Learning from Transness and Disability: Toward a Framework of Bodily Autonomy

Philosopher and critical theorist Nancy Fraser associates the rise of group identities with the end of the Cold War and the beginning of the “post-socialist” age, when it came to replace class interests1. The realm of development followed a parallel evolution, as its “lighthouse was erected”2 following World War II, and its framework has since redefined global relations to a large extent. In the late 1950s, social activists and field-workers who had become involved in the development sector attributed the failure of early projects to the use of top-down approaches3. As a result, and because involving locals proved to be more cost-efficient to the sector, development grew increasingly concerned with participation mechanisms. Consequently, social movements and development work became intertwined in a feedback loop of continuous mutual, but unequal, influence, where the development sector retained much of its power despite appearing to concede some of it. Within this bilateral dynamic, the development sector4 has contributed to rigidifying identity-based politics in how it channels stakeholder participation, distributes funding, and conceives its policies, programming, and beneficiaries. The development realm values practicality; it requires a level of clarity and measurability that is bound to turn complex intersectional experiences, which are located on a continuum, into legible, categorical labels. Over time, experiences of transness and disability became collapsed into rigid identity categories like “trans people” and “people with disabilities”5.

While identity-based approaches to organizing present some advantages such as community-building and focused interventions, they also pose significant limitations. First, identity-based organizing is often confronted with the arbitrariness6 of its categorizations, which can be a source of exclusion, oppression, and discrimination in and of themselves (essentialist, nationalist, etc.). By insisting on and reproducing identity categories, this approach contributes to exceptionalizing struggles that should be understood as interconnected and experiences that are shared across differences. It also reinforces the understanding that identity groups are homogenous, when they are not. Second, individuals can easily become siloed in increasingly specific groupings. This tunnel-vision can undermine collective action, produce a simplistic vision of complex issues, and significantly limit possibilities for cross-movement organizing, resourcing, exchange, and solidarity. For instance, excessive fragmentation can lead to competition over resources and recognition. Even in attempts to create inclusive or intersectional meta-categories, identities in the development realm remain distinct boxes to be ticked, thereby reinforcing sub-categorizations (but maybe conceding that they are not mutually exclusive). Finally, these practices contribute to a discourse that understands identity as fixed, clear-cut, and well-defined. The umbrella category of “marginalized groups” in particular reproduces those included under it as “marginalized”, “impotent”, “dependent”, or “in need”. 

As activists and organizers working on trans and disability issues, the practical and discursive limitations that we’ve encountered in the framework of identity politics have led us to seek other approaches to movement building that are capable of accounting for the interconnected nature of struggles without reinforcing categorizations as exceptional experiences or essential identities. More specifically, when it comes to transness and disability, identity politics fall short of addressing the continuum of oppression that reproduces the category of the cis-abled-healthy body and pathologizes deviance from that norm at the same time. We contend that the constraints of identity-based approaches may be overcome if we adopt instead a framework of bodily autonomy, and learn from the experiences of trans people and people with disabilities to inform broader social movements organizing.

In what follows, we unpack some of the common assumptions about transness and disability that underlie transphobia and ableism in Lebanon, focusing on notions of productivity, reproductivity7, and bodily agency. We draw on years of involvement with our communities, on our own lived experiences and our exchanges with trans peers and peers with disabilities, and on our situated knowledge of trans and disability issues in Lebanon as activists and organizers, to argue in favor of shifting from identity-based politics and towards a framework of bodily autonomy that centers bodily issues and cuts across fixed categorizations and understandings of identity. 

1. Valuing bodies that are not cis-abled: insights from Lebanon

Productivity

While some trans people and people with disabilities find themselves unable or unwilling to participate in conventional forms of economic activity like formal employment, this cannot be generalized as a trait of transness or disability. But because their labor is often made invisible (because it is informal, or because it is unpaid), trans people and people with disabilities are often assumed to be unproductive, economically inactive, or financially dependent on support programs or family throughout their lives8. Under this ideology, the idea of a career-driven trans person with disabilities is hardly conceivable. That said, many trans people and people with disabilities have come to view work as an important means of self-actualization and social integration. Here, the accessibility and quality of general and reproductive healthcare plays a big role in allowing or preventing access to conventional forms of work for trans people and people with disabilities. 

