Hello, I’m Shelley Tremain and I’d like to welcome you to the thirty-ninth installment of Dialogues on Disability, the series of interviews that I’m conducting with disabled philosophers and post here on the third Wednesday of each month. The series is designed to provide a public venue for discussion with disabled philosophers about a range of topics, including their philosophical work on disability; the place of philosophy of disability vis-à-vis the discipline and profession; their experiences of institutional discrimination and personal prejudice in philosophy, in particular, and in academia, more generally; resistance to ableism, racism, sexism, and other apparatuses of power; accessibility; and anti-oppressive pedagogy.
I acknowledge that the land on which I sit to conduct these interviews is the traditional territory of the Haudensaunee and Anishnaabeg, covered by the Upper Canada Treaties and directly adjacent to Haldiman Treaty territory. I offer these interviews with respect and in the spirit of reconciliation.
My guest today is Catherine Clune-Taylor. Catherine (Cato) is a postdoctoral research associate in the Program in Gender and Sexuality Studies at Princeton University, who holds a Ph.D. in Philosophy from the University of Alberta and a B.A. of Medical Science in Immunology and Microbiology from Western University. Catherine’s doctoral project was a critical analysis of the science, ethics, and biopolitics underwriting medical efforts that aim to secure a cisgender future for a minor, the medical management of intersex conditions in children, and the treatment with so-called conversion therapies of trans kids. Cato is currently the Vice-President of CSWIP.
Welcome to Dialogues on Disability, Catherine! You have various areas of expertise because you have a varied educational background. You began your academic career in the medical sciences. What motivated you to continue your education in philosophy? And how have your backgrounds in both medical science and philosophy complemented and complicated each other?
Hi Shelley! Thank you so much for inviting me. It’s an honour to be included in this important series. As you know, I’ve been a fan of your work for quite some time.
I do have a pretty varied and, in some ways, atypical background for a philosopher. I was born in Toronto, Canada, to a white Canadian mother of Irish Catholic and French-Canadian descent and a Bahamian immigrant father. I aspired to become a doctor from a pretty young age—maybe four or five—it’s what I remember always wanting to do. My parents really supported and positively reinforced that plan.
For the child of an immigrant from a working-class/lower-middle class family, that was a very legible pathway towards class mobility. I took all the maths and sciences in high school and got a full-time summer job while I was still in high school doing administrative work in a busy family medical practice in Toronto. I was fifteen with my eye towards my eventual medical school applications, filing test results, making referrals, booking appointments, triaging patients over the phone. Things like that. I even went back to Toronto to work at the practice for the first couple of summers that I was an undergrad at Western.
I started my first undergraduate degree at Western, with the plan of pursuing my M.D. as soon as I was done or doing a M.Sc. in microbiology before going on to medical school. I start to stumble—and I mean, really stumble—off this path when I took Philosophy of Gender and Sexuality with Helen Fielding as an elective during the second year of my B.M.Sc. I took the course because it fit into my lab schedule and satisfied my essay requirement for that term. It also sounded personally interesting. I was already out as queer, active in LGBTQ organizing on campus, and identified as a feminist, albeit a rather naïve one. The very first topic that we looked at in the course was the medical management of intersex conditions, reading work by Anne Fausto-Sterling, Suzanne Kessler, Robert Crouch, and Michel Foucault. The reading had a huge impact on me.
Like the rest of my classmates, I was horrified by the heteronormativity of the treatment model; by the lack of evidence supporting it; by the blatantly unethical performance of medically unnecessary genital-normalizing surgeries on those unable to consent for the sake of “society;” by the fiction of naturally dimorphic sex; and by the legacy of physicians withholding information from and outright lying to patients and their surrogates, all of which the authors that we read detailed. I was also very taken by Foucault’s account of biopower as a form of knowledge/power over life itself, particularly in the medical context. As someone actively working to become a doctor, I just couldn’t shake the readings or their implications. It disrupted a lot of what I thought I understood about medicine: about its role in society, about the relationship between biomedical science and medical practice, and about the “objectivity” of science itself.
