A Feminist Neuroethics of Mental Health

By Ann E. Fink

Ann Fink is currently the Wittig Fellow in Feminist Biology at the University of Wisconsin–Madison, with an appointment in Gender and Women’s Studies and concurrent affiliations with Psychology and the Center for Healthy Minds. Her research in cellular and behavioral neuroscience has appeared in the Journal of Neuroscience, Journal of Neurophysiology, PNAS and other journals. Ann’s interdisciplinary work addresses the ethics of neuroscience in relation to gender, mental health and social justice. 

Emotionality and gender are tied together in the popular imagination in ways that permeate mental health research. At first glance, gender, emotion, and mental health seem like a simple equation: when populations are divided in two, women show roughly double the incidence of depression, anxiety, and stress-related disorders^1-3. Innate biological explanations are easy to produce in the form of genes or hormones. It could be tempting to conclude that being born with XX chromosomes is simply the first step into a life of troubled mood. Yet, buried in the most simplistic formulations of mental illness as chemical imbalance or mis-wiring is the knowledge that human well-being is a shifting, psychosocial phenomenon. Learning and memory research offers a treasure trove of knowledge about how the physical and social environment changes the brain. Feminist scholarship adds to this understanding through critical inquiry into gender as a mode of interaction with the world. This essay explores how a feminist neuroethics framework enriches biological research into mental health. 

Problems with “Biology-from-birth” stories 

What if understanding gender and health isn’t a tale of two gonads (or genitalia, or chromosomes)? The primary theoretical problem with applying binary biology to health is essentialism^4,5, an oversimplified view of gender as comprising two distinct groups of people separated by innate and static biological traits. Feminist neurobiology counters this view with the observation that gender, a complex biopsychosocial phenomenon, cannot be reduced to dimorphism. This is illustrated by work from neuroimager Daphna Joel indicating that brains (unlike most genitalia) live happily in the land of intersex. Joel proposes a “brain mosaic”: human brains are a hodgepodge of statistically “male”-biased, “female”-biased, and neutral characteristics, rather than reflecting two categories⁶. Similarly, psychologist Janet Hyde demonstrates that genders are more alike than different in most cognitive and behavioral characteristics⁷.

The different components of biological sex.

Image courtesy of Wikimedia Commons.

What about those characteristics that differ by crude biological measures of sex? To ignore binary health disparities could be irresponsible. This reasoning precipitated the 2015 NIH mandate to study “sex as a biological variable”⁸, a corrective for the exclusion of “female” tissues and organisms from prior biomedical research. This move has in turn raised questions about what it means to properly study sex, and what, if anything, such research has to do with gender^9,10. The problem: sex and gender represent complex, interacting outcomes of social and biological forces. The first danger of essentialism is, therefore, to scientific knowledge in its own right. Other potential forms of harm then emerge from this oversimplification.

One danger of “biology-from-birth” stories is the possibility of iatrogenic (arising from medical care) disparities in health arising from inappropriate treatment differentials. As an example^9,10 the hypnotic drug zolpidem is cleared more slowly, on average, from women’s bodies compared to men’s, leading to concerns about inappropriate dosing. This gender difference, however, is mediated by weight, which correlates with gender. Potential harm and benefit emerge from this example. Dosing by gender risks overdosing men who weigh less than average, and ineffectively dosing women who weigh more than average. To base decisions on gender, rather than directly predictive indicators, in such cases might constitute negligence. This concern is amplified for people who do not fit neatly into binary categories of sex/gender.



Mental illness labels raise unique questions about autonomy and psychological competence. Furthermore, the definition of psychological disorders is particularly entangled with gender roles. Innate biological explanations risk activating stigma¹¹ by framing mental illness as static and disqualifying, and equating susceptibility with inferiority. The interactions of gendered stigma and mental health stigma can also deliver a double-hit of marginalization¹². The medico-social risks of stigma and assessments of incompetence include undermined consent, patient autonomy, and bodily integrity, as seen, for instance, in the dismal and ongoing justification of coerced sterilizations (tellingly, first labeled “asexualization”¹³). In a more subtle example, one suspected reason for women’s disproportionate cardiovascular mortality is their more frequent referral to psychiatrists than cardiologists (e.g. [14]).