Because productivity is highly valued under globalized late capitalism, and because transness and disability are unduly associated with a lack of productivity, trans people and people with disabilities find themselves having to demonstrate their legitimacy as social subjects either by proving they can – or want to – be productive, by becoming productive, or by having to redefine the meaning of productivity. For these reasons, it is a widespread practice, primarily in western medical fields, to treat bodies that are not cis-abled in ways that make them working bodies that are capable of participating in capitalist production processes9. This is also somewhat present in the Lebanese context as doctors often give (sometimes false) hope to parents of children with disabilities that their child can one day “be normal” through sufficient medical intervention. 

In the Lebanese context, the assumption that trans people and people with disabilities are not (and will not be) productive leads to a great deal of harm and contributes to foreclosing future possibilities. To begin, it shapes the way the medical field values and cares for the bodies of trans people and people with disabilities. The assumption that people with disabilities are not economically active is a common pretext for providing them with a lesser quality of healthcare. This is also common among trans people, with the exception of transfeminine people whose labor is assumed to be limited to sex work. 

In addition, the assumption of unproductivity furthers the belief that trans people and people with disabilities cannot organize for themselves, that they are “voiceless” and must be spoken on behalf of. While this can lead to inadequate policies, advocacy and programming, it can also lead to higher risks of tokenizing the presence of trans people and people with disabilities in different spaces and movements, when in reality there is a dire need for plurality.

Reproductivity

We cannot discuss transness and disability without addressing the discourse of eugenics that associates perceived or actual (bodily) difference with inferiority, and seeks to regulate those whose bodies should be reproductive.

It is a common practice among doctors in Lebanon to suggest removing the ovaries of people with intellectual impairments, and to have the parents make that decision on their behalf. While courts require hysterectomy procedures for trans people filing a case to change the gender marker mentioned in their identification documents, ovary removal procedures in specific are not explicitly required  and have been demonstrated as medically unnecessary10, but they continue to be performed by doctors as part of hysterectomies. Yet until today, part of the medical field’s resistance to providing gender-affirming care in Lebanon and elsewhere lies in the belief that such interventions are in fact compromising “capable bodies”11, thwarting their reproductive potential12, and rendering them “lesser” members of society. As a result, when seeking a healthcare provider, trans people in Lebanon often have one criteria: that their doctor be “trans-friendly”– as in willing to provide gender-affirming care – regardless of their professional qualifications. 

While the purely medical/biological understanding of reproduction can and should be critiqued, we turn our attention to how such beliefs within the medical field also shape the ways trans people are perceived and understood within society at large in Lebanon. Backed by medical authority, the generalizing association between gender-affirming care and the loss of reproductive capacity turns into wider assumptions that trans people cannot (and should not) be parents, that they cannot (and should not) form families and care for them, that they cannot (and should not) be romantically involved, and that they cannot (and should not) have these aspirations altogether. This is all the more acutely felt by trans people who do not fall within the gender binary. Transfeminine people in particular tend to be hypersexualized, and sex work becomes the moral ground for excluding trans people from the social imaginary, while denying them their right to parenthood, family, and romantic love. 

Similarly, in Lebanon, medical workers often assume that people with disabilities are not sexually active, and overlook a key aspect of their health by doing so. It is also a widely-held belief in and outside the medical system that disability impacts one’s capacity to parent. These assumptions are clearly gendered, at least in the Lebanese context: while it is common for men with disabilities to marry able-bodied women, women with disabilities are not expected to have romantic interests, marry, have biological children, care for a family, or have a sexuality. These biases can translate into many forms of medical violence, such as physical, psychological, or emotional abuse, neglect, discrimination, and interventions without patients’ informed consent. Further, the expectation that women with disabilities should have lower standards when it comes to romantic pursuits introduces a power differential that can enable forms of gender-based violence.  

These assumptions about the reproductive, sexual and romantic capacities of trans people and people with disabilities perpetuate social stigma while also shaping the quality of medical care available to them. 

Bodily Agency and Authority

With the above in mind, it becomes understandable  – but not justifiable – that trans people and people with disabilities are subject to heightened forms of authority over their bodies. This authority manifests on multiple levels, in different kinds of relationships, and across a spectrum of spaces ranging from the intimacy of home to the public street, and it contributes to shaping relationships with parents and family as children and as adults, as well as dynamics with doctors and healthcare providers, and encounters with state institutions and security apparatuses, among many others. In what follows we focus on how this authority plays out in the medical sphere, and how it translates into conditioned or policed forms of access to public life.