So, I continued to research intersex conditions and their management on my own after the class moved on, reading in both the sciences and the humanities, doing work on the topic where I could manage to work it in. For example, I did the major research project for my Biochemistry of Genetic Diseases class on the most common intersex condition, Congenital Adrenal Hyperplasia.
I also began to take more philosophy courses—as many as I could, really. When I was advised that the conditions of my B.M.Sc. program wouldn't allow me to double major, I took a heavy course load, such that by the time I finished my degree in Microbiology and Immunology, I had enough philosophy credits to complete my B.A. in the area in only one more year, which I did. The more engaged with philosophy that I became, the more I researched intersex conditions and their management.
The more Foucault that I read, the more alienated that I became from my dream of going to medical school. I had begun to reinterpret and reframe some of my past experiences with medicine in terms of my own medicalization as a patient and the medicalization of my parents, both of whom were disabled. Most importantly, I had begun to reflect on the patients with intersex conditions who had come through the practice in which I worked and the way in which they and their families had been managed.
Many of my favourite feminist philosophy professors at Western encouraged me to consider graduate school in philosophy so that I might continue to pursue my research and concerns about intersex conditions. In all honesty, I took their advice and enrolled in the M.A. program in philosophy at Western not because I was sold in any way on the idea of professional philosophy as a career, nor because I felt like I had found my “true calling.” Doing the M.A. simply seemed like a productive way to spend a year while I figured out what to do “for real”.
Completing my M.A., however, only left me feeling further adrift; the courses that I took and the research that I did only served to put me even further off a future in medicine. Moreover, as the child of working-class parents, neither of whom had advanced beyond secondary school and one of whom had never completed elementary school, it wasn’t anywhere on my radar to be an academic, let alone a philosopher.
At twenty-five, with three degrees and unsure of what to do next, I decided to take a year off and was lucky enough to be offered two year-long courses to teach at Western—which I enjoyed far more than I expected. During this time, Tracy Isaacs, Carolyn McLeod, Helen Fielding, and in particular Samantha Brennan, encouraged me to apply to do a Ph.D. at the University of Alberta where I could work on intersex with Cressida Heyes—who, at the time, was the Canada Research Chair in Philosophy of Gender and Sexuality.
I had absolutely no idea at the time how lucky I was to be guided towards working with Cressida. I could go on at length about the ways that she supported and guided me, intellectually and personally, during my Ph.D, which was, admittedly, very difficult. I had very little funding and had to work a good deal to keep myself afloat during my doctorate. I was also the first Black woman to go through the Ph.D. program in philosophy at Alberta, which was about as homogeneously white, male, and hostile to feminists as a philosophy department can be. There were multiple times when I almost dropped out. I would have dropped out if I hadn’t had Cressida’s support. I am a far better philosopher than I ever imagined that I could be because of Cressida and her guidance.
In October 2015, I defended my dissertation, for which Judith Butler was the external examiner, was awarded my degree in June 2016, and began my three-year position as a postdoctoral research associate in the Program in Gender and Sexuality Studies on July 1, 2016.
[Description of coloured photo below: Catherine, a Black woman with very short hair, is sitting in a car, looking slightly sideways into the camera, and faintly smiling. She is wearing fabulous glasses with cat’s-eyes shaped frames. Light is pouring in from a window behind her.]
I think of my backgrounds as deeply complementary. Indeed, I could not do the kind of thoroughly interdisciplinary, critical research that I do without the kinds of formal training that I’ve had. There are certain arguments and conclusions that I make in my research that I could not have come to without the experiences that I’ve had working in medicine, the work I did in different research labs, or the training that I’ve received in both science and philosophy.
That said, I think that we do not acknowledge the additional training and workload that rigorous interdisciplinary scholars often must take on—in those rare academic contexts where interdisciplinarity is actively encouraged beyond mere lip service. I do think that there are ways in which my backgrounds and the kind of research that I do puts me in a somewhat complicated position disciplinarily.
Philosophy is a discipline that, to its detriment, loves to police its boundaries. The deeply interdisciplinary nature of my work detracts from my legibility as a philosopher. I also increasingly find that various aspects of my background lead others to make certain assumptions about my work or the positions that I must take. For example, I’ve encountered the assumptions, more than once, that because I am influenced by Foucault in my approach, or deny the “objectivity” of science, that I must be anti-science and anti-medicine, or somehow don’t understand science or am unfamiliar with its practices—none of which assumptions is true.
