in case you’re interested.
Note: these essays had a word limit so I couldn’t go in-depth the way that these subjects really require.
Essay One — applying Foucault’s theories to lesbian health issues and suggestions for therapeutic work on that issue
By dint of being a woman, a lesbian is in a position of lesser privilege, compounded further by her status as a sexual minority, and possibly even more so if the lesbian in question is a woman of color. In their study of attempted suicide among transgender individuals, Clements-Nolle, Marx and Katz (2006) cite previous research that shows “lesbian, gay, and bisexual (LGB) individuals are more likely to attempt suicide than their heterosexual counterparts (Cochran & Mays, 2000; Faulkner & Cranston, 1998; Garofalo, Wolf, Wissow, Woods & Goodman, 1999; Remafedi, French, Story, Resnick, & Blum, 1998),” positing that “discrimination and victimization are related to several measures of psychological distress, such as anxiety and depression… that in turn may increase one’s risk of attempting suicide.” Working with a lesbian client necessitates addressing that some issues may arise from societal discrimination rather than individual psychology. Foucault’s analysis of the systems of power that are built up around sexuality may aid the therapist, or the client themselves, in better understanding the power differentials that exist in life as a lesbian.
Foucault’s very first point when discussing these systems of power is the “hysterization of women’s bodies” (1978). With the growth of medicine and psychology, the female body was analyzed, deemed pathologically sexual and remanded to the medical realm. In the case of lesbians, they were also subject to the “psychiatrization of perverse pleasure” which “assigned a role of normalization or pathologization with respect to all behavior…” (Foucault, 1978). The view of lesbians as pathological is a deeply embedded one. Karl Ulrich’s outdatedly fanciful theory of “spiritual inversion” (Valentine, 2007) has its modern counterparts, evinced in the search for a “gay gene” or any concrete, medical explanation for sexual orientation. Several studies suggest that women with congenital adrenal hyperplasia (CAH) exhibit a higher rate of lesbianism and “gender nonconformity” as children, (Ehrhardt, Evers, & Money, 1968; Berenbaum & Hines, 1992; Ehrhardt & Baker, 1974; as cited in Bailey, 1995) presumably due to their “masculinized” physiology and neurochemistry. By turning a woman’s body into a medical subject, the woman’s individual agency is taken away. The body of a lesbian is a further oddity and her identity is not authentic until it has been validated by a medically discernible factor.
This contentious relationship with the medical establishment may lead some lesbians to avoid contact with medical practitioners, even to the point of serious ailments going undiagnosed and untreated. Stein and Bonuck (2001; as cited in Harcourt, 2006) reported that, in a study of gays and lesbians in New York, 17% reported avoiding or delaying a medical visit for fear of their sexual orientation leading to discrimination. In the area of lesbian medical health, a therapist may work with their client on being more assertive with their doctor. This could mean asking the doctor about their knowledge of LGBTQ issues and requesting a referral to one that is more knowledgeable, if need be, or even simply gathering the courage to make a doctor’s appointment in the first place.
Anxiety and depression generated by societal discrimination may be more difficult to address because it is initially perpetrated by an outside source but may become lodged in the mind. It is the role of the therapist to help their client dismantle the negative beliefs about their own sexuality that they may have internalized. While eradicating internalized homophobia may not stop homophobia in others, being freed from unwarranted self-loathing can be quite powerful and, clearly, more psychologically healthy.
Essay Two — applying Foucault’s theories to trans* people and suggestions for therapy
Transgender individuals exist in a nebulous area of society, the groups included under this umbrella-term fluctuate, depending on just who is using the term. The position of trans* people in Foucauldian power structures is difficult to discern. Certainly, they are as entrenched in this power structure as anyone is, but their positions may shift as their identities. In fact, Valentine (2007) cites Stryker’s (1998) statement that identifying as transgender is “a way of wresting control… from medical and mental health professionals to replace… pathology with… self-determination…” exemplifying Foucault’s statement that “where there is power, there is resistance” (1978). But this power struggle is quickly reframed with Foucault’s principle of “the psychiatrization of perverse pleasure.” While a trans* person may view their transgender identity as a strike against a society that is heterosexist and cissexist, medical and psychiatric authorities are the ultimate gatekeepers to the tools for a trans* person to affect their transition.
A key component to the removal of homosexuality from the DSM was the assertion that there was no difference between a “normal” homosexual and a “normal” heterosexual, as shown in Evelyn Hooker’s groundbreaking 1957 study (Kimmel & Garnets, 2003). Essentially “a claim to invisibility,” (Valentine, 2007) this approval of heteronormative same-gender desire was followed by the creation of Gender Identity Disorder, the diagnosis for those whose transgressions were not invisible. In allying themselves with heterosexuals, in becoming people that did not need a “cure,” homosexuals delineated themselves from transgender people, creating a new hierarchy. A trans* person’s access to hormones and surgery is predicated on a diagnosis of Gender Identity Disorder and “medical providers must be certain that the person who is being treated with cross-sex hormones or who is receiving genital surgery is actually transsexual” (Lev, 2007) which has led to trans* individuals whose identity lies entirely outside of a binary gender system to “lie and create false narratives so that they could be approved for treatments” (Lev, 2007). While there is an emerging view that the current rigid classifications do not fully represent the plethora of gender identities and expressions and instead “encourage educated consent and advocacy instead of expert approval” (Lev, 2007), it is telling of the power wielded by the medical establishment that they must be the ones to come to this conclusion in order for nonbinary trans* people’s identities to be seen as valid.
Working with a transgender client may be trying, in that many of the difficulties they face are “socially structured and sanctioned phenomenon… intended to maintain privileges for members of dominant groups at the cost of deprivation for others” (Krieger, 2000; as cited in Harcourt, 2006). While a therapist may wish they could change society to fit the client, rather than advise the client on how to cope with a society that rejects them, such actions aren’t feasible. As important as it is to facilitate the client’s identity formation on a personal level, it is also important to help them with their identity within society at large. Hormone treatment, surgery, or even different clothing can change the way that an individual is perceived. A female-to-male trans* person may find that, because they can be “read” as masculine, they now have access to the socioeconomic advantages bequeathed to men. Conversely, a male-to-female trans* person may experience increased disadvantages because of their female identity, or discrimination through the invalidation of that female identity. In these instances, the therapist may best serve their client by helping to deconstruct the assumptions built around their new role, and it is imperative that the therapist remain objective and lead the client to their own identity, without pushing for a more restrictive or a more fluid identity.
