Incorporating the Medical Gaze in Queer and Transgender Life Writing and Video

de Villiers, Nicholas

[O]ne effect of this critique of the pervasive dualisms and metaphors that animate representations of the body is to call into question the assumption that we ever know or encounter the body—not only the bodies of others but our own bodies—directly or simply. Rather, it seems, the body that we experience and conceptualize is always mediated by constructs, associations, images of a cultural nature.

—Susan Bordo, “Feminism, Western Culture, and the Body”

In an author’s lexicon, will there not always be a word-as-mana, a word whose ardent, complex, ineffable, and somehow sacred signification gives the illusion that by this word one might answer for everything? . . . This word has gradually appeared in his work; at first it was masked by the instance of Truth (that of history), then by that of Validity (that of systems and structures); now it blossoms, it flourishes; this word-as-mana is the word “body.”

—Roland Barthes, Roland Barthes by Roland Barthes

Gay autobiographical writing would seem to be the perfect example of confessional discourse in which the author, as narrative subject, reveals his/her sexuality as the secret truth of his/her identity, and feels this to be liberating rather than a sign of what Michel Foucault calls the “millennial yoke of confession” (History 61). But such speech acts do have the advantage of attempting to reverse the typical relationship of subject and object between heterosexuality as an authorized position of knowledge and homosexuality as a medicalized object of knowledge that is not authorized to speak.1 Though Foucault noted that homosexuals began to speak on their own behalf often using precisely those terms by which they had been medically disqualified, he insisted that such forms of “reverse discourse” were a necessary first step in the homophile movement (Halperin, Saint 58). Despite Foucault’s brilliantly paranoid attention to how relations of power and surveillance are “internalized” by the subject, I want to consider whether certain discursive reversals and forms of internalization of the “medical gaze” might occasion more destabilizing forms of resistance to objectification and disqualification. I will chart the incorporation of a “medical gaze” in queer life writing and video dealing with AIDS and trans-embodiment, in order to argue that this incorporation of a medical way of looking at the body is also a way of resisting and resignifying some of the power associated with the medicalization of the individual.2

The texts on HIV/AIDS which I will examine—Hervé Guibert’s autofiction in To the Friend Who Did Not Save My Life, The Compassion Protocol and Cytomegalovirus: A Hospitalization Diary as well as his video-diary Modesty and Shame (1992);3 Tom Joslin and Peter Friedman’s video-diary Silverlake Life—The View from Here (1993)—are in some ways dated, in that they are from an era “before highly active anti-retroviral therapy had transformed HIV/AIDS from an acute, fatal, disease into a chronic and largely manageable one” (Halperin, What 38). I wish to locate a specific mode of resistance to medical objectification in them that may be an artifact of their historical context. However, they remain relevant for the present,4 which is why I make the perhaps unusual move here of associating their strategies of resistance with those emerging from the self-assertion of the transsexual and transgender movements because they share an emphasis on the need for peer-education and patient-centered medicine.

At a moment when trans media politics has shifted toward focusing on narratives that do not over-emphasize medical procedures and surgical transitions, it is worthwhile to create a genealogy of these shifts and an archive of forms and tactics of resistance to negative forms of medical objectification. In this respect, I look at Sandy Stone’s discussion of transsexual autobiography in “The ‘Empire’ Strikes Back: A Posttranssexual Manifesto”; the television documentary mini-series TransGeneration (2006); Monika Treut’s documentary Gendernauts (1999); Mark Freeman and Nathaniel Walters-Koh’s Transgender Tuesdays: A Clinic in the Tenderloin (2012); work by J. Jack Halberstam5 on “technotopia” in representing transgender bodies; and Thomas Page McBee’s “Trans, but not like you think.”

Throughout, I focus on questions of transition and “in-between” states, in particular: in between genders, in between illness and health, in between life and death, and in between textuality and visuality.6 I examine how these texts figure and reconfigure illness, sexuality, and gender, emphasizing how the body is mediated through technologies of representation. I also suggest ways to engage students in viewing, reading, and writing about these texts. Such attention to mediation entails a certain critical reflexivity about questions of autonomy, agency, and self-expression, which makes me lean more toward the language of “resistance” and “self-presentation.”