Please describe your recent and current research.
Currently, I’m working on getting out the door multiple publications related to my doctoral research project. My dissertation— which I am currently revising for publication as a book, tentatively titled “Securing Cisgendered Futures: Managing Intersex Lives in the ‘Disorders of Sex Development’ Era”—is a critical analysis of the science, ethics, and (bio)politics underwriting the “Disorders of Sex Development” (DSD) treatment model for intersex conditions that was introduced in 2006.
I’m also in the early phases of my next major monograph-length research project. The project really takes up all medical efforts that aim at securing what I refer to as a specifically cisgendered future for minors unable to provide informed consent—which includes both intersex management strategies and the treatment of trans kids with so-called conversion therapies. The project is motivated by the introduction the DSD treatment model—after decades of feminist scholarship and intersex activism that critiques the pathologization of intersex bodies and their treatment with necessarily experimental, medically unnecessary, normalizing genital surgeries—and its controversial endorsement by some academics and activists who were previously critical of pathologization.
In the course of this project, I show that just like the Optimal Gender of Rearing treatment model which came before it, the DSD treatment model, as I said, aims at securing a specifically cisgendered future of the intersex individual, a normalized trajectory of development across the lifespan in which multiple sexed, gendered, and sexual variables remain in dynamic, but “coherent,” alignment. These variables include primary sex characteristics (such as external genitalia and internal reproductive structures, as well as gonadal makeup), secondary sex characteristics (from the development of breasts to sex-typical fat distribution, and hair growth patterns), and gendered characteristics (including identity, but also behavior, presentation, and non-sexual gendered desires such as toy and profession preference).
I outline the first account of the core pathology of intersex conditions available in the literature in terms of Cisgendered Function, referring to the function that the assemblage of physical sex characteristics is taken to perform in terms of providing a stable ground for predictions regarding an individual’s future gender, with gender referring to not only gender identity, but also gendered behavior and non-sexual preferences or desires. I also argue that despite acknowledgements within the clinical literature that there is inadequate empirical support for Brain Organization Theory—which holds that hormones organize brains into an either a typically male or female fashion prenatally and throughout the lifespan—the theory nonetheless drives clinical management in practice under DSD.
In addition to publishing articles out of, and related to, this project and getting the book itself published, I’m also in the very early phases of another book-length research project, tentatively titled “The Matter of Black Life and Death: Race, Biopolitics, and the American Health Insurance Market.” This project will begin from an understanding of Black Lives Matter as an anti-eugenics movement—where eugenics is understood to refer to management of the population—in order to explore the ways in which the market-based system of the bureaucratic administration of healthcare in the U.S. functions to maldistribute life-chances to Black and other people of colour.
I think there has been a lot of very good research on the “Black” and the “Matters” dimensions of “Black Lives Matter,” but not on the “Lives” dimension. I want to think about BLM with regards to the historical and contemporary sociopolitical and material constitution of Black Lives as a kind of, or form of, life. There has also been a lot of excellent research focusing on the ways in which the carceral system functions to maldistribute life-chances among Black and other people of colour in the U.S., and understandably so. However, I want to think about this maldistribution specifically in terms of the health-care system and access or lack of access to quality medical care.
Cato, your work draws upon philosophy of disability and work done in disability studies. How do you understand the relationship of work on intersex and disability?
It does indeed—and thank you for this question—because there are times when I feel like the influence of work in disability studies, as well as my own experiences as someone with disabled parents and who generally passes as "able-bodied" is not as clear in my research as I would like. I see all my research—both on intersex and on race and health insurance—as doing work that could properly be called critical disability studies, an approach that you introduced in which both disability and bodily, physical impairment are taken to be socially constructed in contrast to an approach such as the social model according to which disability is socially constructed, while impairment is natural.
