Dr. Alice D. Dreger, from the Department of Humanities and Bioethics at the Feinberg School of Medicine at Northwestern University, spoke at Hamilton on September 11 and 12.
Dr. Dreger's lecture on Monday was titled "The Role of Doctors in the Future of Normal" and focused on the medical community's ideas about and treatment of individuals born with "socially-challenging bodies." Dreger's research has focused on such conditions as intersex, conjoined twins and cleft lip.
Dreger began her seminar with three questions. First, she asked, "What does your body have to do with who you are?" Dreger said that the meaning of body types and body parts "changes with time and place;" for example, what it means to be female changes with what country the person is in. The second question was "Are anatomical differences a legitimate basis for differences in social and political differences?" While many people argue for same-sex marriage, said Dreger, many of the same people would not believe that a five-year-old should be allowed to be married, and the difference in these situations are essentially anatomical. The third and final questions asked, "What are the roles of medicine and science in mediating anatomically-based politics?" Frequently, said Dreger, "Doctors and scientists are not considered important players [in politics]."
Dreger's interest in "socially-challenging bodies" began with studying intersex people. Intersex people are born with genitalia that seems to be partly male and partly female. Traditionally throughout history, at birth doctors would decide to make the child either a boy or, most commonly, a girl via reconstructive surgery and the child would be raised as such and never told about their condition at birth. The general notion, explained Dreger, is that our social system is oppressive and doctors and parents are only trying to help a stigmatized child fit in. There is a belief among physicians that "you can't change society." Dreger cited such historical instances as the Civil War and the Women's Suffrage Movement when she said, "Yes, you can change society." "These doctors are part of the system that is validating these norms," said Dreger.
Dreger expanded her research to try to understand whether this anxiety in society about "abnormal" conditions is about sex or abnormality. She compared the testimonies of intersex, or those born intersex and now living as women, people with conjoined twins. She found that the most common response of the individuals was that "they described themselves as different, but normal for them." In general, people believe that the body they are born into is the body they are meant to have. In fact, it was not until 2004 that the first pair of conjoined twins decided for themselves to be separated (both died during the surgery). However, most parents and doctors choose to separate conjoined twins, even at the high risk of one or both dying during the surgery or afterwards. Why, then, does the medical literature and society lead us to believe that no one would want to live like this?"
Dreger drew several parallels between intersex conditions and conjoined twinning. "There is an assumption that this is a horrible state," she said of both conditions. However, medical literature ignores the history of successful lives without surgery. There is a belief within our society that medicine should "liberate" these children, whatever the costs or risks, said Dreger. Perhaps most importantly, the medical literature treats these cases as "obvious medical cases." According to Dreger, this is not always the case.
Dreger cited several hopes and goals for the future. First, she hopes to see the medical system think about these conditions as psycho-social and not necessarily medical. Most people born with these conditions would live, and many have a better chance of surviving without surgery. Many intersex people resent that they were "turned in to" a female when perhaps they feel more "male." Dreger fears that medicine is increasingly becoming social and cited the example of treatments such as botox, which is cosmetic and based on society's ideas that wrinkles are unattractive. "There is a notion that an appropriate use of healthcare is social normalization," said Dreger. "This is really problematic."
It has been said that "The problem of the 20th century is the problem of the color line." Dreger argues that the problem of the 20th century is the problem of the "anatomy/identity line." Returning to the three questions she posed at the beginning of the seminar, "These questions are actually getting harder to answer," said Dreger. For example, science is now showing that many anatomical categories are not discrete, such as the line between genders. Medicine is "liberating," she said, "by bringing these people into line within these 'categories'" that do not necessarily exist exclusively.
Dreger closed by encouraging people going into medicine to ask these questions. "Change the system to be more just, don't change the people to fit the system," she said.
Dreger's Tuesday lecture was titled "Something is actually happening: should academics do something about it?" and discussed being an activist within academia. Usually, she said, people think of academia as "pure scholarship." Academics usually respond to social injustice by talking and writing about it rather than doing something about it. Dreger used herself as an example. She did her Ph.D. dissertation work on intersex people and tended to think about it in terms of people in the 19th century.
When intersex people approached her for help she was hesitant. It was not until she read modern medical textbooks that actually recommended surgery for children who had physical traits that doctors thought predisposed them to becoming gay or lesbian. Modern medicine also suggested lying to females with androgen insensitivity syndrome, meaning they had a Y chromosome but were not sensitive to hormones that would make them look physically male. "There should be science backing up what they were doing," said Dreger. It was experiences like these that led her to become an activist in her field.
Physicians' responses to Dreger's claims included defenses like the parents were too stressed out about their child's condition and it would be better for the patients socially. Dreger began to and is still trying to get physicians to think more clearly about ethics and look at these cases as psycho-social and not medical. She used an example of a woman who had given birth to stillborn conjoined twins and was never allowed to see them or hold them before they were taken away because the doctor believed it would be harder for her to look at them. Dreger helped this woman o understand what her twins had looked like and try to find medical records or pictures the hospital may have taken at the time of the delivery, 30 years before. It was not until the mother was able to picture her children as they probably looked that she was able to begin grieving, 30 years after her pregnancy.
"Many academic don't think of this as something you talk about in academia," said Dreger. There is a stereotype of academics as "cloistered" and tucked away in stone buildings with ivory growing up the side. "It is not a coincidence we have that notion," she said, because universities grew out of monasteries. There is a general notion that "The mind is pure and the body is impure," and academics tend to value the mind over the body. The conflict, said Dreger, is that "activism is necessarily of the body." Academics often want their teaching to be free of anything else. She argues that there are moral lessons in every class; for example, in chemistry, the professor is teaching his or her students a lesson about "what matters in the world." When Dreger teaches, she tries to "think about the lessons in what was embedded" in whatever it is she is teaching.
Dreger then posed the question, "Why do activism within academia?" First, tenured professors have a lot of privilege. "They have an extraordinary opportunity to do dangerous things while you are safe…they have a certain safety very few other people in our community have," said Dreger. Her second reason was that when "we get out of the ivory tower, we help people outside academia understand the value of scholarship." Dreger encouraged going out into the community and helping in areas where your expertise was needed.
Dreger also argued that academics should use activism as a way to reduce human suffering. "At the end of the day, the problem I am writing about is not a philosophical issue for the people living it," she said. If professors want their students to be actively engaged in the world, "we have to show them," argued Dreger.
-- by Laura Trubiano '07