Documentarist as Patient: Fighting Fat

First, let us start with a template for this incorporation of a medical gaze in a documentary text that is illustrative precisely for its reliance on a privileged “generic” body from which the texts I will be discussing are (for better or worse) exempt. Morgan Spurlock’s Super Size Me (2004) is less interesting for its message (i.e., McDonald’s food is bad for you) than its method of submitting the filmmaker’s body to quasi-medical examination by Spurlock himself in direct-address video-diary form and rigorous medical examination by a team of experts: several dieticians and doctors. They chart his weight gain, lethargy, mood swings, sexual dysfunction,7 and continually caution him against his one-month diet consisting of only McDonald’s food. Cartesian dualisms are both played out and subverted as Spurlock is divided into mind (i.e., will) and body, and these play a sort of protagonist/antagonist role: whether his mind is the antagonist which causes his protagonist body to suffer, or his body’s addicted cravings and fatigue play antagonist to Spurlock’s likable onscreen protagonist persona. But his likeability is in part due to how supposedly generic he is as a white male who was not previously “fat.” Doctors would no doubt prefer the term “clinically overweight” as more scientific and less offensive, but I am using the term “fat” here to indicate the degree of insult implicit in the documentary (but, like “queer,” as holding the potential for defiant resignification). Other bodies marked as fat in Spurlock’s film simply have their foregoing visual and moral stigmatization confirmed by the film: anonymous or blurred out fat, lower-class, and female bodies exist only as cautionary examples and indexes of the culture’s moral disapproval and our presumptive “knowingness” about how exactly they got fat. As Eve Kosofsky Sedgwick and Michael Moon argue, we think we know all about a fat woman’s eating habits, her willpower, even her emotional state, but we also think we know something she does not know about herself: if she knew what she looked like, if she knew that she was killing herself, etc.8 Worse yet, these forms of medically-authorized knowingness are phrased not as insult but as the very voice of compassion! Spurlock thus takes on an heroic role, allowing himself to become fat and unattractive, in a sense “taking a bullet” for the children who are the film’s target and give it its inevitable morality: “save our children” (Spurlock appears to directly address children in his discussion of the Happy Meal and Ronald McDonald, but his benevolent approach is really directed at parents, since his film was rated PG-13). Class, unfortunately, drops out of the equation (despite Spurlock’s admirable anti-corporate moments) as both Spurlock and the medical experts are lionized as fighting the good fight against bad food (cf. Berlant 113; de Villiers, “Love” 197). However the war on the obesity epidemic becomes (in visual terms) a war on fat people (like the Little Britain “Fat Fighters” skits). Sedgwick and Moon describe “the nascent unfolding of a movement much younger than gay/lesbian liberation, namely the fat liberation movement” in which “the politicized insistence on a willed agnosticism about individual causes, the anti-ontogenic crux moment in fat liberation, rhymes so closely with the analogous moment in gay liberation” (Tendencies 234). This, they argue “records a profound and unacknowledged historical debt” (235). My attempt in what follows to connect the analogous movements of AIDS activism and trans activism is strongly indebted to Sedgwick and Moon’s approach to historically dense “identity linkages” between different stigmatized groups (218).

The “war on obesity” follows a long history of the rhetorical trope of medicalized war. Catherine Waldby argues that this was especially dangerous as it was invoked during the first response to the AIDS epidemic: “biomedical science understands the ‘war on AIDS’ as a war on the virus, but [Simon] Watney and many other commentators understand it as a war on People Living With AIDS (PLWAs) and on those identity categories which feature in AIDS discourse” (4). Waldby argues that biomedicine “does its work through the wielding of violence, cast in terms of preventative, therapeutic or diagnostic practices.” She cites Eric Michaels’s AIDS diary as a record of this violent quality of medical examinations: “I have just today returned from two nights spent in the Infectious Disease Ward . . . Mama, you wouldn’t believe how people treat you there! It’s not the rubber gloves or facemasks, or bizarre plastic wrapping on everything. It’s the way people address you, by gesture, by eye, by mouth” (qtd. in Waldby 4). Michaels explains that his diary acts as “a struggle with institutional forms, a possible Foucauldian horror show, which must be resisted, counteracted somehow” (qtd. in Waldby 4). Diary-keeping serves “to keep another set of definitions going against the quite barbaric ones that were inflicted in these last few days, through rubber gloves, facemasks, goggles” (qtd. in Waldby 4). Life writing and video dealing specifically with HIV seropositivity and AIDS compounds the discourse of “coming out” with the important claims for agency made by those who were until recently classified as terminally ill, and as Michaels reveals, were treated as if they were themselves infectious matter. My current students’ shock upon learning that AIDS was once referred to as “gay cancer” and GRID (gay-related immunodeficiency disease) makes it all the more worthwhile to continue reading these early forms of gay life writing about AIDS so as to avoid historical amnesia.

Patient as Documentarist: Writing Back

Hervé Guibert’s works of “autofiction” (edited diary writing that becomes “novelesque”) about AIDS are like Michaels’s in his attempt to record the violence inflicted on the PLWA. In To the Friend Who Did Not Save My Life, Guibert reveals the abominable cruelty of “double blind” drug experiments where the patients cannot tell if the drug they are receiving is real or fake (142–3) (in Pharmacopolitics, Arthur A. Daemmrich documents how AIDS activism actually changed regulatory regimes in the U.S. [97–98]). Guibert also recounts in gruesome detail how often he has to have “an astronomical amount of my blood . . . siphoned off under the pretext of determining the number of my T4 cells the virus had massacred in one month” (Friend 41), thereby sapping what little strength he has (both physical strength and subjective agency, including the will to write).