Indeed, in your "On The Government of Disability," which was quite influential on me, you turn to intersex clinical management to illustrate the social construction of impairment through the pathologization of the otherwise “healthy” bodies that challenge traditional biomedical definitions of male and female, revealing impairment to be disability all along in the same way that Butler revealed sex to be gender all along. In my work on intersex, I am, in some ways, continuing the project that you start in that article, exploring the social construction of sex, gender, and pathologies of them through the current DSD treatment model in far more detail. This assumption regarding the social constitution of impairment underwrites all my work—and will surely be clear within the next project as well.
I think this position is still regarded by many theorists and researchers in disability studies as a somewhat radical, or, at the very least, politically tenuous position to hold. Indeed, the assumption is that we can’t justify access to care without the assumption that pathologies are in fact natural, either as kinds, or as things over which we have no control. I do not see these claims as in tension with each other. Medicine is itself a sociopolitical institution, like all others.
If disability studies is going to become truly intersectional, if it is really going to diversify, it will need to take the social—including environmental, economic, material, and psychological—constitution of impairment seriously. For example, fifty percent of police shootings in the U.S. involve Black disabled people. Eighty percent of the world’s population of disabled people live in what is often referred to as the “global south” and many of them are disabled via the material conditions of globalized capitalism and environmental degradation. As Jasbir Puar points out, most theorizing about disability comes out of the global north.
Recently, there have been discussions around the profession—that is, on philosophy blogs and other social media—about definitions of “woman,” trans issues, "gender critical" feminism, etc. Do you think your work can inform these discussions? If so, how?
I do think that my work can inform these discussions. I’m happy to detail the ways in which I think that it can. First, however, I would like to express my general disappointment at this most recent round of discussions regarding definitions of “woman,” which—to be clear—are specifically about whether or not transwomen are women, and not, for example, about whether transmen are men; what, apparently, makes ciswomen women; or a variety of other potential “purely metaphysical” questions that one could raise regarding gendered embodiment and identity.
It seems like every few years someone tumbles out of the woodwork to complain that no one except them is taking the “metaphysical differences” between transwomen and ciswomen seriously, even though the daily news features a parade of clips oscillating between politicians and schoolboard trustees debating which bathroom transpeople should use and reports detailing the gruesome murder of yet another, usually black, transwoman. Every time this happens, trans philosophers are forced to take time from their lives to educate those who, through their arguments, make painfully clear—yet again—that they have forgotten that excellent scholarship by trans philosophers exists on these issues, that they haven’t read it, or that they have simply refused to engage with it in good faith. To be honest, the term gender critical feminism strikes me as ironic at best.
While there is much that I could say about why both these discussions and the fact that philosophers entertain them disappoints me, I will limit myself to noting that the assertion that this apparently pressing debate is, could be, and or should be a solely metaphysical debate strikes me as an argument made in bad faith. Whatever metaphysical discussion that we have about women as a kind is always already a political discussion, insofar as gender is always already a political category. The argument that lacunae in our knowledge should be filled by research simply because the lacunae exist—though again, it is not clear to me either that there is a dearth of people debating the status of transwomen or that feminist philosophers should be racing to join such debates—does not strike me as argument that we should accept.
First of all, it is not clear to me that the arguments issued by gender critical feminists should count as knowledge insofar as they neither present a novel argument, nor present a reasonable critique to the already-existing literature that defends the inclusion of transwomen in the category of ”woman.”
Furthermore, there are other areas of research in which gaps in knowledge production exist because filling the gaps would be politically and ethically problematic—for example, we place strict limitations on clinical research on children. It is not clear to me why philosophers think they are somehow less morally responsible for, or less obligated to consider, the social, political, and ethical consequences of their research, particularly when the “others” about whom they philosophize insist that research cannot be extricated from the context of its consequences.
It seems hypocritical, to say the least, for feminist philosophers to insist that knowledge production is somehow objective, or neutral, or that discussions about who gets included in the category “women” could be solely metaphysical in character and somehow divorced from the actual lives of women, particularly transwomen, while arguing that the exclusion of women from philosophy and from philosophical knowledge production is both political and contributes to the constitution of knowledge in the field.
