A Stoller Model for social policy?

A case for a clinical model as a social model

When Alice Dreger first invited me to be her debate partner for MIT Free Speech Alliance’s Great Debate on Sex and Gender Identity, I was apprehensive because of the wording of the resolution, but I like & respect Alice so I agreed to meet with her to see how much common ground we have. We have plenty. For one, we don’t agree with the Queer Theory framing of what sex and gender are. We agree that there are people in unusual and difficult liminal social space, outside of what cultures find acceptable for male and female categories. We discussed the various measures of sex: gametes, genital appearance, hormones, chromosomes, and how, whichever measure is used to determine sex-based policy, though all will be accurate over 99% of the time, there will still be a small number of people in need of consideration. Take for example gametes, which is the most accurate measure (kudos rad fems). If all spaces were separated by this measure alone, women with CAIS would be excluded.

Then there’s the problem with implementing policy, because most spaces would still be self-selected, with no one at the door inspecting gametes. Self-selection would be based on “gender identity”.

When Alice argued that “sex is a social construct”, she doesn’t mean that biology itself is a construct. What I understand her to mean from our debate planning conversations is that the sex categories, to some degree, are socially constructed depending on which measures of sex are favoured and what society considers acceptable for sexed bodies and behaviour. The Fa’afafine in Samoa, for example, are highly effeminate gay men but seen in their social context as existing between the sexes – not really men, and not really women. This is a social construct.

Soon after accepting the invitation to join Alice in the debate, I read Alex Byrne’s excellent book and browsed some of Holly Lawford-Smith’s work, including this recorded debate presentation on the same topic. I didn’t find many points of disagreement. Maybe some subtle ones. I find them both to be factual, intellectually honest, and reasonable in regard to accommodating the complexities of the human condition. For about two weeks afterwards, I waded through a feeling of “oh shit, how am I going to debate, when there’s very little disagreement?” Good thing I enjoy a good challenge, but it took about 2 bottles of wine and many scrapped drafts to find a solution I could live with, without compromising my own intellectual honesty: a bait and switch on the term “gender identity”.  I can’t defend a concept I don’t believe in. I can defend a concept I do believe in. So, I focussed on definitions. (I had momentarily toyed with the idea of dying my hair blue and doing my best comical impersonation of a Queer Theorist, to demonstrate how utterly stupid it is. I had some laughs to myself over that idea. I could have pulled it off. But, I’m not sure I could have respected myself and I would have let many people down, had I followed through with a clown act.)

I could have argued that Robert Stoller’s definition of gender identity, meaning one’s perception of their own sex, is accurate more than 99% of the time making it just as reliable a measure of sex as any of the others and therefore acceptable. This, of course, would have been entirely rhetorical, but could have been connected to the proposition that gender identity could replace sex in policy. But, I’m never satisfied with the purely rhetorical. It would have been no better than Queer Theory. So, I still had a problem to solve. The more I considered Stoller’s work, which I agree with clinically in regard to the cognitive development of Gender Identity Disorder, I did start to see value in utilizing his framework as a model for working through the ethical dilemmas of including/excluding people whose bodies or cognitive incongruence pose challenges for inclusion. His model has three parts, which I described in the debate as three lenses:

1. Biological sex

2. Social context

3. Other biological factors

This is not a sex denialism model. Nor is it a denial of human complexity, variation and the social realities in which people are situated. It’s integrative, and therefore not a dualism between biology and context. Which is good, because people themselves aren’t a dualism between our biology and social realities either. I support sex-based spaces, but we need some sort of framework for working through how to accommodate edge cases in ways that are safe, fair, and reality based.

I used the example of Caster Semenya, an athletic sprinter from Africa whose DSD sparked public debate about where she fits. The public discussion tended to pit biology against identity, as unreconcilable. The IOC decided to prioritize her identity. Critics were determined to prioritize her biology. Is there a third way? I think Stoller’s model could be developed to fit that bill, since its variables include both biology and social contexts. If Stoller is correct, and I think he is, Semenya would herself have grappled with all three variables, and through those same three variables, we can meet her in that grappling to find solutions which respect both the individual and the public at large. What do both need? In this case, I see no need to tamper with Semenya’s self-perception. If it’s working within her social context, with no harm, leave her be. But, her biology is not typical of a woman and, I believe, it gives her an unfair advantage over women in sport.

Let’s try another example. Jazz Jennings. Now, I adamantly disagree with childhood transitions, but it’s happening. What if Jazz was an athlete?

Stoller’s model:

1. Biological sex – Jazz is biologically male

2. Social factors – Jazz was transitioned at an early age, was socialized as female and has a self-perception as female as a result, by no fault of her own.

3. Other biological factors – Jazz is likely a “homosexual transsexual”. There is evidence that homosexuality (especially in males) is biological, related to the prenatal sex differentiation process. Because Jazz was medicalized at an early age, she did not go through a male typical puberty. Is there a biological advantage over natal females? Evidence should answer that question.

Photo by Braden Collum on Unsplash

Though not perfect, Stoller’s model is applicable, on a case-by-case basis, for those whose gender identity was formed through the early childhood development process he described – those with DSDs who were “assigned” a sex (the correct use of that term), those with DSDs who experience gender incongruence (which is rare, but some DSDs are correlated with higher than average rates of perceived incongruence) and the homosexual childhood incongruence that persists into adulthood to the degree that we live “as” the opposite sex. (I believe these two types of perceived incongruence are rooted in the exact same cognitive process). It’s not applicable to other types of “gender dysphoria”, such as Transvestic Disorder with autogynephilia, nor ROGD, since they follow a completely different developmental pathway. I see this as a feature, not a bug of this model. The blue haired kids experimenting with Queer Theory aren’t in need of policy protections any more than the goths or hippies did.

When I was working in healthcare, I faced difficult ethical dilemmas all the time, and had frameworks for working through them. There aren’t easy solutions, but models help make decisions.

I hope that someone smarter than I am will look at Stoller’s three variable gender identity concept, and build it out onto a working solution, so that policy makers aren’t always left scrambling to know what to do when a case like Semenya’s happens.

Post debate conversation with Holly Lawford-Smith here