Moreover, Guibert obsessively catalogues the progress of the virus and acts as if he is his own nurse. But this sometimes entails a struggle of wills between himself and his doctors, whereby he is often treated as a hypochondriac (since they are the experts, and he is simply a self-taught novice). One doctor tells him he has “dysmorphophobia, which means that you have a hatred of all forms of deformity” and then writes him a prescription for antidepressants (38). He recounts one psychiatrist who had “found a great way to talk to AIDS victims about the disease; he’d say to them, ‘Don’t try to make me believe that you didn’t dream about death at some time or another before you became ill! Psychic factors are instrumental in the onset of AIDS. You longed for death, and here it is’” (120).9 In fact, Guibert freely admits to such accusations of morbid thinking: “I’ll kiss the hands of the person who’ll tell me I’m doomed” (38). This might appear odd, but is in fact an understandable response to the free-fall anxiety of (terminal) illness, as Sedgwick explains how breast cancer has been for her almost an experiment in applied deconstruction, revealing the instability of oppositions that structure an experience of the self such as “fear and hope (when I feel—I’ve got a quarterly physical coming up—so much less prepared to deal with the news that a lump or rash isn’t a metastasis than that it is)” (Tendencies 12).10 Guibert mines such affective ambivalence throughout To the Friend: “I told myself that we both had AIDS. In an instant, this certainty changed everything, turned everything upside down, even the landscape, and this both paralyzed and liberated me, sapped my strength while at the same time increasing it tenfold; I was afraid and light-headed, calm as well as terrified” (31). But in his relation with his friend Muzil (a fictionalized representation of Michel Foucault, written during and following Foucault’s death from AIDS-related illness), Guibert fails to psychologize him as morbid: “I said to him, ‘Actually, you hope you have AIDS.’ He shot me a black look, one that brooked no appeal.” (31). In his next book, The Compassion Protocol, Guibert is forced to admit “after dreaming so much of dying, from now on I only have a horrible yearning to go on living” (143).

Compassion and Cytomegalovirus: A Hospitalization Diary are even more direct examples of writing as a form of resistance to being treated as an object (in the manner described by Michaels) by nurses he describes as “pig-sticking commandos” (Compassion 48) and doctors as “sadists” (Compassion 126). They also focus more directly on how “the medical gaze” is incorporated into the text through descriptions of these procedures: “fibroscopy, coloscopy, alveolar lavage, tubes down my gullet, up my hole, I’ve had the lot” (Compassion 19). In The Compassion Protocol, Guibert explains that, “I’d like to be able to use medical jargon perfectly, it’s like a code, it gives me the feeling that in their presence I’m not a little boy in front of whom the grown-ups speak a foreign language when talking about fucking.” (89). He points out that “My father had wanted me to do medicine. I have the impression that because of this illness I have been both studying and practicing medicine.” (67). Cytomegalovirus, with its specialized title (in fact, the English translation was done with the assistance of an MD), is also urgently concerned with the question of vision, as Guibert fears going blind: “There’s an eye at stake.” (12). His hospitalization diary is used as a form of resistance to his sometimes cruel and neglectful treatment by nurses and doctors: “You have to make them respect you right away, it’s exhausting, a test of wills that lasts one or even several days and nights. They want you to lose, they count on wearing you down. Then, according to the situation, they respect or they flatten you” (21). He fears that if he cannot write or read anything then perhaps “The hospital has finally won?” (78).

In Compassion, Guibert explains that every visit to the hospital turns him into “the documentarist”: “Each time I become the voyeur spying on myself” (88). Guibert also adds to the medical gaze both a photographic and video camera gaze to record the weakened state of his body.11 His friend Jules suggests that they photograph his naked skeletal figure, and he is shocked even though he might just as well have made the suggestion himself “a few weeks earlier, asking him to photograph my haggard nudity” and had thought of asking a painter to paint him as “Nude suffering from AIDS” and to appear naked on stage despite possible criticism “that you are making yourself into an exhibition” (17).12 But again Guibert notes his ambivalence: “My relationship to my body must have changed since I’d thought to sacrifice it to the painter and on the boards of a theatre: then it would have been a gesture of defiance, a flaunting of courage and dignity that went beyond all bounds, but now there was nothing but pity, a very great compassion for this ruined body, which had to be sheltered from human sight” (17). He also recounts his ambivalence about the production of the video Modesty and Shame which was produced by Pascale Breugnot for French television and shown after Guibert’s death in December 1990: “Yesterday I wanted to take advantage of the Thursday morning fibro to film it, with a big close-up on my face, the tube entering my throat. Today the whole idea disgusts me.” (41). He does film a massage session, explaining “I think we’ve just shot one of the most bizarre documentaries ever made.” (84).

Guibert also attempts to bring the camera into the examining room with his doctor Claudette Demouchel, who is singled out by Guibert as a sympathetic, even romantic figure despite their professional relationship. He argues with her about why he wants to film, saying “you can’t very well prevent me from filming, it’s my body, it’s not yours” (197) which she rebuts by saying that her body would be filmed as well. Without even asking for her permission, he changes the angle of the take and films Claudette. “I filmed her long white hands that were tapping the keyboard of her computer. I filmed her face in that sublime radiance, I was so happy. With my eye to the eyepiece I saw that the image was trembling slightly to the rhythm of my breathing, the beatings of my heart” (199). Thus Guibert manages to gain some control by making his doctor into a (romantic) object for the camera, which becomes incorporated into his body as it moves with his pulse and breathing (he also seems to enjoy the reversal, like when he fantasizes about becoming a doctor himself).

In fact, Guibert said he never viewed any of the 10 hours of video that he recorded, and once Modesty and Shame had been completed, he had no desire to see the film; nor did he insist that the film be broadcast in his lifetime. This attitude repeats his view of the diary form as a mode of exorcism (he often insisted that he wrote in order to forget). As Jean-Pierre Boulé discusses in “Hervé Guibert: Autobiographical Film Writing Pushed to its Limits?” there was some controversy regarding whether the video’s representation of Guibert’s frail, sick body was appropriate for broadcast on French television.