What contribution can my own research make to these discussions? I think my research is helpful insofar as it highlights both the historical and contemporary constitution of sex and gender. This aspect of my research reveals the ways in which binary sex and gender are both technologies of power—always already political "kinds"—and undermines the kind of essentialism that agitations over “metaphysical differences” suggest. The type of coherence amongst bodies sexed as female that this kind of essentialism presumes is not empirically supported—and it would only take a couple of afternoons of reading to know this. If it were empirically supported, perhaps the International Olympic Committee could come up with a non-controversial method for distinguishing two, binary, physical sexes. So far, it can’t.
How has your scholarship been informed by your identity as a Black queer woman who often passes as "able-bodied" and your past involvement in the care of and advocacy for your disabled father?
Thank you for this question. My identity, along a variety of dimensions, though perhaps more importantly, my experiences as a cisgendered woman who herself is without a diagnosed intersex condition—particularly my experiences with my father, who was something of a masterclass in bioethics—deeply inform my research in ways that are often not explicitly clear in my research on intersex and trans management.
As a Black, queer woman, I think that I tend to, out of course, take intersectionality seriously. As I have mentioned, I have had disabled parents and I pass as "able-bodied," generally speaking. I have a mild case of congenital clubfoot, which was exacerbated by injuries. My right ankle was surgically reconstructed when I was eighteen. My left ankle will be reconstructed in the near future. I also have arthritis in my ankles and knees associated with that, along with occasional back pain. I sometimes walk with a cane.
My mother uses a walker to get around and has issues with her spatial perception, which means that she can’t drive a car. My father was a type-2 diabetic with very high blood pressure and all the attendant co-morbidities—vision issues, nerve damage, vascular damage, and, eventually, renal failure. He was first diagnosed shortly after he immigrated from the Bahamas in 1982. Managing his health was an active concern in my family for as long as I can remember. One of my very first memories in fact is of visiting my father in the hospital during an inpatient stay while doctors were attempting to re-jig his meds. We generally managed his health as a team, attending physicians appointments together as a family.
[Description of coloured photo below: A young Cato with her father. She is holding a toy stethoscope to her ears and looking up at her smiling father who is sitting on a chair in front of her. His left hand is holding the end of the toy instrument to his heart.]
He was a wonderful, complicated man with a very complex set of health issues that are very common among Black people and many other people of colour. As I got older, I became increasingly involved in his care. His formal education ended before he was ten and the more familiar I became with medicine and biology, and the more degrees I acquired, the clearer it was that I, as a light-skinned, educated person who knew the system, could often get more accomplished than he could as an uneducated Black immigrant. I used this privilege and specialized knowledge however I could to improve his care because I saw how, at times, clinicians didn’t believe him, or dismissed him, or refused to collaborate with the other specialists managing his care, a concern since meds prescribed by one specialist could sometimes conflict with meds prescribed by another.
Shortly after I started my Ph.D., my father began to lose renal function quite quickly due to mismanagement by his doctors. His nephrologist wouldn’t explore other medications that might keep my father’s blood pressure down, wanting instead for him to go straight to dialysis. His endocrinologist had become complacent with out-of-control blood sugar, refusing to try other kinds of medications/insulins/insulin combinations, despite our repeated requests. His cardiologist, who had joined the team after my dad had a heart attack in 2003, didn't agree with how either the nephrologist or endocrinologist were managing his care, yet deferred to them professionally, as specialists in their fields. No clinician is inclined to revise the prescriptions or treatment plan that another clinician on the team, in another area of expertise, has put in place, especially in a delicate and complex case like my father’s.
So, I quietly did my research and assembled a new team. The kidney function was our biggest concern; so, I found the best nephrologist in Toronto and asked him which cardiologists and endocrinologists he most respected and worked with best. Then I got my dad’s family doctor to make referrals. We kept him off dialysis for another seven years and, during that time, his blood pressure and blood sugar were better managed than they had been in his entire life.
I learned a lot of things from my father, as a feminist philosopher thinking about bioethics, medicine, and disability. More than anything, I learned from him that nothing that we talk about is all or nothing. All of it is relational—autonomy, competence, beneficence, risk, disability, agency, capacity, identity.
In caring for my father, I learned that there is no one single kind of patient. At times, my father was compliant. At other times, he wasn’t. Caring for my father also taught me that race and gender definitely matter, that intersectional analyses are essential in thinking about medicine and science. I’ve also come to believe—and I’m by no means the first to say this—that caregiver burn-out is something to which we do not give enough attention. In fact, I believe that it would be useful to start thinking about caregiving itself as, not only deeply racialized and gendered, but also, in itself, disabling.
