This year, Trinity College revealed its Gender Identity and Expression Policy, the first of its kind in Ireland. The policy recognises College’s “commitment to recognise and support an individual’s gender identity and gender expression so that all members of the College community experience a positive and tolerant environment where every member is treated with dignity and respect.”
The document’s opening statements include several definitions key to the understanding of the policy. The policy defines the term “intersex” thusly: “An umbrella term used for a variety of conditions in which a person is born with a reproductive or sexual anatomy that does not fit the typical definitions of female or male. Although intersex individuals do not always identify as transgender or do not consider themselves covered by the trans* umbrella; where this policy uses the term trans* it equally applies to intersex individuals.”
The policy was designed for the strict purpose of guaranteeing the right to self-express one’s identity, so to then lump one identity in with another on the first page for the sake of handiness seems surreal.
“If a policy is going to refer to intersex as trans* then why not revert to referring to everyone as “mankind” or to using “he” as the go to pronoun? Though the policy is forward-looking in its commitment to the trans* community, the gross oversight of intersexuality is in keeping with the prejudices of today.”
Intersex and trans* are not interchangeable terms, though they are not always mutually exclusive. They do not experience the same gender realities. They do not identify or express in the same way. It seems absurdly self-defeating for the policy to claim to seek to champion the individual’s right to self-identify and at the same time to deny the reality of intersexuality.
The document claims that “consultation was carried out with a range of administrative and student service areas, human resources, staff and student representatives and the Equality Committee in drawing up this policy.” However, Stephen Hatton, a former Students’ Union LGBT Rights Officer and a member of the working group who oversaw the drawing up of the policy, has said that when it came to intersex, it was largely assumed that the trans* consensus spoke for both.
If a policy is going to refer to intersex as trans* then why not revert to referring to everyone as “mankind” or to using “he” as the go to pronoun? Though the policy is forward-looking in its commitment to the trans* community, the gross oversight of intersexuality is in keeping with the prejudices of today.
Intersexuality undermines the accepted binary of sex in a way that trans* does not. Trans* still operates within the societal construct of sex as a binary. Intersexuality is the physical reality that destabilises the binary sexual power structure on which so much oppression is founded. It is no surprise then that it is the last “gender issue” to be faced. (Even assigning it as a “gender” rather than a “sex” issue is telling.)
The “I” of intersexuality is often forgotten from the acronym of LGBTQI and intersex people often find themselves on the fringes of the queer community. When solidarity is not forthcoming from within the community it is little surprise then to see intersexuality excluded from a document like Trinity’s Gender Expression and Identity Policy.
The policy is forward-looking, despite the gross exclusion of intersexuality. However, it is also inward-looking. Trinity, in many respects, is a bubble and the Gender Identity and Expression Policy, though a positive step, has further widened the gap between what goes on within the walls and the world outside.
The policy recognises that it is limited by the national situation. It states that “Ireland currently has no Gender Recognition legislation. This policy reflects the College’s commitment to meet its obligations under these Acts [Employment Equality Acts 1998-2011 and Equal Status Acts 2000-2012] and foreseeable future legislative initiatives in the area of Gender Recognition.”
Though in this instance Trinity has distanced itself from the national norm by progressing, in other ways it perpetuates both the bubble and the outside world’s reactionism by having one policy for life within the university and another for its dealings with the world outside of College. This can be seen in the ideological discrepancies between the Identity and Expression Policy and certain curriculums in College, particularly that of the School of Medicine.
School of Medicine
Stephen Hatton, a student of the School of Medicine, has attempted to enact change in the School’s curriculum, finding it outdated in terms of its acknowledgement of the queer community. As a second year class rep, he was invited to the School of Medicine undergraduate student curriculum committee, which looked at the curriculum and student progress.
Hatton emailed the committee with a presentation on LGBTQI education in the medicine curriculum and asked if it could be added to the agenda but he was told the deadline for submitting items had closed. This was two weeks before the meeting and no closing date had been outlined in the email. However Hatton pursued the issue:
“At the meeting I brought it up in Any Other Business and took out my laptop and put up the slide. And I was told no this is inappropriate. I said I think you underestimate the significance of the issue, may I proceed? And then the Director of Undergraduate Teaching told me that she would discuss it with me personally, right then, but that the meeting had to end. So all the teaching staff and other class reps that had been there were thanked and left. So I did the presentation and said in the preclinical years you don’t even explain what the LGBT acronym means, let alone teach us anything of any relevance to someone who is sick and may be a member of the community. This needs to change. And she said ok well we don’t want you to define a patient by any labels. You have to treat the patient holistically. And I said that’s how the teaching is going but with this overtone of them being a heterosexual cisgender patient. That’s the patient we’re taught to think of holistically. We really need the School to recognise that one in ten patients will be from the queer community. Can you even tell us that fact, just to make us conscious of it?”
Reluctance to change
Hatton has found that the curriculum is based on an assumed heteronormativity. In a class on pelvic anatomy, a lecturer showed a live MRI of a man and a woman having sex. Hatton says that though heterosexual intercourse is deemed acceptable to show to a class, if the same thing were to be shown with two women or two men having sex, it would be deemed inappropriate.