Image courtesy of Wikimedia Commons.

If essentialist categories of identity and mental illness pose a threat to the health and autonomy of pathologized groups, a related risk is the justification of ongoing inequities and violence in larger social structures. Early-life maltreatment and lifelong adversity are major additive risk factors for poor psychological and physical health^15,16; these vary by gender and other aspects of social identity^17,18. Economic instability follows suit: a 2016 study links the gender wage gap to mood disorders¹⁹. To willfully ignore gendered, racialized or otherwise targeted harm in assessing health risk is to tacitly condone such harm. A feminist neuroethics recognizes the need to address social causes of biological susceptibility. 

The future of gender, neurobiology and mental health 

Feminist neurobiology avoids the pitfalls of simple, untenable “biology-from-birth” explanations. Rippon et al.’s guidelines for sex/gender research in neuroimaging⁴ are broadly applicable: their framework takes into account gender similarities (“overlap”) and brain mosaicism, recognizing brains as the ever-changing material substrates for equally dynamic mental states and social interactions (“entanglement”). They also call for improved experimental design, analysis²⁰, and interpretation. Feminist neuroethics respects historicity in science, acknowledging prior harm and proposing restorative and protective measures²¹. Feminist ethics can also protect against other forms of biological essentialism, including deterministic concepts of mental capacity. In agreement with philosopher Helen Longino’s formulation of science as a social endeavor requiring participation by a representative community²², feminist analyses acknowledge that mental health represents a continually debated set of norms.

Finally, a feminist neuroethics incorporates social causality and responsibility into biobehavioral health. Its guiding principle is a sustained attention to the problems of power, violence, and inequality that are so readily buried in reductionist research models. This view adds to mental health research by asking: 1) what interventions curb the staggeringly gendered experience of sexual and intimate partner violence²³ or the exposure to stress and deprivation that contribute to both social stratification and mental illness?, and 2) what are the neurobiological effects of, and remedies for, marginalization and interpersonal violence? (for starters, see: 24-26). A feminist neuroethics invokes biology as an enquiry into a dynamic world, embraces ambiguity, and promises a more nuanced and valuable knowledge of human health. 

References

1. Altemus, M., N. Sarvaiya, and C.N. Epperson. 2014. Sex differences in anxiety and depression: clinical perspectives. Frontiers in Neuroendocrinology 35(3): 320-330. 

2. Steel, Z., C. Marnane, C. Iranpour, et al. 2014. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. International Journal of Epidemiology 43(2): 476-93. 

3. Kessler, R. C., P. Berglund, O. Demler, et al. 2005. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):593–602. 

4. Rippon, G., R. Jordan-Young, A. Kaiser, and C. Fine. 2014. Recommendations for sex/gender neuroimaging research: key principles and implications for research design, analysis, and interpretation. Frontiers in Human Neuroscience 8: 650. 

5. Haslam, Nick, and Jennifer Whelan. 2008. Human natures: Psychological essentialism in thinking about differences between people. Social and Personality Psychology Compass 2, no. 3 (2008): 1297-312. 

6. Joel D, Berman Z, Tavor I, et al. (2015) Sex beyond the genitalia: The human brain mosaic. PNAS 112(50): 15468-15473. 

7. Hyde, J.S. 2005. The gender similarities hypothesis. American Psychologist 60: 581-592. 

8. Clayton, J. A., and F. S. Collins. 2014. Policy: NIH to balance sex in cell and animal studies.  Nature 509 (7500):282-3. 

9. Richardson, S. S., M. Reiches, H. Shattuck-Heidorn, et al. 2015. Opinion: Focus on preclinical sex differences will not address women's and men's health disparities.  Proc Natl Acad Sci USA 112 (44):13419-20. 

10. Ritz, S.A., D.M. Antle, J. Cote, et al. 2014. First steps for integrating sex and gender considerations into basic experimental biomedical research. The FASEB Journal 28: 4-13. 

11. Rusch, N., A. R. Todd, G. V. Bodenhausen, and P. W. Corrigan. 2010. Biogenetic models of psychopathology, implicit guilt, and mental illness stigma. Psychiatry Research 179(3): 328 – 332. 