The View from Here

A similar documentary imperative can be found in Tom Joslin and Peter Friedman’s AIDS video-diary Silverlake Life: The View From Here. Attention is repeatedly drawn to the recording apparatus (the video monitor and equipment for editing), and the camera focuses on the daily regimen of medication, visits to the doctor, and their exasperation with insurance paperwork.13 Silverlake Life acts as a form of “thanatography” which makes possible “the perception of death in life” (Foucault, Birth 171) but also vitality in the face of death.14 One of the most provocative moments occurs at a spa where Tom Joslin and his partner Mark are asked not to bathe shirtless because Mark’s KS lesions are making people uncomfortable. In response Mark displays his back for the camera saying “I’m being political.” We can then ask: How does the display of the body constitute a political act in the age of AIDS?

Likewise, camp is usually considered apolitical (after Susan Sontag’s famous “Notes on ‘Camp’”), but Mark is particularly skillful at using camp as a political practice to assert some agency and control in the examining room of the clinic when his KS lesions are being photographed and he says, “I’m ready for my close-up Mr. DeMille” (quoting the famous closing line from Sunset Boulevard). In this, Mark signifies not only his humor but also his resistance, camp as a form of resistance to what Christian Lassen calls “the stigma of illness” and “the tyranny of caring.” Lassen reads Adam Mars-Jones’s short story “Slim,” for how camp enables the narrator of the short story, an AIDS-patient, to expose the underpinnings of a tyranny of caring whose allegedly benevolent manifestations, such as the caring professions, charity or the appeals to positive thinking, nevertheless frequently aim at the subjection of the sick rather than their wellbeing. On the other hand, camp imagination provides the narrator with a surplus consolatory impulse, misleadingly light-hearted and yet intensely comforting, that attempts to cure the stigma of (this) illness (Lassen, abstract).

ACT UP activist politics also made use of camp as a form of resistance in an “uprising of the sick against their doctors,” what David Halperin has characterized as a strategy of resistance to what Foucault identified as modern forms of “bio-power” (Saint 28). These strategies can be seen in Jim Hubbard’s documentary United in Anger: A History of ACT UP (2012).

SRS and Beyond

A similar power struggle between doctors and patients can be found in the history of the medical diagnosis and surgical sex reassignment of transsexuals. In “The ‘Empire’ Strikes Back: A Post-transsexual Manifesto,” Sandy Stone recounts the history of gender dysphoria clinics (in particular Stanford and the work of Harry Benjamin) in terms of a struggle between two “camps”:

The two groups, on one hand the researchers and on the other the transsexuals, were pursuing separate ends. The researchers wanted to know what this thing they called gender dysphoria syndrome was. They wanted a taxonomy of symptoms, criteria for differential diagnosis, procedures for evaluation, reliable courses of treatment, and thorough followup. The transsexuals wanted surgery. They had very clear agendas regarding their relation to the researchers, and considered the doctors’ evaluation criteria merely another obstacle in their pathsomething to be overcome. In this they unambiguously expressed Benjamin’s original criterion in its simplest form: The sense of being in the “wrong” body. This seems a recipe for an uneasy adversarial relationship, and it was. It continues to be, although with the passage of time there has been considerable dialogue between the two camps. (“‘Empire’”)

In rejecting the “wrong body” argument as overly binaristic, Stone calls for an expression of “transition” and mixture, not the creation of a closet of one’s past. A good example of both “the transsexual closet” and its refusal can be seen in Jennie Livingston’s Paris Is Burning (1990), in which the testimonial interviews point out the relationship between transsexual surgery and autobiography. In particular, there is a scene on the beach with Carmen and Brooke, where Brooke tells her life story as a series of surgeries. Brooke explains that now she has had “a transsexualism operation,” and she is no longer a man, she can “close the closet door.” As she is speaking to the camera her envious friend Carmen affectionately encourages her to “tell it like it is.” This scene is similar to a moment in Pedro Almodóvar’s All About My Mother (1999) where the transsexual sex worker “La Agrado” presents her authentic “life story” on stage as a series of receipts for her cosmetic surgery, reconfiguring the concept of “authenticity.”

In the television documentary series TransGeneration, Raci, a Filipina MTF transsexual, is in some ways an example of the kind of “closet” Stone is talking about: Raci starts the documentary as passing, and is not “out” as transsexual. She is even compared to a drug addict trying to get her fix of hormones on the street. The film shows her being directed to a clinic and safer legal means of obtaining hormones, thus in some ways “responsibilizing”15 her as an out trans female subject who is accountable to the medical institution, but this is conceived as a form of self-empowerment rather than coercion. Likewise, FTM Lucas resists attempts to see him as mentally ill (despite the fact that his mother says it would be easier to tell friends and relatives that a doctor has confirmed that Lucas has “gender identity disorder”).16 Instead, Lucas becomes his own doctor as he starts taking “T” (testosterone), delighting in making a record of his transformation through photographs of his hair growth and tape recordings of his lowering voice. The camera used to record the “ethnographic” program TransGeneration (with subtitles to explain specialized transgender and medical terms to outsiders) is thus doubled by Lucas’s own appropriation of the medical gaze to examine his body’s transformation. We might compare Lucas’s documentary impulse to a more recent appropriation of the medical gaze in a self-portrait project by Wynne Neilly, “Female to ‘Male’,” with weekly photographs, recorded vocal changes, and documents (including doctors’ notes) that “represent a segment or moment in his gender exploration” after beginning hormone therapy.17

