Introduction to Christoph Hanssmann’s Work
Christoph Hanssmann examines the development of transgender therapies and health advocacy through historical research carried out in New York City and Buenos Aires in *Care Without Pathology: How Trans-Health Activists Are Changing Medicine*. According to Robin Skyer, the publication is a crucial addition to research on depathologization attempts in transgender care because it shows how grassroots movements are upending cultural and medical power structures.
Book Details
Care Without Pathology: The Impact of Trans-Health Activists on Medicine*. Hanssmann, Christoph. University of Minnesota Press. 2023.
Insights on Trans Health Activism
The actions that may benefit the majority of trans people the most? None of them are gender-specific. At a conference in 2020, Paisley Currah—a highly regarded political scientist and co-founder of the top blog in trans* research TSQ: Transgender Studies Quarterly—made what appears to be an obvious point. However, given the ways in which dominant political and media discourses discuss trans* therapeutics (the term used by Christoph Hanssmann, the author of *Care Without Pathology*, to describe the wide range of gender-affirming care), trans* health, and consequently trans* lives, are still regarded as an exception.
(Following Marquis Bey) As a disruptive term that disturbs ontological states, I use the asterisk “trans*” in this article. The name “trans” is most frequently used in Anglophone contexts to refer to people whose gender identities go beyond, include, or reject a linear structure. By using the underscore, “trans*-ness” is released from its nominalist, physical bonds. Instead, “trans*” develops into a function or expression whose scope is neither predetermined nor constrained.
Evolving Definition of Trans Therapeutics
From transgender medicine in the 20th century to modern crip, trans*-feminist-informed healthcare infrastructures, Hanssmann charts the evolving definition of trans* therapeutics.
In *Care Without Pathology*, Hanssmann observes that, in contrast to gay and lesbian depathologization, trans* activists and advocates have not sought a separation from treatments (as the means of providing medical care were, and still are, under state control), but rather for the transformation of medical care structures. This is not to suggest that the action aims to integrate into or be included in existing systems; rather, it asks, “What would it be like to get the care we ask for, in the way that we need?”
Hanssmann’s Approach to Trans* Health Activism
Care without Pathology… protects pathologized groups from the negative effects of legitimate, state, administrative, and monetary systems.
Hanssmann emphasizes how problems with hegemonic power relations, such as medical elitism and self-determination in care settings, are problems that many (multiply-) marginalized groups encounter when interacting with medical practice. He contends that care without pathology necessitates a wider change in healthcare infrastructures as well as the protection of pathologized groups from the negative effects of authorized, state, administrative, and financial systems. Trans* wellness activism therefore shares more similarities with female and disability movements because they challenge power hierarchies and widespread harm within the constraints of the present.
Historical Study and Methodology
Care Without Pathology, a historical study, is based on eight years of research conducted in New York City, USA, and Buenos Aires, Argentina. Hanssmann contends that he was able to engage in “transhemispheric discursive inquiry” (17), an approach that departs from a typical comparative study by acknowledging the interactions and relations between research sites. Hanssmann’s use of this exaggerated duality is something I would disagree with, but his choice of locations allows us to examine various contexts where significant changes in the regulation of trans* therapeutics occurred between 2012 and 2018.
Significant Legislative Changes in Trans* Therapeutics
The Gender Identity Law, which eliminated the need for treatment for trans* therapies, was passed in Argentina in 2012. The Diagnostic and Statistical Manual (DSM-5) published in 2013 by the American Psychiatric Association removed “Gender Identity Disorder” from their recommendations and added a new diagnostic category called “Gender Dysphoria,” which proponents viewed as progress toward depathologization. *Care Without Pathology* thus covers a time of considerable change, the results of which are still being felt today. Additionally, Hanssmann makes sure that the voices of social workers, society members, activists, and activists’ voices are heard throughout the book by drawing on ethnographic observations and interviews.
Examples of Local Activism and Political Compromise
Hanssmann gives stunning examples of local activism and how it has a tumultuous relationship with political compromise. For instance, Chapter Three focuses on the use of demographic memoirs by community-based researchers in Buenos Aires
In order to create visuals and information about how violence and prejudice affected the health and lives of trans* people and travesti, historical data were combined with statistics. By using this strategy, organizers were able to institutionalize neglect and violence in the areas of employment, healthcare, and housing while also drawing political attention to the Brazilian state’s responsibility for early deaths. However, as Hanssmann emphasizes, this use of analytical collectivization and the idea of “population” are closely related to trans* necropolitics, architectural violence, and state power.
The Challenge of Changing Struggles
Care Without Pathology skillfully demonstrates the difficulty of change struggles through the conversation of these opposing concepts.
In Chapter Four, where Hanssmann describes the “narrow passageways of action” (149) used to challenge Medicaid exclusion, another example is provided. By using the dialect of state government, which primarily spoke of financial risk, activists and advocates pushed for admission to trans* therapeutics. They reframed the narrative of trans* therapies as a public good while emphasizing the drawbacks of austerity measures. However, as Hanssmann explains, adhering to these liberal notions may cause more harm (or allow it to rot) by using a strategy that draws on human capital and the politics of investment. When coalitional interpersonal change is what you are aiming for, it seems contradictory to use monetary value as a yardstick for the “worthiness” of life.
Exploration of Self-Procurement and Therapeutic Experimentation
What happens when trans* people try to find self-supporting solutions and distance themselves from biological and state organizations?
Hanssmann acknowledges that there has been a narrative shift from trans* health to trans* wellness, a change that reflects depathologization efforts. He also mentions the work of scholars such as Cameron Awkward-Rich, Hil Malatino, and Andrea Long Chu, who highlight the constitutive pain and negativity of trans*-ness as a counter to “curative” discourse surrounding trans* therapeutics. Yet what could expand upon Hanssmann’s work is an exploration of self-procurement and therapeutic experimentation. What happens when trans* people try to find self-supporting solutions and distance themselves from biological and state organizations? Consequently, we may ask whether the term “trans* therapeutics” is appropriate to describe trans* care practices. It is in this area that my own PhD research is situated. My current research approaches the topic of trans* care through qualitative, participatory techniques and looks to complement Hanssmann’s analysis.
Conclusion
The display of trans* activisms that have acknowledged the philosophical relations between groups and individuals that are labeled as “an other” is where *Care Without Pathology* succeeds. Hanssmann highlights the need for coalitional engagement in the fight for social change and as opposition to colonization by showing how the politics of change harms through medical structures and different systems of energy. It is a great addition to the list of books that academics, activists, and anyone else interested in social movements, queer studies, or the sociology of health should read.