Shortly after I began my postdoc, my father’s health began to rapidly decline. But I continued to be an active part of his management and the decision-making around it. In the Spring of 2017, I was often travelling every four days between Toronto, Princeton, and whatever conference at which I was presenting. My father eventually made the decision to discontinue treatment and I went back to Toronto to—with the aid of the folks at the Temmy Latner Centre—oversee his palliative care at home. I was with him when he died on July 31, 2017.
I chose to do this care labor because it was very important to me personally that I, along with my mother, was able to play an active role in caring for my father until the end of his life. My choice reflects how I understand ethical relationality. Nonetheless, it is also clear to me that career expectations in academia do not support devoting time to the provision of that kind of care, or recuperating from the effects of providing it, and that social expectations disproportionately make women and racialized others responsible for that care labor, without acknowledging the compounding effects of it. Luckily, my colleagues at Princeton have been overwhelmingly supportive of me during my time there. I consider myself immensely fortunate that things happened how and when they did.
I’ve been making up for lost time in my publishing plans over the last few months and preparing for the upcoming market. While doing so, however, I can’t help but also consider the ways in which that kind of care labour is ultimately illegible in academia and in the capitalist job market at large, how that illegibility reifies heteropatriarchical capitalist white supremacy at large, and what disability studies might be able to contribute to such considerations. In this sense—especially if we think about disability as something constituted in relation to one’s capacities to fill expectations as a worker rather than as a reductively cliché "tragedy"—engaging in care labour is a kind of voluntary disabling of the self with regards to capital. I think disability studies can be exceptionally generative when we assume a critical stance.
Cato, would you like to say anything else about any of the subjects that we’ve discussed in this interview or recommend some resources to our readers and listeners?
If folks are interested in reading some of my research on the management of intersex conditions, they can check out my 2010 article, “From Intersex to DSD: The Disciplining of Sex Development,” as well as my entry on the “Intersex Movement” in The Wiley Blackwell Encyclopedia of Gender and Sexuality Studies.
Because of everything that has occurred in the past few years, I am a little behind on my publishing schedule and only now catching up. As I mentioned before, however, I currently have multiple articles under review and will be launching a website prior to market season this year. So, if anyone reading or listening to this interview is interested in my work, I urge them to keep an eye out—a few things should be, fingers crossed, coming out in the next little while.
I encourage people who are at all interested in intersex management to seek out the work of, and support of, activist organizations—particularly InterAct, which is doing amazing work.
For those still interested in debating the status of transwomen, I’d direct them towards Talia Mae Bettcher’s "When Tables Speak: On the Existence of Trans Philosophy," as well as her Stanford Encyclopedia of Philosophy entry entitled, “Feminist Perspectives on Trans Issues”. I’d also like to encourage people to seek out the work of some excellent junior trans scholars like JR Latham and Perry Zurn.
Finally, I’d like to give a shout-out to CSWIP, of which I am currently V.P. Finding community with other women and minority philosophers has been centrally important to keeping academia sustainable for me. I found a lot of that community via CSWIP and its annual meetings. I’m happy to be able to give back to that organization in my current position.
Thank you for this provocative and poignant interview, Cato. I’m sure that many readers and listeners have been moved by it and learned a great deal from it.
Readers/listeners are invited to use the Comments section below to respond to Catherine Clune-Taylor's remarks, ask questions, and so on. Comments will be moderated. As always, although signed comments are encouraged and preferred, anonymous comments may be permitted.
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Please join me here again on Wednesday, July 18th at 8 a.m. ET for the fortieth installment of the Dialogues on Disability series and, indeed, on every third Wednesday of the months ahead. I have a fabulous line-up of interviews planned. If you would like to nominate someone to be interviewed (self-nominations are welcomed), please feel free to write me at s.tremain@yahoo.ca. I prioritize diversity with respect to disability, class, race, gender, institutional status, nationality, culture, age, and sexuality in my selection of interviewees and my scheduling of interviews.
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