Monika Treut’s documentary Gendernauts (1999) also attempts to allow its transgender subjects a degree of control and autonomy in front of and with the camera (for instance, Sandy Stone takes the camera and films Monika, resulting in a reflexive moment of “exchange” of the camera’s potentially objectifying ethnographic gaze). The filmmaker clearly admires what she depicts as an almost heroic kind of autonomy, but the film also documents a shift towards trans-catering clinics with “advised consent” policies about the risks of taking hormones. This is the subject of the more recent documentary Transgender Tuesdays: A Clinic in the Tenderloin directed by Nurse Practitioner Mark Freeman, which interweaves historical narratives with testimony by trans people and nurses.

Treut’s Gendernauts also illustrates recent connections between the Trans and Intersex movements. In her introduction to Undoing Gender, “Acting In Concert,” Judith Butler explains both the tensions and the shared assumptions within what she calls the “New Gender Politics” that has emerged in recent years: “a combination of movements concerned with transgender, transsexuality, intersex, and their complex relations to feminist and queer theory” (4), noting that “The task of all these movements seems to me to be about distinguishing among the norms and conventions that permit people to breathe, to desire, to love, and to live, and those norms and conventions that restrict or eviscerate the conditions of life itself” (8). Treut’s film highlights the creativity of trans ways of life and desire. Unlike Jennie Livingston’s attempt to remove herself from her ethnographic documentary, Treut uses voice-over to speak about desire (intersex as sexy) and her camera highlights the power of gender “transubstantiation” which Butler sees as only implicit in the role of Livingston’s camera in Paris Is Burning (Butler, Bodies 136). Treut thus foregrounds the issues of desire, and participant-observer ethnography, perhaps more successfully than Livingston. (For a counterpoint to this assessment, see Lucas Hilderbrand’s Paris Is Burning: A Queer Film Classic.)

One of Treut’s FTM participants who appeared in Treut’s earlier film Female Misbehavior, Max Valerio, discusses the effects of taking T on his libido, shows off his chest surgery, but also explains his sense of his body as malleable (“male-able” as it were): “we are the furthest, most extreme expression of manipulation of the body, almost as though the body—that human stretch of flesh—were a piece of plastic or some other nearly synthetic malleable substance. We restructure our glands, our body fluids, skin, nerves, and genitals.” This sentiment is echoed by Susan Stryker at the end of the film, who argues that the body is one’s own possession to do with what one wants. While Stryker’s comment seems to construe the body as the ultimate piece of property, it raises an important question in transsexual and transgender discourse,18 namely the issue—or perhaps “paradox”—of autonomy (Butler 100–01).

Within In a Queer Time and Place: Transgender Bodies, Subcultural Lives, J. Jack Halberstam argues that, as a contradictory site in postmodernism, “the transgender body has emerged as futurity itself, a kind of heroic fulfillment of postmodern promises of gender flexibility” (18). He asks, “Why has gender flexibility become a site of both fascination and promise in the late twentieth century and what did this new flexibility have to do with other economies of flexibility within postmodernism?” (18). Halberstam is aware of the fact that the flexible body becomes a commodity, providing the example of cosmetic surgeries. But he hopes that his work “moves beyond the binary division of flexibility or rigidity,” citing Steve Pile’s argument that “the subjects of resistance are neither fixed nor fluid, but both and more. And this ‘more’ involves a sense that resistance is resistance to both fixidity and to fluidity” (qtd. in Halberstam 21). This “more” is elaborated by Halberstam in a chapter of In a Queer Time and Place on representing the transgender body in contemporary art, in which he proposes the concept of a “technotopic aesthetic” in which “postmodern space and postmodern embodiment” collide (103) in a “utopian, technotopian, or spatially imaginative formulation of a body with new organs and expanded sensorium” that “corresponds precisely to the new forms of embodiment that have come to be called transgender in certain queer communities” (101). Halberstam’s Gaga Feminism: Sex, Gender, and the End of Normal continues this exploration of new forms of embodiment beyond binary and “genital” gender. This is clearly what Treut means by a “gendernaut,” and her film reveals how this new conception of embodiment will require a reconfiguration of “the gaze” in order to represent such a body in a non-pathologizing way (indeed, the desire to avoid pathologizing trans and queer subjectivities is what connects work by Halberstam, Butler, Valentine, and Halperin). However, like Guibert’s documentary impulse, these subjects attempt to become their own doctors as well, hoping both to master the language of science and create new descriptive vernacular language, such as the term “transgender” itself (Halberstam, “Masculinity” par. 14; Valentine 33–34).

