion are approaching it with rage, self-righteousness and fear.
It’s such a difficult and loaded conversation to have. So much of the discourse around it reminds me of the BS psychiatry and the mental health industries offer to people — one-size-fits-all and demonization if you disagree. It’s also frustrating to me personally when people critique gender-affirming care, but stop there, before pulling back the curtain on the complete horror of psychiatry’s legacy. As those of us who wind up here know, it is way more than the problems with the gender-affirming care model that’s a problem.
It’s a hard time for trans people right now. I am certain being repeatedly demonized in the press causes psychic wounding. Psychiatric survivors are not strangers to constant dehumanization. I’ve tried raising this issue with others before, but it has always gone so badly that I just drop it. I’ve had my own experience as a lesbian who I suppose is by default not “gender-conforming” of being suspected/coerced into seeing myself as a trans. It’s obviously more than gays and lesbians being targeted or coerced. The umbrella of LGBTQ is currently mostly composed of individuals who don’t experience same-sex attraction. The all are welcome approach are positives, and I’m not here to gatekeep people who want to explore their authentic self, but it’s exhausting being told being a homosexual woman is discriminatory or a type of privilege. It’s far worse than being told it’s a trend, or a fad. I think the born this way neoliberal narrative did more harm than good. Human sexuality is complex and influenced by many factors. I would have zero peace were a clear cause of homosexuality found. What happened to the simple It’s Okay to Be Gay slogan?
The contemporary LGBTQ movement resoundingly ignores the harm psychiatry caused our elders and what goes on today. It’s a corporatized, pro-psychiatry and mental health awareness movement. I want better for gays and lesbians and trans people.
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Thank you for your comment. As the author of this article, I want to be able to engage the discussions this article might provoke in a good way, so I felt the need to respond to certain points within your comment with what little expertise I can claim, as a psychiatric survivor and as someone who has studied queer/Mad history on an academic level. There will be certain topics I am simply not qualified to speak on, as someone who is ostensibly not trans and has no intention of medical transition- but in the wake of anti-trans moral panic and the long history of psychiatric abuse against people, both trans and cis, in North America, I feel compelled to reply.
I completely understand your caution around medicalization, and agree, to an extent- as someone who has had adverse, and disabling, reactions to antidepressant prescriptions and medical treatments for social distress. What I want to highlight- and correct me if I am wrong- is that when we discuss medical treatments for gender dysphoria/distress, it seems we are coming at them from the view that they are somehow different from other medical, non-psychiatric treatments. For instance: we prescribe the same estrogen/Estrodial to transgender women that we do to cisgender women on menopause, or to women with PCOS, and with both conditions it is debatable the “medical necessity” of the treatment. What is the medical issue with women growing some beard hair due to PCOS? And yet, we usually do not talk about the long-lasting effects of hormonal treatments among cis women with a wide range of hormonal conditions that the medical establishment has deemed necessary to treat (unless I am missing some major discourses). Or, on that hormone example: we have been treating cisgender children with hormone blockers since the 1950s when we deem their puberty to be “early,” or when they express intersex characteristics (which is a rabbit hole discussion concerning children’s agency and right to control their own bodies I probably should not go down in this comment).
We could also discuss surgeries. Top surgery for transgender men follows the same procedures as a mastectomy; or, even further, we treat war veterans with penile reconstruction with the same tools and procedures we do for transgender men. In all of these cases, the materials/”tools” are the same: what I am picking up from this discussion (and the wider discourse on gender-affirming care) is that we are more wary over the transgender context of those “tools.”
Now, I do not want to put words in your mouth. Perhaps you have critiques on all of these practices and are bringing it up in this context because this is the discussion which was provoked. What I hope to illustrate through all this is the reason why I come to my position which is implied in the blog, that being, a defense of access to medical transition and other gender-affirming care. I could cite recent studies which measured the regret rates of various surgeries and found that gender-affirming care has some of the lowest rates of regret among people who use them, illustrating their necessity. (And I’d be happy to provide the study I’m referencing if you’re interested!) We do have to be careful with numbers, however, because it is so very easy to manipulate statistics to meet a particular narrative. Numbers also may not be particularly helpful in this discussion.
What I hope to push back on is the idea that, because there are risks to surgery or medical treatments like HRT, they should be restricted more than they are now, as seems to be the analogous conclusion to antidepressant medication. If we take the assumption that gender-affirming care is not, materially, different from other forms of medical treatment which is prescribed on debatable “necessity” grounds, then the medical risks are no worse/better than other forms of treatment. Every surgery has risks, and regrets. I certainly have regrets on my appendectomy- it left a nasty scar which will never go away, disfiguring my body in a way I didn’t consent to. But the necessity of the surgery is out of the question. I would have died without appendectomy. I carry deep distress over my experience of surgery and medicalization, and yet, that distress is not grounds to restrict access to surgeries entirely. For a range of treatments which are “debatably” medical yet, nevertheless, have incredibly low regret rates compared to the most standard surgical procedures, why have the debate? In essence: gender-affirming care is no different than any other, everyday surgery or procedure.