12. Koenig, Anne M., and Alice H. Eagly. 2014. Extending Role Congruity Theory of Prejudice to Men and Women With Sex-Typed Mental Illnesses. Basic & Applied Social Psychology 36 (1):70-82. 

13. Stern, A. M. 2005. Sterilized in the name of public health: race, immigration, and reproductive control in modern California.  Am J Public Health 95 (7):1128-38. 

14. Maserejian, N. N., C. L. Link, K. L. Lutfey, et al. 2009. Disparities in physicians' interpretations of heart disease symptoms by patient gender: results of a video vignette factorial experiment.  J Womens Health (Larchmt) 18 (10):1661-7. 

15. Cohen, S., D. Janicki-Deverts, and G. E. Miller. 2007. Psychological stress and disease.  JAMA 298 (14):1685-7. 

16. Felitti, V. J., R. F. Anda, D. Nordenberg, D. F., et al. 1998. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study.  Am J Prev Med 14 (4):245-58. 

17. Berger, M., and Z. Sarnyai. 2015. "More than skin deep": stress neurobiology and mental health consequences of racial discrimination.  Stress 18 (1):1-10.  

18. Westfall, N. C., and C. B. Nemeroff. 2015. The Preeminence of Early Life Trauma as a Risk Factor for Worsened Long-Term Health Outcomes in Women.  Curr Psychiatry Rep 17 (11):90. 

19. Platt, J., S. Prins, L. Bates, and K. Keyes. 2016. Unequal depression for equal work? How the wage gap explains gendered disparities in mood disorders.  Soc Sci Med 149:1-8. 

20. Fine, Cordelia, and Fiona Fidler. 2015. Sex and Power: Why Sex/Gender Neuroscience Should Motivate Statistical Reform. In Handbook of Neuroethics, ed. Jens Clausen and Neil Levy, 1447-1462. 

21. Chalfin, M. C., E. R. Murphy, and K. A. Karkazis. 2008. "Women's neuroethics? Why sex matters for neuroethics."  Am J Bioeth 8 (1):1-2. 

22. Longino, Helen E. 1990. Science as social knowledge : values and objectivity in scientific inquiry: Princeton, N.J. : Princeton University Press. 

23. Smith, S.G., J. Chen, K.C. Basile, L.K., et al. (2017). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010-2012 State Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Downloaded on 8/4/2017 from https://www.cdc.gov/violenceprevention/nisvs/summaryreports.html 

24. Sapolsky, R.M. (2005) The Influence of Social Hierarchy on Primate Health. Science 308 (5722):648-52.  

25. Cacioppo, JT et al. (2011) Social isolation. Annals of the New York Academy of Sciences, 1231: 17–22. 

26. Hackman, DA et al. (2010) Socioeconomic Status and the brain: mechanistic insights from human and animal research. Nat Rev Neurosci 11(9): 651 – 659.

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Fink, A. (2017). A Feminist Neuroethics of Mental Health. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/08/a-feminist-neuroethics-of-mental-health.html

Diversity in Neuroethics: it’s more important than you might think

By Nicholas Fitz and Roland Nadler**

Nicholas Fitz

Nick is a Graduate Research Assistant at the National Core for Neuroethics at the University of British Columbia. 



Roland is a third-year J.D. student at Stanford Law School and previously worked as a Graduate Research Assistant at the National Core for Neuroethics at the University of British Columbia.



**equal contribution

Roland Nadler

The second decade of neuroethics is now well underway. Much like the human brain itself, some of its developmental “critical periods” have run out, but many others remain open. How will we use these remaining opportunities to shape the field?



Junior participants in these spaces should take the initiative to engage with unresolved questions about the nature and structure of neuroethics as a discipline. After all, those of us at the beginning of our careers have a particularly significant stake in the answers to those questions, with most of our academic and professional lives still ahead of us. As we work to integrate society’s growing technological power with best ethical practices and societal values, we must ask: whose practices, whose values?



Last year, in a bid to foster this discussion, we offered three visions for diversity in neuroethics. In that article, we devoted much attention to diversity along intellectual, disciplinary, and political lines.



Today, we offer a few more thoughts on the importance of diversity in neuroethics in the more familiar sense of having a wide array of identities and backgrounds represented in the field.