This calls for new forms of narrative as well, beyond the formulas of “coming out” and “the wrong body,” a subject addressed by Thomas Page McBee in “Trans, but not like you think.” When I teach TransGeneration in my undergraduate gender studies courses (which works well since the film is about college students), I ask my students to write in response to this prompt: “In what ways does TransGeneration (2005) illustrate Thomas Page McBee’s claim that all stories of gender transition are not the same? Conversely, what forms of ‘typical trans narrative’ are present in the format of the television program?” Students find both McBee and the made-for-TV documentary quite accessible, while reading Stone and Jacob Hale’s “Suggested Rules for Non-Transsexuals Writing about Transsexuals, Transsexuality, Transsexualism, or Trans” prepares them to consider the ethics of such writing (for example, Hale’s Rule 13: “Don’t imagine that you can write about the trope of transsexuality, the figure of the transsexual, transsexual discourse/s, or transsexual subject positions without writing about transsexual subjectivities, lives, experiences, embodiments. Ask yourself: what relations hold between these categorial constructions, thus what implications hold between what you write about one and what you don’t write about another.”).

But since 2005 when TransGeneration first aired, a different generation of trans documentary filmmakers have called for a move beyond medicalized stories that hinge on transition. In 2013, transgender writer Mitch Kellaway surveyed a number of these films and filmmakers in “Beyond Transition: Documentaries Capture Rich, Complex Transgender Lives,” noting a common theme:

Gender transition, while a significant milestone, is not the only, or even necessarily the defining, part of every trans person’s life. It’s an ongoing process that informs and interacts with other roles and identities, albeit one that is too often rendered tragic by medical and legal stumbling blocks and social stigma. And, like any major change, it’s worth celebrating -- even as life goes on despite and because of it. (“Beyond”)

One of the filmmakers interviewed by Kellaway, Cecilio Asuncion is particular about what he shows and what he doesn’t. He relates how documentaries about trans women seem to usually be about ‘how sad or how hard a trans woman’s life is’ and ‘would always end with the SRS,’ referring to sex reassignment surgery, also known as gender confirmation surgery. While undue suffering is real and genital reconstruction is important to many transitioning people, Asuncion purposefully avoids drawing the conclusion that transition or womanhood is ‘incomplete’ without surgery (or hormones) (“Beyond”).

This shift in narrative structure marks an important turn away from the kinds of transfigurations of the medical gaze that I have traced here. However, I would underscore that the texts I have assembled also push beyond simple reversal of medicalizing discourse and offer forms of productive resistance to stereotyping, stigmatization, and objectification.

Intimate Motives

I would like to close by considering the question of identification in these texts. In Super Size Me, Spurlock relies on his “generic,” normative, and otherwise healthy able body as a kind of ideal site of identification for the viewer, but the texts I have considered neither have that luxury, nor do they accept its logic. The logic of identification operating is instead identified by Sedgwick in terms of the profound and “generous” task of making one’s own body available for identification—“in the very grain of one’s illness (which is to say, the grain of one’s own intellectual, emotional, bodily self as refracted through illness and resistant to it)” (261). In other words, identification for Sedgwick suggests the anti-normativity and in-betweenness of one’s body as it crosses genders, and resists illness (including gender dysphoria as an alleged mental illness). Thinking about the cross-identifications she experienced with Michael Lynch during his AIDS-related illness and her breast cancer diagnosis and treatment, Sedgwick explains that:

[T]he framework in which my friends . . . and others made available to me almost overwhelming supplies of emotional, logistical, and cognitive sustenance—was very much shaped by AIDS and the critical politics surrounding it . . . The AIDS activist movement, in turn, owes much to the women’s health movement of the 70s; and in another turn, an activist politics of breast cancer, spearheaded by lesbians, seems in the last year or two to have been emerging based on the model of AIDS activism. The dialectical epistemology of the two diseases, too—the kind of secret each has constituted; the kinds of outness each has required and inspired—has made an intimate motive for me. (15)

In highlighting such activist debts and inspirations, Sedgwick is also arguing against any attempts to somehow pit breast cancer research funding against AIDS research funding and thus undermine collective political struggle (262).

My hope has likewise been to show how transgender and HIV/AIDS life writing and video also reveal such shared and mutually-inspired forms of queer resistance to the sometimes brutalizing effects of being made into a medical case study. Transsexual and transgender medical politics might in fact offer a model for a non-brutalizing medical practice related to queerness. Treut’s Gendernauts and Freeman’s Transgender Tuesdays indicate that the medical profession has begun to address these problems and shift towards patient-centered medicine and peer education, but it is crucial to remember that this is due to the hard work of activists and cultural producers. It is in the “queer pedagogical” hope of passing on this memory across generations—as Sedgwick asks us to do in “Queer and Now”—that I continue to teach these texts to student writers interested in life writing and mediated narrative. For my students, YouTube is yet another platform for life writing and peer education, democratizing the power of the camera’s gaze. But to avoid repetition of “It Gets Better” and “Born This Way” as empty clichés, I also encourage students to historicize the literary and documentary strategies and genres by which queer, medicalized, and stigmatized subjects engage in tactical reversals of discourse, potentially moving beyond the “same terms” by which they were medically disqualified.


1This is David Halperin’s argument in Saint Foucault: “By constituting homosexuality as an object of knowledge, heterosexuality also constitutes itself as a privileged stance of subjectivity—as the very condition of knowing—and thereby avoids becoming an object of knowledge itself, the target of a possible critique. In this, it is of course unlike homosexuality, which is a perennial object of inquiry but never a viable subjective stance, never a disinterested, nonpartisan, legitimate position from which to speak, and is therefore never authorized except as the occasional voice of an already discounted and devalued subcultural minority” (47).