Generally speaking, and especially when dealing with trans people and people with disabilities, medical practitioners assume that they know what is in the person’s best interest, more so than the person. Patients are expected to listen to the medical professional and to take their word at face value. For people growing up with disabilities, this attitude is reinforced and upheld by parents (or a sibling or family member taking on the role of a parent or a guardian). When dealing with medical specialists who are not informed about gender-affirming care, or who are not familiar with some forms of disability, trans people and people with disabilities find themselves in the difficult position of having to inform their healthcare provider about their general health, to transmit whatever knowledge they have about their condition and possible treatments, forms or care, or courses of action, and to be aware of and draw their healthcare provider’s attention to the specificities of their bodies. Failing to paint a holistic picture to one’s healthcare provider can lead to medical interventions that could cause a great deal of harm. This places trans people and people with disabilities under an unreasonable amount of pressure, and misplaces the responsibility of a holistic approach to their healthcare onto them instead of their healthcare provider.

When medical staff are not well-informed about or familiar with specific conditions related to gender-affirming care and disabilities, authoritative attitudes in medical settings can lead to violent – if not fatal – outcomes for trans people and people with disabilities. The quality of healthcare available to trans people and people with disabilities is also worsened by the pathologization of bodies that are not cis-abled, who are considered “abnormal”, “unhealthy”, or “sick” by the medical field13. This has justified many medical violations and abuses against trans people and people with disabilities. Support groups and conversations among peers reveal how non-consensual medical experimentation has been conducted on trans people and people with disabilities, and how these bodies have often been used as teaching opportunities without prior consent. Some doctors provide a lesser quality of medical attention to trans people and people with disabilities precisely because they locate their baseline for “health” differently than they do for able-bodied persons. Such an approach can significantly worsen their condition and require extensive remedial interventions. 

When engaging in public life, trans people and people with disabilities, more than others, find themselves in situations where they must disclose personal information about their bodies. In Lebanon, to pass through security checks or access certain spaces or services, people with disabilities are asked to present a disability card, especially if their disability is not visible to others. The process of obtaining this card involves “proving” the person’s disability, which can be an invasive and difficult process. People whose disabilities are less visible – for instance, people with chronic illnesses, people with speech, auditory, psychosocial, or intellectual impairments – are often put in the uncomfortable position of having to justify their requests for certain accessibility measures to be put in place in order for them to participate in public life.

Similarly, trans people whose appearance does not match their identification documents advise one another, as a precautionary safety measure, to carry a diagnosis issued by a psychiatrist mentioning that the person suffers from gender dysphoria. Although not legally required, presenting the diagnosis document whenever an ID must be shown can facilitate the process. This diagnosis document is usually requested by doctors as a condition for trans people to access gender-affirming care. Obtaining it requires trans people to prove they are “psychologically fit”, save for their “preoccupations with gender”, in front of a psychiatrist. 

Additionally, the legal-medical requirements for changing the gender mentioned on one’s ID in Lebanon also place trans people in the position of having to “demonstrate” their transness according to standards and criteria set by the state and motivated by its own sectarian, sexist, and patriarchal political agenda14 (imposing irreversible surgeries including sterilization, binary presentation, etc.).

2. Transness, Disability, and the Broader Struggle for Bodily Autonomy

Transness and disability are not exceptional experiences. They constitute accelerations, decelerations, or intensifications of conditions faced by all living beings as bodies age. This is one reason why the term “TAB” (Temporarily Abled Bodies), used by many disability activists, is so insightful. This is also what underpins the logic of using the term “gender-affirming care” as opposed to “transition” to refer to the various kinds of (medical and non-medical) measures taken by all human beings to continuously embody and affirm their gender in different stages of their lives. 

A framework of bodily autonomy, which emphasizes the importance of personal autonomy, self-ownership, and self-determination over one’s own body, centers bodily issues as an entry-point to understanding how oppressive structures operate. Bodily issues encompass a wide array of matters including informed consent, reproductive rights, medical decision-making, privacy, and data protection. Understood through the framework of bodily autonomy, the perspectives and experiences of trans people and people with disabilities can be seen as indicators for structural shortcomings.

Because of their marginalization relative to the cis-abled body, transness and disability test the limits of social, legal, and medical institutions, and reveal the biases behind their practices. As a result, trans people and people with disabilities are often able to call out beliefs, practices, and structures – some of which we have touched on in this text – that also impact cis- and able-bodied people negatively, even if less visibly, and which have been normalized. They reveal how, all too often, access to basic human rights is conceived with a cis-abled body in mind, effectively reserving access to these rights to cis-abled bodies.