Chiefly, we hope to convince you that robust identity diversity is beneficial — indeed, crucial — to neuroethics. The field simply could not provide the kinds of insights that it promises if its practitioners were a homogenous group of people speaking comfortably from positions of social power and privilege.



To be sure, neuroethics is off to a strong start in establishing itself as a diverse field. The successes of Neuroethics Women Leaders, especially well-represented at this year’s Society meeting, deserve special recognition in this regard. While there is always room for improvement, we can be glad that neuroethics is not especially male-dominated as disciplines go.



Our purpose in this post, then, is not to allege that neuroethics is insufficiently diverse — though we should and surely can do better. Our aim, rather, is to highlight that our existing levels of diversity are not merely tangential goods. Heterogeneity is in no way incidental to the field’s ability to carry out its job effectively — much less mere window dressing, a matter of appearances.



Much more than simply insulating the discipline from charges of being exclusionary, diversity positively contributes to the mission of neuroethics. Its contribution can be understood in two senses: a generating sense and an inoculating sense.



Bringing a wide variety of personal experiences and worldviews — along the axes of race, gender, socioeconomic status, (dis)ability, and more — to bear on neuroethics acts as a generator for novel perspectives. If neuroethics is to help steer the responsible use of emerging technology and knowledge, it must acknowledge the ways in which that project touches on bias (from implicit identity biases to larger structural inequalities) and on the heterogeneity of lived experience. And it needs a maximally broad pool of perspectives to draw its critiques from: if that pool lacks, for example, the perspective of transgender people, we may go a long time without realizing how our conversations about the relationship between personal identity and the brain skate blithely over flawed assumptions about gender.



Concretely, then, those at the field’s power centers must reach out in support of investigators from a variety of backgrounds. There is much wisdom to be found in a diverse crowd.

From Phillips, 2014

Meanwhile, one of the greatest pitfalls for any meta-scientific discourse is the tendency to interpret seemingly neutral or objective facts in ways that serve established ideologies. This risk is heightened even more when the science under discussion has some claim to dealing with the “essence” or fundamental nature of human beings — as the history of research on race and IQ so chillingly reminds us. Diversity in the ranks of neuroethics helps inoculate us against this threat. Ideology has a characteristic way of quietly infecting the way we talk about “the big questions,” and bringing people who are ordinarily pushed to the edges of the discourse into the conversational spotlight is the first step towards immunity.



As we know all too well from recent work on biological essentialism, stereotyping, and the seductive allure of neuroscientific explanations, contemporary neuroscience does not operate in a vacuum, but rather can reinforce social categories. The fact that neuroscience is science — not pseudoscience like its predecessors, craniometry and phrenology — affords little defense against its potential to serve such unacknowledged agendas. As the late Stephen Jay Gould put it, “Shall we believe that science is different today simply because we share the cultural context of most practicing scientists and mistake its influence for objective truth?” By fostering a mosaic community of practicing neuroethicists, the field can help protect itself — and society — from these side effects of neuroessentialism.



Indeed, neuroethicists are especially well-situated to understand the value of diversity. Given that the literature on the causes and consequences of biased and motivated reasoning is an essential point of departure for neuroethical investigation, those in the field already have access to tools and techniques that reduce these biases. But we still have work left to do.



Our next step is to brainstorm ways to collectively wield these tools, and to do so effectively and responsibly. As we further diversify the field, we have a responsibility to convince rather than foist, and to seek grassroots engagement rather than tokenize. Having lent our voices in this call to action, the two of us writing here — hardly embodiments of the diversity we are extolling, after all — ought to step back and open up the space for underrepresented neuroethicists to helm the conversation. We hope our readers will join us in helping this happen!





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Fitz, N. and Nadler R. (2015). Diversity in Neuroethics: it’s more important than you might think. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/02/diversity-in-neuroethics-its-more.html

Response to “Society Does Not Make Gender” by Dr. Larry Young and Brian Alexander

"A queer symbol of new gender image"

by Finnish artist Susi Waegelein

At the beginning of August, Ruth Padawer published a piece in the New York Times magazine about gender non-conforming children and parents. Last week, Dr. Larry Young of Emory University and science writer Brian Alexander (who are publishing a book together, The Chemistry Between Us) published a response to the article, in which they argue, essentially, that gender is biologically hardwired into the brains of fetuses by the organizational effects of hormones. They go on to implicitly endorse what has been called the “brain sex theory” of transgender identity/behavior. According to this theory, hormones organize the sex/gender of the brain much later than they organize the sex/gender of the genitals, allowing for a discordance to develop between the two (Bao 2011).



