The majority of content regarding the globalization of biomedicine focuses on biomedicine and its impact on foreign entities. Biomedicine, being that of a culture of medicine focused on sciences such as biology, chemistry, and so on. However, there are many people within stabilized, biomedical motherlands that are continually hurt by practices rooted in biomedicine norms and proofs. This holds true in an interview I had with Phoenix Kendall, a 21 year-old nonbinary person of color. Through Phoenix’s experiences, it is shown that the biomedical field does not foster an environment that is inclusive of gender non-conforming or transgender individuals. Even in communities that center biomedical practices like the United States, biomedicine creates a harmful culture for patient experience that can be noted through the social distance between physicians and patients, the structural iatrogenesis that exists in the gender binary, and the medicalization of gender identity as a byproduct of mental illness.
Biomedicine supports the binary, and although biomedicine may acknowledge the difference between sex and gender, it does not include practices that implement the differentiation of the two. This can be seen through the concepts of AFAB and AMAB: assigned female at birth and assigned male at birth, sex classifications that bleed into gender restrictions from birth on. Even for intersex individuals, a specific gender is chosen for them at birth and they may undergo extensive surgeries because the norm does not include an in-between or an absence of either gender (InterACT). After birth, many individuals encounter unsettling situations with practitioners because of their lack of respect or knowledge of treatment procedures for queer, transgender, and gender non-conforming patients.
In this case study, I interviewed Phoenix Kendall. They are a 21 year-old nonbinary person of color who resides in Ann Arbor, MI. Phoenix noted that since they were a child, they realized that something was not right with their gender. They did not feel like a “tomboy,” a “girly girl,” or any sort of gender associating role. Once in the 7th grade, they learned about transgender people but felt that did not quite fit them either. After intensive research studying gender theory throughout high school and college, they could confidently say that they found their identity to be best described as nonbinary.
The emotional and knowledge-based distance between practitioners, healthcare professionals, and clinic staff in regards to non-binary and transgender individuals is profound and can be seen through Phoenix’s experience. During my interview, they mentioned how healthcare workers often lack cultural sensitivity training which can lead to preventable harm. More specifically, when they were an inpatient at a psychiatric ward, Phoenix mentioned that nurses and other staff would not respect their pronouns, or even if they did, would combine their pronouns with words such as “girl.” These mannerisms, which seem small, can weigh on a person and negatively affect their mental health in that space. Additionally, Phoenix told me that, “Trans people are at a higher risk for violence and sexual assault-- especially queer, trans people of color (QTPOC). Our lives are fundamentally different. Substance use, mental illness, sex work, and rape are higher in our circumstances because we're fucking miserable, not because we were born to be like that.”
Many practitioners negatively view life choices relating to substance use and sex work and this view disregards the lived experiences that lead to these situations. This behaviorism ideology not only alienates QTPOC, but further divides the practitioner and the patient, making care inadequate and potentially harmful. Phoenix notes that many practitioners do not understand that QTPOC individuals like themselves are discriminated against in the workplace, and sex work is one of the only options many may have. Receiving shame and judgement from a provider, whether obvious or subtle, continues to make QTPOC individuals feel unwelcome and uncomfortable. Biomedically speaking, it is no surprise that practitioners and their staff exist in this divide and continue to widen it as LGBTQ+ healthcare is not a standardized practice nor does it fit in the norms that biomedicine has created over the decades (Morris, M et al.). They see these cases as exceptions and abnormalities rather than treating individuals equally.