In addition to how transness and disability might intersect and co-constitute the experience of a trans individual with disabilities, trans people and people with disabilities face cross-cutting issues that relate to productivity, reproductivity, agency and autonomy, among others, which we believe are relevant to anyone mobilizing, organizing, funding, and advocating for trans rights, disability rights, and bodily autonomy in all its forms. Shifting frameworks from an identity-based approach to an approach of bodily autonomy allows us to recognize some of these cross-cutting issues, and can provide a sound basis for more intersectional and impactful funding and programming, more solidarity and organizing across interest groups, and an actionable discourse that politicizes bodily issues. 

*Note: This text draws on ongoing exchanges that started in 2022 between community organizers Zakaria Nasser and Beirut-based Amal Charif, a designer, activist, disability organizer and director of HalTek. Nasser and Charif’s position as organizers and community members grants them a privileged view into practices and abuses that are notoriously difficult to document formally, and for which there are no reports, recorded evidence or interviews.

• 1. Nancy Fraser, "From recognition to redistribution? Dilemmas of justice in a “post-socialist” age", New Left Review, Issue 212, 1995, p. 68-93.
• 2. Wolfgang Sachs, “Preface to the New Edition”, The Development Dictionary: A Guide to Knowledge as Power, 2nd edition, London & New York, Zed Books, 2009, p. XV.
• 3. Majid Rahnema, “Participation”, The Development Dictionary: A Guide to Knowledge as Power, 2nd edition, London & New York, Zed Books, 2009, p.128.
• 4. We use this term to refer to a broad range of organizations, institutions, and activities that are focused on improving economic, social, and environmental conditions through humanitarian aid, poverty alleviation, infrastructure development, education, healthcare, policy, advocacy, and other types of efforts often carried out by governments, non-governmental organizations (NGOs), international agencies, philanthropic foundations, and other stakeholders.
• 5. These categories are often caught in one of two scenarios. In the first scenario, trans people and people with disabilities are considered separate and unrelated, except for their occasional overlap. This allows for specific responses to be tailored to specific needs, which is useful on the level of community support, services, advocacy, and policy, and on the level of funding and resource distribution. By the same logic, one could argue that further specificity would be beneficial. For example, trans issues being a question of gender could benefit from being addressed separately from issues that are a matter of sexuality. It can also be argued that different disabilities (mobility, sensory, neurological, etc.) require different approaches. Women with disabilities could also benefit from focused attention to their gendered experiences and needs. In the second scenario, trans people and people with disabilities are absorbed into the larger umbrella category of “marginalized groups'' – along with refugees, racial and ethnic minorities, religious minorities, and others depending on the context. While the umbrella of marginalization continues to be based on identity categories, it can allow for exchanges to happen across identity groups. It has the advantage of bringing together diverse experiences of oppression, and has the potential to allow more inclusive and integrated approaches to understanding complex issues and addressing them.
• 6. This refers to their deliberately chosen quality, rather than their randomness.
• 7. That is to say, the capacity or potential of being reproductive.
• 8. David T. Mitchell and Sharon L. Snyder, “Disability as multitude: Re-working Non-Productive Labor Power”, Journal of Literary & Cultural Disability Studies, Issue 4, no. 2, 2010, p. 179-193.
• 9. Dan Irving, “Normalized Transgressions: Legitimizing the Transsexual Body as Productive”, Radical History Review, Issue 1, no. 100, 2008, p. 38-59.
• 10. See for example Katherine Rachlin, Griffin Hansbury & Seth T. Pardo, “Hysterectomy and Oophorectomy Experiences of Female-to-Male Transgender Individuals”, International Journal of Transgenderism, Issue 12, no.3 , 2010, and the article reviewed by Dr Heidi Wittenberg, “Should You Keep One Or Both Ovaries?”, Hysto.net, undated.
• 11. Dan Irving, “Normalized Transgressions: Legitimizing the Transsexual Body as Productive”, Radical History Review, Issue 1, no. 100, 2008, p. 38-59.
• 12. David O. Cauldwell, “Psychopathia Transexualis”, International Journal of Transgenderism, Issue 5 no. 2, 2001.
• 13. This belief extends beyond the medical field. In Lebanon, people with disabilities are often considered a financial risk by loan-dispensing government and private entities, and as a result have significantly limited economic agency. For instance, the Public Corporation for Housing has been known to exclude people with disabilities from subsidized housing loans. This feeds into the conception that people with disabilities do not live long lives and are seen as a liability, when in reality many live on to be elderly and disability does not mean an early death. This also assumes that the disabled are not economically productive when many are employed and financially independent. This practice excludes people with disabilities from the primary form of access to housing in Lebanon.
• 14. For more on this topic, see Maya Mikdashi, “Sextarianism: Sovereignty, Secularism, and the State in Lebanon”, Stanford University Press, 2022.