Admirably, Young and Alexander use the brain sex theory to argue for an acceptance of gender non-conforming children. They write, “so rather than seeing threat, we should embrace all shades of gender, whether snips and snails, sugar and spice, or somewhere in between.” However, there are (at least) four major problems with their argument: they essentialize gender; they uncritically embrace human brain organization theory; they uncritically embrace the double-edged sword of essentialism on behalf of transgender people; and they selectively (mis)use evidence about intersex and transgender people to support an ideological claim about the innateness of gender differences.





Essentializing sex/gender



In their post, Young and Alexander write, “Society -- toy makers, churches, parents, fashion magazines -- does not make gender.” They go on to argue, “Such [hormonally driven brain] organization, not advertising, is why boys, as a group, are more likely to shoot a doll full of BBs, while girls, as a group, are more likely to dress dolls and "nurture" them.” They also chastise most feminists for trying to “ignore real differences between typical boys and girls.”

Do these things really not make gender?

Photographs by Janet McKnight

I’m going to assume for the sake of my own sanity that what Young and Alexander meant was “society alone does not make gender.” If that’s what they meant, I agree wholeheartedly. Feminist sciences studies scholars view sex/gender as the product of a continuing interaction (or “intra-action” as Karen Barad puts it) of biological and social factors, within a larger framework that sees the biological and the social as co-constitutive.

If Young and Alexander meant (improbably) that “society does not at all make gender,” then I refer them to the fields of history and anthropology, which have spent decades accumulating evidence that ideas about gender vary across time and culture, and that different ideas about gender influence how people think, feel, and behave as gendered beings. I would also point out that evidence of average differences between populations of boys and girls or men and women do not, in themselves, confirm the innateness of gender as even infants adapt themselves to the gendered contexts in which they find themselves. And if you believe that in today’s world, infants, children and adults are no longer socialized into gender roles, then I refer you once again to Cordelia Fine’s excellent book, Delusions of Gender, in which she uses substantial evidence, primarily from cognitive science, to argue that gender stereotypes are very much alive and well and that these stereotypes powerfully influence our feelings, thoughts, and behavior, often unconsciously.



Uncritical embrace of human brain organization theory

Image from Harvard University Press

Young and Alexander write, “Unfortunately, neither side [those who encourage gender diversity and those who oppose it] seems to have heard of something called the Organizational Hypothesis.” Unfortunately, neither Young nor Alexander seems to have heard of the serious critiques that have been made of the Organizational Hypothesis in regards to humans. The most comprehensive critique has been made by Rebecca M. Jordan-Young in her book Brain Storm: The Flaws in The Science of Sex Differences (2010). In the book, Jordan-Young reviews the more than three-hundred scientific studies conducted between the late 1960s and 2008 on the organizational hypothesis in humans. She concludes that the evidence from these three-hundred studies is too disjointed and even contradictory to provide real support for the claim that sex/gender or sexual orientation are “hardwired” into the human brain prenatally by the action of hormones. According to Jordan-Young, in the three domains with the most evidence for hard-wiring – feminine and masculine sexual behavior, sexual orientation, and sex-typed interests – different scientists have used such different definitions of, for example, “feminine sexuality” that different studies cannot actually be said to support one another.

I don’t have the space here to summarize the entire book. Slate has a slightly longer summary here. I would recommend the book to everyone and especially to scientists conducting research in the field of brain organization theory. Even if scientists end up disagreeing with Jordan-Young’s analysis, it at least needs to be reckoned with, which Young and Alexander clearly have not done.