Queer representation is something that is found to be severely lacking in the curriculum. In another instance, following a lecture on breast cancer, Hatton asked if the lecturer could include a line on the prevalence of breast cancer among lesbians, based on a study conducted in the UK. The lecture had included the information that nuns are more at risk of breast cancer, due to not having children or breastfeeding, but refused to include the same information for lesbians.
Another example saw the students being taught the modifiable and non-modifiable factors for a stroke. The lecturer included gender as a non-modifiable factor. When Hatton raised the issue that gender was indeed a modifiable factor and that sex, in terms of DNA, was a more appropriate term, the lecturer again refused to change it.
“I told him that it’s a very small change”, says Hatton, “no one would even notice, but it would make me and trans* people or people who modify their gender very happy that you’re recognising this. And he said ‘This is a scientific talk. If I was giving the talk to a group of trans* people then I would change it.’ So I said to him so no one in this room is trans*? Because they’re scientists they can’t be trans*?”
In a clinical lecture, an MCQ was put to the class in which a 56 year old male was suffering from abdominal pain. Several options were given, including ovarian torsion. However, this diagnosis was treated as a “joke answer”, the idea being that, as a man, he could never have ovaries.
In certain instances of intersexuality, men can indeed have ovaries. Hatton raised this issue with the lecturer and found that there was a serious lack of understanding of trans* and intersexuality: “She was a really well-educated surgeon but she asked me is it transgender before they have an operation, and transsexual afterwards?”
There have also been examples of homophobic language by teaching staff. Hatton has heard of an instance wherein a surgeon referred to a patient as “one of those” to a student, implying that the patient was gay: “The student asked him what he meant by that? He repeated ‘one of those fellas’ and again she told him that she didn’t know what he meant until he left it.”
It would appear pointless to roll out a Gender Expression and Identity Policy if it doesn’t extend to the actual teaching of students. The policy is essentially a social document, applicable to “college life” rather than academic study. As students in the Trinity bubble then, we have to be conscientious. But the information we consume for use outside of College is not subject to being updated.
Hatton believes that the root of the problem is a lack of knowledge among lecturers: “When the lecturers who are teaching us were being educated there was no engagement in the field of medicine with marginalised groups. And then there was a big push within the field of medicine to recognise people with cultural differences.
So we’re very well educated when it comes to dealing with a different culture or religion or ethnicity. The School of Medicine has taught us well about these. We’ve had multiple presentations that we’ve had to do on diversity and patient populations but that same progress hasn’t been across all groups. The Traveller community is affected by very specific issues in health care and they don’t receive the same focus. And queer people receive even less.”
In his interactions with the School and his attempts at change, Hatton has come up against a refusal to engage with queer issues which is partly out of a fear of insulting queer people, a fear which ultimately stems from ignorance. There is a reluctance to teach treating patients along the lines of queer or trans* as lecturers have said they don’t want students “labelling” patients.
Hatton has likened the need for positive engagement with queer patients to that of treating pregnant patients: “The Director of Undergraduate Teaching said that she didn’t want to pathologise LGBT people. That it’s not an illness, we don’t want to be offensive. But if we were talking about pregnancy and supporting a pregnant woman in hospital, no one would say anything about her being ‘sick’. She has a condition that needs medical support to be well. Why can’t we adopt this sort of paradigm for marginalised groups, including queer people?”
The School of Nursing has, by comparison, a much more engaged approach in terms of the treatment of LGBTQI patients. In first year, students have a module on marginalised groups and one of the options is on LGBTQI people in healthcare. There’s also a lecture on caring for someone who is trans*.
When Hatton brought this point to the School of Medicine, the reaction was that in first and second year, students wouldn’t know anything about surgery or hormone therapy and therefore how could they learn about treating trans* patients. This however, Hatton explains, is not the point:
“I’m talking about educating people so they know what trans* is and so they know not to say ‘this man was born male but is now a woman’, so they know not to say things like that. If you just educate them on the simple basics it’s a great platform.”
Hatton says there has been some progress with outside speakers coming in to the School: “As part of a weeklong module called Psychiatry and Psychology Applied to Medicine, a speaker from the Gay and Lesbian Equality Network (GLEN) came and gave a whole lecture on LGBTQI mental health. This had never been in the curriculum before. He was quite the authority who taught us very appropriately and it was a very enlightening talk for everyone. And it was something I commended the School on and said that it was very useful and could it be a protected part of this module?”
Though the Gender Expression and Identity Policy is a move in the right direction and is something that would never have seemed feasible even five years ago, it is perhaps most useful as a tool for gauging the prejudices that remain. Intersexuality is still a hurdle that needs to be, first of all acknowledged, and then brought into the public consciousness in the way that homosexuality and transsexualism have been.
The glaring shortcomings of the education College is providing its trainee doctors in the area of treating queer patients is a reflection of both the prejudices that still hold sway in society and the discrepancies between the rarefied world of “College life” and the “real world”. it would appear that there needs to be a culture change, or indeed a cultural overhaul, in how medicine is taught in Trinity.
If College is really concerned with gender expression and identity it should extend this to the knowledge it imparts onto students, and not just to a proposed scheme (that is itself full of short-comings) as to how to behave towards each other outside of class.
Illustration: Nadia Bertaud