Life

How we use the theory to fight against oppression

Monday, August 7, 2017

Katrina Karkazis: Sport may seem like an unlikely or unexpected place to find a struggle about sexual rights and freedoms, but it is still widely viewed as a masculine endeavor and a conservative arena across vastly different cultures.

Katrina Karkazis is a Senior Research Scholar at the Center for Biomedical Ethics at Stanford University. The heart of her work is aimed at promoting social justice. Drawing on her training in cultural anthropology, science studies, and empirical bioethics, her work is deeply interdisciplinary, and addresses a range of topics challenging entrenched scientific and medical beliefs about gender, sexuality, and the body. She is author of Book: “Fixing Sex: Intersex, Medical Authority, and Lived Experience”.

Philosopher and author of book: „Das Neue und Das Bestehende - Eine materialistische Untersuchung zu Heidegger, Adorno, Foucault und Derrida” Dr. Halis Yildirim interviewed Katrina Karkazis.

Halis Yildirim: You are known for your work on intersex and, more recently, for your critical work on testosterone in the context of sport regulations that ban women who are deemed to have too much. What is the current status of the sport regulations? 

Katrina Karkazis: You’re asking this at a very important time. We are nearing a critical deadline. Let me give some background. 

In 2011, the governing body for track and field (the International Association of Athletics Federations, or IAAF) implemented a regulation limiting women’s eligibility to compete based on their natural testosterone levels. Women whose testosterone exceeded a specified ceiling were banned from competing in the female category unless they lowered their testosterone via surgery or drugs. The International Olympic Committee put in place a similar regulation in 2012.

When I started this research in 2011, I hadn’t worked in sport, but I had spent a decade thinking about gender ideologies in medicine and science in general, and also within the context of intersex more specifically. For instance, I examined the ways in which physicians and parents draw on cultural ideas about a series of binaries—sex and gender, nature and culture, body and society—when considering medical intervention for intersex. And how the medicalization of intersex enabled the avoidance of broader questions—such as whether any treatment is actually necessary for gender-atypical bodies—and thus sustained the assumption that physicians should intervene to control the “sex” of the body. The intersex work gave me a lens from which to approach the testosterone regulation, which employs similar binaries to make claims about what makes someone male or female and who is “really” a woman, and then uses these to rationalize medicalization and intervention (e.g., high T makes women unhealthy). 

Policymakers have sought to distinguish the new regulation from decades of sex testing regulations by “scientizing” it and making an argument about a purported relationship between testosterone and athleticism. They argue women with higher T have such an “unfair” advantage over women with lower levels that they should be excluded from the female category. But this turned out to be a bait and switch. Only the screening criterion differs from those used in earlier sex testing regulations: while before, for example, it might have been chromosomes, now it’s testosterone levels. Unlike chromosomes, however, T levels can be manipulated, and because of this women can be coerced into altering their bodies, sometimes to great harm, to maintain eligibility. This violates standards of medical ethics. Policymakers nevertheless characterize the regulation as “progressive.”

This issue underscored for me how effective testosterone is at obscuring operations of power and deflecting attention away from areas of grave moral concern, such as discrimination against women and medical harm. I was also alarmed by the way in which this supposedly neutral and scientific regulation exclusively targets women of color from the global South.

I became interested in how testosterone ideologies reinforced the policymakers’ agenda so easily, allowing them to make claims that appeal to broad swaths of people simply because they sound like common sense. The claims they are making—testosterone does not belong in women or is jet fuel for athletes—are claims for which people often require no evidence. This in part stems from the “sex hormone” concept and what people think these steroids do, which is often not grounded in what they actually do. 

With my co-authors, we wrote a piece called “Out of Bounds? A Critique of Policies on Hyperandrogenism in Female Athletes” in the American Journal of Bioethics, which critiqued the IAAC’s underlying scientific assumptions (including the selective use of science to support the regulations’ rationale), the differential power embedded in the policymaking process and the way in which the policies could only be framed as fair if one did not examine which female athletes were affected. 

This was followed by a piece published in British Medical Journal that upended the claim that the policies were created to protect the “health” of athletes, instead revealing therein a phony benevolence. IAAF medical experts revealed—unethically—that they performed medically unnecessary surgery on four young women from “rural or mountainous regions of developing countries” to lower their T so that they could remain eligible. Alarmingly, they also performed clitoral reduction surgery. Other athletes quit rather than undergo these invasive interventions, which are not only medically unnecessary but carry short and long-term side effects that can be debilitating to an athlete. For many of the women, complying would also have meant giving up their career. It’s a choice between two unbearable outcomes, which is really no choice at all.

A later piece in Science uncovered the dubious scientific practices enabling the policymakers to claim a “huge no man’s land” between male and female T levels, a claim essential to the validity of the policies’ rationale. 

All of this research provided the foundation for a legal challenge to these regulations by Dutee Chand, a top-level sprinter from India. Chand was banned from competition in 2014 under the IAAF regulation. She considered it blatantly unfair and made a courageous choice to challenge it, saying, “I won’t undergo surgery or any other procedure. At every level of my life… I have competed the way I am. I’ve been told the hormonal issue with me is natural so that’s why we have decided this.” She took her challenge the Court of Arbitration for Sport (CAS)—the world’s highest sport tribunal—to be heard. Exposure of these problems was critical to her case which, to my great disappointment, hinged almost exclusively on the science. Though we managed to have the regulation suspended, it was a temporary suspension. CAS gave the IAAF two years to submit evidence to support the regulation. 