2Michel Foucault’s task of historicizing the medical, criminological, and psychoanalytic science of the subject often drew attention to the prominent role of surveillance and the expert “gaze.” In The Birth of the Clinic, Foucault describes the modern medical gaze that made a scientific object of the patient, whereby “Medical rationality plunges into the marvelous density of perception, offering the grain of things as the first face of truth . . . the experiment seems to be identified with the domain of the careful gaze . . . the eye becomes the depository and source of clarity” (xiii). As he explains in Discipline and Punish, surveillance both normalizes and individualizes subjects by means of the examination (125, 183–4) and “the examination . . . makes each individual a ‘case’” (191), thus creating an archive of documents rendering the individual an object of expert knowledge (189). In The History of Sexuality Volume I, Foucault charts how psychoanalysis joined confessional discourse with the rules of scientific method to produce a knowledge of the individual as a “personage, a past, a case history,” most notably the invert, the pervert, the child, and the hysteric.

3I am clearly not alone in making this connection: after composing this essay I discovered Joanne Rendell’s “A Testimony to Muzil: Hervé Guibert, Foucault, and the Medical Gaze.” For more on the connections between Foucault and Guibert, see: Ralph Sarkonak, Angelic Echoes: Hervé Guibert and Company; Tom Roach, Friendship as a Way of Life: Foucault, AIDS, and the Politics of Shared Estrangement; and Nicholas de Villiers, Opacity and the Closet: Queer Tactics in Foucault, Barthes, and Warhol.

4In his more recent impassioned intervention in current discourses surrounding gay male subjectivity and HIV/AIDS, What Do Gay Men Want?: An Essay on Sex, Risk, and Subjectivity, Halperin argues that “public discourses about ‘the return of unsafe sex’ have contributed to the repathologizing of homosexuality” (32; also see 34). Since psychology and psychoanalysis seem to inevitably reintroduce standards of health and normality, and questions of individual pathology, Halperin insists that we must locate alternative traditions of thinking about queer subjectivity. He finds a non-psychological account of “abjection” in the writings of Jean Genet, presenting the possibility of “power’s productive reversal—and of the corresponding empowerment to be found by those inferiorized individuals who somehow take the very substance of humiliation and forge from it the stuff of a paradoxical exaltation.” (80) My own project here aims to locate similar possibilities.

5Some of the work was published under the name Judith Halberstam, but I will refer to the author as J. Jack Halberstam and use masculine pronouns throughout. See: <>.

6I would like to thank the organizers of the Performance Studies international conference Interregnum: In Between States (University of Copenhagen, Denmark, 2008) and Battleground States conference “The Body & Culture” (Bowling Green State University, 2008) for the opportunity to present earlier drafts of this project. I would also like to thank Thomas O. Haakenson, Kevin Amidon, and David Prickett for their feedback on an earlier version of this essay.

7The emphasis on sexual dysfunction adds a seemingly confessional tone to the video-diary, enhancing the sense of voyeurism but also “truth” for the spectator (a common device in “Reality” television since MTV’s The Real World).

8Connecting the “closet of sexuality” with the “closet of size,” they note that, incredibly, in this society everyone who sees a fat woman feels they know something about her that she doesn’t herself know. If what they think they know is something as simple as that she eats a lot, it is medicine that lends this notionally self-evident (though, as recent research demonstrates, usually erroneous) reflection the excitement of inside information; it is medicine that, as with homosexuality, transforming difference into etiology, confers on this rudimentary behavioral hypothesis the prestige of a privileged narrative understanding of her will (she’s addicted), her history (she’s frustrated), her perception (she can’t see herself as she really looks), her prognosis (she’s killing herself) (229–30). My argument is that Spurlock’s film encourages precisely this knowingness in his audience, in a way that is damaging to what Sedgwick and Moon call “fat liberation” (234).

9Hence Halperin’s critique of “death drive” theories (Tim Dean in particular): “how, specifically, can we combat the HIV/AIDS epidemic without treating it as a symptom of an alleged death drive, a death drive that somehow ends up becoming the peculiar property of gay men and people living with HIV/AIDS . . . ?” (What 102).

10I find some comfort in the use of the customary “literary present” tense here to discuss Sedgwick, whose impact on my thinking is obvious.

11My use of the term “gaze” is drawn from Foucault’s Birth of the Clinic and Discipline and Punish. For many, however, it will immediately connote Laura Mulvey’s “Visual Pleasure and Narrative Cinema.” For a critique of the conflation of the Foucauldian “gaze,” the Lacanian “gaze,” and the “male gaze” in feminist film theory, see Joan Copjec’s “The Orthopsychic Subject.” For another critique of the emphasis on assaultive gazing in film theory, and the conflation of “the look” with “the gaze,” see Carol Clover’s “The Eye of Horror” (209–10). While I appreciate their attempts to disambiguate “the gaze” (often to bring it back in alignment with Lacanian orthodoxy) I prefer to offer an alternate usage linking Foucault to Guibert. For Guibert, the gaze is sometimes that of a medical apparatus/procedure (“-scopy”), and at others he refers to his camera or videocamera. What is unique about his writing is the way in which the camera is incorporated textually, and indeed much of his work as a writer and photographer explored the complex interplay between text and image. In Ghost Image, he writes about photographs but does not reproduce them (echoing Roland Barthes’s unreproduced “Winter Garden” photograph of his mother in Camera Lucida), declaring that, “this text is the despair of the image, and worse than a blurred or fogged image, a ghost image . . . .” (16). Guibert’s photographic “autoportraits” can be found in Hervé Guibert Photographies. For a rigorous examination of cinematic writing, see Cesare Casarino, “David Wojnarowicz, AIDS, and the Cinematic Imperative.”