Then there are comments about whether we should treat gender dysphoria and distress as a psychiatric/medical issue at all: a point I do not feel qualified to comment on. Wiser people than I have discussed this issue at-length. Trans people themselves have spent generations debating the necessity and effects of the medicalization of their lived experiences. (If you want suggestions from trans authors themselves who discuss the wide, wide range of engagements with their “transness,” inclusive of people who do not believe medical transition necessary for their identities, I suggest authors like Leslie Feinberg (ESPECIALLY Transgender Warriors- which is such a quick and fascinating read), Susan Stryker, Julia Serano, and Paul B. Preciado.) Rest assured: the debate had by trans people themselves is lively and uncensored, for the most part.
From my standpoint, I don’t believe I have the right to debate for trans people the necessity/validity of medicalization in their lives, especially when medical transition is not materially different from a range of treatments which are prescribed in both medical and non-medical contexts, for a variety of conditions, behaviors, and desires. What I do believe in is solidarity. Looking at queer history (and here I’m referencing the book Bad Gays: a Homosexual History, by Huw Lemmey and Ben Miller), queer people of all stripes have been lumped together since time immemorial, and the idea of sexuality being separated from gender identity is a more recent invention. This separation can be useful for clarifying identities and politics- but in its initial context, it was sexology and psychiatry making those divisions between people, a division which was picked up on by white, middle class “good” gays who did traditional masculinity “right” to differentiate themselves from the gender-nonconforming gays and people who we would call “transgender” today. Trans people have been part of the queer and Madness movements- and often times, LED the movements- for a very, very long time now, so when they get attacked by the media, and by moral panics which are spurred, in part, by sanism, I feel compelled to speak up.
What this comes down to, for me, is not whether we should “medicalize” transness- that becomes a philosophical question of how to define an identity and experience- but rather, a question of whether we should restrict a group of people, who have become their own, sub-cultural group, from accessing the same treatments and respect we afford most other groups of people. While many trans and queer people tend to distance themselves from the Mad movement, to the point of embracing the traditional Mental Illness model in their community organizing, the grounds on which our culture is attempting is restrict their access to care is sanist, and this has been the case for decades now. This is, I believe, an important point of solidarity and an important reason to defend the right to medical transition, even as the medical establishment has a history rife with abuse and has caused distress for many, many people, myself included.
I hope my arguments make sense and don’t come across as moral grandstanding nor dismissive/disrespectful- I just have a particular interest in medicalization, as a process, and the cultural grounds on which we debate medicalization, if that wasn’t obvious by how long-winded this comment was 🙂 I hope you are doing well and have a good day!
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Unfortunately this argument against access to gender affirming medical care is not based in reality. For context, I am transgender and have used some (but not all that are available) medical interventions to support my transition. Additionally, I have been psychiatrically labelled and spent time in various treatment settings, including inpatient psychiatric hospitals. I am part of a thriving community of trans people, some of whom have also spent some time in the psychiatric system.
I had to fight to access trans-affirming medical care. Every other trans person that I know, of any age, has also had to fight to access medical care. No one rushed us or pushed us into it. In most cases people tried very hard to push us away.
By contrast, I had to fight _against_ medicalization of my distress. When I sought help for severe distress, the only help that was offered was medical in nature. I was constantly faced with offers of more drugs, coupled with sly threats (“If you won’t take it voluntarily we’ll be forced to call the police and have them bring you to the ER”). Even when I knew exactly what I needed, it was never available if it wasn’t drugs or therapy. No one in the mental health system, at any point, ever even suggested the possibility that my struggles could be caused by anything other than my own faulty brain chemistry, or that there could be any help for them anywhere outside that system.
Whereas when I, after many years of internal struggle and wrestling with social conceptions and individual experiences of gender, listening to many other trans people’s experiences, and years of research, determined that I needed to transition and that hormone replacement therapy was likely to serve that- it took additional months of effort and advocacy to find a prescriber, then months of appointments (and written permission from a therapist) to satisfy them that I was serious, before I gained access to my first dose. My friends who’ve had gender-affirming surgeries had to push through layer after layer of barriers to access those surgeries, often taking years of concerted effort as well as written permission from therapists and psychiatrists.
The idea that anyone has a momentary experience of possible gender dysphoria and is then immediately rushed into hormones and surgery (like I was immediately rushed into antipsychotics and mood stabilizers and involuntary hospital stays) is a fantasy. It simply does not happen in real life. Please stop repeating it as if it were true.
There are two striking similarities that I see between medical supports for trans people and medical responses to emotional distress and neurodiversity. One is that in both cases we are assumed to be incapable of making decisions about our own bodies and lives and thus need permission from licensed mental health professionals, who as owners of the concept of sanity get to decide for us whether we’re in our right minds. The other is that in both cases people with no direct experience of our lives love to speak for us and over us, when we are perfectly capable of speaking for ourselves.
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What a refreshing examination of these issues! Thank you for contributing to discussion. The concepts you bring to the table definitely make sense to me. I hope you and others keep pushing forward with this framework for helping humanity understand and accept themselves and each other.
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There are people who do have marked concerns: https://x.com/LGBCourage/status/1900213621784715771?t=fVovwT9vKi1JFPcFTtRZ6A&s=19
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