Many nonbinary and transgender individuals are subject to structural iatrogenesis through the protocols and construction of biomedicine. Structural iatrogenesis is defined as medical harm or complication due to the structural systems in the situation (Stonington 2019). Due to biomedicine’s steadfast stance on the gender binary, Phoenix and many others have experienced harm from medical systems that did not originally intend to do harm. Things as small as not having appropriate labels on forms (not woman/F or man/M only) to gender assumptions due to biomedical training have hurt Phoenix and other transgender and non-binary individuals. A situation that Phoenix mentions that shows the harm that the biomedical structure has on nonbinary and transgender individuals is the cishetero-normative view of reproductive health. When seeking reproductive health, Phoenix noted that the physician not only misgendered them, but then made assumptions about their partner’s gender as well. Biomedicine creates a culture that prevents taking time to ask questions before making assumptions and physicians are expected to know everything before their encounter in order to work swiftly and fit in as many patients as possible in one day (Weber, D. 2019). This structure is not beneficial to any patient experience, especially for patients that do not perfectly fit the biomedical view of gender and its effect on health.
Biomedicine’s medicalization of all aspects of life harshly affects all patients, but most notably nonbinary and transgender people. This can be seen from Phoenix’s account of their experiences when seeking treatment: “I don’t disclose that I have [Borderline Personality Disorder] (BPD). I’ve had so many negative experiences disclosing that. I do not want to be told my gender is a symptom, I don’t want to hear that I’m a liar. Being a person with BPD and AFAB, it overly complicates things''. Many healthcare professionals in Phoenix’s experience will not recognize their gender identity as valid without viewing it through the medical gaze. For someone like Phoenix, who has been sure that they are nonbinary for years, it is dehumanizing to hear of the stable aspects of their identity regarded to as a symptom of mental illness. For others who may also be exploring gender identity, this treatment can be detrimental in their progress. Overall, the stereotypes and implications that mental illness has within biomedicine disproportionately impact those not following the gender binary.
Phoenix noted that small changes can go a long way toward healthcare being more inclusive of transgender and nonbinary individuals. They said, “those name tags with pronouns on them go way farther than people think” and something so simple can create a more welcoming atmosphere that can make encounters between practitioners and their staff in regards to transgender and nonbinary patients less traumatic. Additionally, intake forms with more inclusive options and asking gender-related questions ahead of time will decrease harm; this removes the situation where healthcare staff stare at patients while silently, yet obviously, thinking “what are you then?”. Even though these seem like small steps to take as individual practitioners, systematically, biomedicine would have to adapt numerous behaviors, procedures, and training, as well as implement new resources. Given the history of biomedical interventions, it is unlikely to see biomedicine shift practices on a large scale for a smaller group as biomedicine is a medical system that is for the entity and not the individual.
Through Phoenix’s overwhelmingly negative encounters with biomedicine, it is obvious that the current system does not acknowledge or respect individuals of difference. Biomedicine, when engaging with smaller groups or minorities, often tramples them and belittles their experiences in order to please the majority. This trend is seen far too often, and although practitioners and professionals within the biomedical system can personally take action to mitigate negative encounters, widespread change within the biomedical culture is needed to diminish preventable harm.
Of these changes, smaller ones made by individual practitioners can occur first. The use of name tags including pronouns, intake forms with pronoun entries, and asking patients at the beginning of the visit their preferred name are small behavioral changes that can be made. More efforts could also be made to expand and standardize LGBTQ+ inclusive health curriculum to those studying healthcare. Finally, widespread action on laws that protect and empower LGBTQ+ individuals can begin to change the healthcare disparities faced by this population.
Works Cited
InterACT: Advocates for Intersex Youth. “I Want to be How Nature Made Me”. Human Rights Watch. 25 July 2017.
Kendall, Phoenix. Personal interview. 3 December 2020.
Morris, Matthew, et al. “Training to reduce LGBTQ-related bias among medical, nursing, and dental students and providers: a systematic review”. BMC Medical Education. 30 August 2019.
Stonginton, Scott. “Structural Iatrogenesis — A 43-Year-Old Man with “Opioid Misuse””. The
New England Journal of Medicine. 21 February 2019.
Weber, David. “How Many Patients Can a Primary Care Physician Treat?”. American
Asscociation for Physician Leadership. 11 February 2019.