12In “Photography and AIDS,” Simon Watney critiques the rhetoric of photojournalism about “the AIDS victim,” arguing that

In all of this it is still important to avoid the conclusion that photography has simply ‘misrepresented’ AIDS, with the implication that at the end of the day there is indeed a clear, unitary visual ‘truth’ of the epidemic that might be directly accessible to the camera. Photographers are particularly well positioned to interrupt the constant flow of images that conflate HIV and AIDS and to challenge the crude and cruel version of the epidemic that continues to regard AIDS as a moral verdict rather than a medical diagnosis. For if we accept that photography participates in the practice of representation that forges our identities, we should be as sensitive to its potential to produce subjects as we are to its undoubted capacity to define objects. (75)

In fact, Watney is critical even of the neutrality of “medical diagnosis,” as he notes that photojournalism emphasizes the “individual patient, facing a medical reality which is threatening and mysterious, and over which he exercises little to no control himself” (70). Both of these statements are immediately relevant for my analysis, and Guibert is remarkably sensitive to the potential of photography to produce subjects and “forge . . . identities.”

13It is worth noting that this aspect is relatively absent in Guibert (though he does focus on bureaucracy, it is obviously not the American medical insurance kind). In “Photography and AIDS,” Watney insists that,

At any given moment, the epidemic should also be thought of as a still-life that is every bit as rich and complex as that of any seventeenth-century Dutch artist: a still life that contains many bottles of drugs, together with the multinational pharmaceutical industry that generates and markets them, and the government agencies that regulate (and frequently inhibit) their availability. The imagery of AIDS includes keys to properties illegally reclaimed by fearful and bigoted landlords; job contracts terminated by prejudiced employers; interminable application forms for every aspect of welfare, social security, and sickness benefits; rejected health insurance and life insurance claims; travel-passes for the disabled; and the collective cultural, political, and personal achievements of thousands of groups and organisations around the world working on behalf of the rights and needs of people with HIV and its many consequences. (74–75)

I quote at length to emphasize the magnitude but also the everydayness of the task of documentation undertaken by Guibert and Joslin.

14For a philosophical examination of cinema and bio-politics in Silverlake Life, see Cesare Casarino, "Three Theses on the Life-Image (Deleuze, Cinema, Biopolitics)" in Releasing the Image: From Literature to New Media, ed. Jacques Khalip and Robert Mitchell (Stanford: Stanford University Press, 2011), 156—68.

15I borrow this term from Halperin, who explains Foucault’s critique of liberal power as follows: “Liberal power does not simply prohibit; it does not directly terrorize. It normalizes, ‘responsibilizes,’ and disciplines” (Saint 18). In What Do Gay Men Want? Halperin likewise critiques “the general process of gay medical responsibilization” in HIV/AIDS risk prevention programs (136n78). The problem with “responsibilization” is that it tends to depoliticize the individual in relation to social institutions. However, in Raci’s case, she is in fact politicized by no longer viewing her hormone therapy as a private, personal issue.

16Indeed, this is the double-edged sword of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnosis of gender identity disorder. In a chapter of Undoing Gender entitled “Undiagnosing Gender,” Judith Butler explains:

Thus, on the one hand, the diagnosis continues to be valued because it facilitates an economically feasible way of transitioning. On the other hand, the diagnosis is adamantly opposed because it continues to pathologize as a mental disorder what ought to be understood instead as one among many human possibilities of determining one’s gender for oneself. One can see from the above sketch that there is a tension in this debate between those who are, for the purposes of the debate, trying to gain entitlement and financial assistance, and those who seek to ground the practice of transsexuality in a notion of autonomy. We might well hesitate at once and ask whether these two views are actually in opposition to one another. (76)

In fact, TransGeneration reveals that this is a false opposition. Note also that the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) has replaced the DSM-IV “gender identity disorder” with the term “gender dysphoria” (removing the stigmatizing word “disorder”). See Wynne Parry, “Normal or Not: When One’s Gender Identity Causes Distress”: <>.

17“Wynne Neilly: Female to ‘Male’”: <>. See: Eliel Cruz, “Photographer Documents Transition from Female to Male in Intimate Portrait Project”: <>.

18Stone, Butler, and Halberstam address both transsexual and transgender movements and communities, so I address them together here. For an important ethnography of the categories themselves, see David Valentine’s Imagining Transgender. Valentine makes an important clarification which is immediately relevant to my concerns here: “I spell ‘transexual’ with one ‘s,’ a usage of activist informants who employed this spelling to resist the pathologizing implications of the medicalized two ‘s’ ‘transsexual.’ However, I make no claim to the value of either spelling” (25).

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This text was accepted for publication after an anonymous peer review process.
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