We are nearing that deadline, which is at the end of September.  

H.Y.: The determination of sex by testosterone is ridiculous. I hope that in September this fact will be so seen. I find your work in this field is very important. Sport and sexuality is therefore interesting for our topic, because in Turkey exist in tournaments and teams that occur more gender for several years now. Let me explain it. Halil Ibrahim Dincdag a professional soccer referee who was suspended because of his sexuality.  There was a strong solidarity with him from various soccer fan communities in Turkey and abroad. It is both an issue of gender as well as a worker’s struggle. The Turkish football federation has been ordered to pay compensation to Halil Ibrahim Dincdag. In the course of this and other experience, more LGBTQ people began to constitute teams.  (Sportif Lezbon, Atletik Dildoa etc.) They also occur very politically. They have been also changing rules of sport. Erdogan has, among other things, dismissed the academics who were interested in LGBTQ topics. I cannot separate the steps, another determination of sex, another sport, and another society. Don't we must talk about the current concept of sport?

KK: More than a worker’s struggle, it is a struggle for human rights and sexual rights and freedoms. Often struggles for sexual rights foreground women’s reproductive rights, but as human rights activist Scott Long has pointed out, “the most vividly drawn and violently reviled enemy typically is homosexuality.” Sport may seem like an unlikely or unexpected place to find a struggle about sexual rights and freedoms, but it is still widely viewed as a masculine endeavor and a conservative arena across vastly different cultures. When you mix that with state sanctioned discrimination against women and LGBTI, sport is an obvious locus for activists for sexual rights and sexual orientation to assert their right to equal protection.

HY: The rights in the field of gender have been expanded with many concrete progressive steps in recent decades. If I can cite you, you write in your book Fixing Sex: “Research on intersexuality from other than biomedical perspectives is relatively recent and constitutes a small, though growing, body of work. Scholars working in disciplines such as history, sociology, social psychology, philosophy, and comparative literature have made important contributions to understandings of intersexuality in a historical and cultural context.” I support this statement. Can you say more about it?

KK: That statement is starting from a recognition of the power differentials that groups use to define knowledge—the way that various social hierarchies shape who is recognized as an authority, and what forms of knowledge are seen as valid. In so many areas right now, scientism reigns. Scientism minimizes or denies validity of the numerous ways of knowing that exist outside of science. It elevates scientific values, evidence, and authority above all others, leaving us with the question of how do you effect change when biases like this are at play?

Answering this is a real challenge, though, because it requires dismantling a set of ideas that have become very sedimented in the West and beyond. Let me give you a concrete example. Testosterone is a stand-in for masculinity and the traits and values associated with males. At the same time, it symbolizes biology, nature in general, as well as science and the values associated with science like objectivity. Because T is coded as natural and in the realm of biology, talk about testosterone fundamentally serves scientism, even as it paradoxically obviates the need for evidence. 

In the decision about Dutee’s case, the panel mentioned the paper in which we criticized the regulation on both ethical and scientific grounds. As a quick aside, when I testified, I was viewed as lacking the formal expertise to evaluate the science at hand, even though our arguments were echoed by the science witnesses on our side, and accepted by the panel. They also judged my discussion of ethical principles (e.g., fairness, notions of normal, and the question of medical need) to be outside the realm of relevant evidence for judging the regulation, and indeed, as outside the purview of “knowledge,” casting my testimony as “sociological opinion, which does not equate to scientific and clinical knowledge and evidence.” This response showed that folk ideas about testosterone not only substitute for evidence, but make demands for concrete, empirical details about testosterone appear puzzling or even unnecessary. Ultimately I was disappointed because though they made the right decision in the case, it was not the reasons I would have liked.

HY: Does not the gender study need to read more, Hegel, Marx, Gramsci, Trotsky, Benjamin, Rosa Luxemburg, Kolontai, Perry Anderson, Tariq Ali, Harry D. Harootunian, Michael Löwy etc.?  So that development continues to evolve? Or do you even see in such a relationship a productive synthesis?  Does the gender study not have to become more socially? 

KK: This really dovetails with our above conversation. We have had a great deal of really excellent work in theories of gender, sexuality, and race, for example, over the last three to four decades. What I am interested in is how we use that theory not simply to analyze problematic practices and policies, but how to use those analyses to minimize harm in concrete ways, to fight against oppression. 

This is where feminist epistemologies and methodologies become important. They are significant in any number of ways: when choosing the topics we study, framing the questions we ask, the way we go about answering them, the partnerships and alliances we seek, how we work with research “participants,” and the venues in which we publish, all of which are critical decisions.

I am committed to research that illuminates pressing social issues by encouraging broad, public conversations with the explicit aim of social change. One aspect is rigorous academic analysis and the second is translating this work for general audiences with the implicit goal of minimizing harm. I publish wherever the argument will have the most impact. This is rarely in journals specific to my discipline. I realized when I wrote my first book very few doctors were going to read it looking for insights, which led me to translate those findings and place them in medical journals. With this work, we went straight to publishing in the kind of journals that would give our claims a certain weight, especially given what I said earlier about judgments about who is an authority. It’s strategic and it’s also very effective.

A friend quoted Foucault to me years ago, saying, "The real political task in a society such as ours is to criticize the workings of institutions that appear to be both neutral and independent, to criticize and attack them in such a manner that the political violence that has always exercised itself obscurely through them will be unmasked, so that one can fight against them." I like to think that much of my work has been and will continue to be in service to that task.

[Michel Foucault, The Chomsky - Foucault Debate: On Human Nature]

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