Uncritical embrace of the double-edged sword of essentialism



In another post for the Neuroethics Blog, Cyd Cipolla talks about the “double-edged sword of essentialism” and sexual orientation. A number of gay-rights supporters have argued that scientific evidence for the innateness of homosexuality (a gay person is “born this way”) should lead to an increase in acceptance for homosexuality. However, as Cyd points out, depending on your already formed beliefs about homosexuality, you could also use scientific evidence for the innateness of homosexuality either to develop biological/medical “treatments” for homosexuality or to conclude that homosexual people can’t be “fixed” and thus should be eradicated. At the same time, calling for gay rights on the basis of the innateness of homosexuality excludes from the conversation those gay people who do not believe their sexuality is innate (remember the furor over Cynthia Nixon’s comments?).

Classic "born this way" argument for gay rights

Are they also are referencing the hypothesized relationship between sexual orientation and handedness?

Picture by Photo Munki

As in the case of sexual orientation, some transgender activists have argued that transgender people are “born this way” and thus should be accepted by society. Some trans activists and allies have specifically used the “brain sex theory” to support their claim that transgender people are “born this way” (e.g. “A Conversation with Milton Diamond, Ph.D.” in The Phallus Palace). This is basically the claim that Young and Alexander make, arguing that gender non-conforming children should not be forced to conform to expectations “in opposition to their wiring” as “in the end, our brains will out.”

However, as in the case of sexual orientation, this plea for acceptance on the basis of innateness is double-edged sword. The “brain sex theory” could also be used to develop biological/medical “treatments” for transgender identity/behavior. At the same time, arguing that gender is fixed before birth (even if arguing that gender may be incongruent with chromosomes and/or genitals) may exclude gender-fluid people from the conversation (to my knowledge, the brain organization theory doesn’t account well for gender fluidity, if I’m wrong, please let me know).



Selective (mis)uses of evidence about intersex and transgender people to support an ideological claim about the innateness of gender differences



Some feminist scholars and queer theorists have used intersex people or transgender people as evidence to support arguments about the social construction of gender (for a critique, see Invisible Lives by Vivian Namaste). Alternatively, a number of scientists have used intersex people as evidence to support arguments about the innateness of gender differences. Both uses are problematic if the ideological lens employed in any particular argument obscures the complexity of intersex or transgender lives.



In their post, Young and Alexander use studies of people with 5-alpha reductase deficiency (5-ARD) to provide evidence for the innateness of gender (people with 5-ARD are exposed to male-typical levels of androgens prenatally, but appear to be female until puberty, at which point their bodies become more male-typical looking). Jordan-Young extensively critiques the interpretation of studies of people with 5-ARD offered by brain-organization theorists (see pages 66-69). Of the use of any study of intersex people to support brain-organization theory, Jordan-Young writes, “the controversy recounted above highlights the difficulty in deciding whether psychosexual differences among intersex people are due to the direct effect of hormones on the brain, or to other factors like indirect effects on behavior via the development of atypical genitals, or the experience of illness and multiple surgeries” (78).

Young and Alexander also reference androgen-insensitivity syndrome so I am including this picture again:

"Women with AIS and related DSD conditions who want AIS to be represented by real, proud people instead of stigmatizing pictures where the face has been removed"

Image by Ksaviano

Although Young and Alexander don’t quite argue that transgender people provide evidence for the innateness of gender, some studies have made precisely this claim (e.g. Garcia-Falgueras et al. 2011). As in the case of the use of intersex people as evidence for gender-innateness, I believe the use of transgender subjects as evidence gender-innateness often obscures the complexity of transgender lives. Ironically enough, some of the gender non-conforming children described by Ruth Padawer don’t seem to be well accounted for by the “brain sex theory.” One boy, Alex, switches back and forth between feminine and masculine dress and behavior. A second boy, Jose, went through a long period during which he wanted to dress and behave in “girly” ways. By age 9, he was much less interested in wearing dresses, although he still liked to play with dolls. Understanding these complex lives requires understanding the role of ever-changing ideas about what are appropriate dress and behavior for boys and girls and the role of biology in the production of sex/gender identity and behavior.



A simple plea



In sum, while I agree with the main conclusion of Young and Alexander’s post (that we should embrace all shades of gender), the way they make their argument is problematic as it essentializes gender, uncritically accepts human brain organization theory, bases a call for transgender acceptance on biological essentialism, and (mis)uses studies of intersex people to support an ideological claim about gender essentialism.

Image from Routledge

In other blog posts, I have encouraged neuroscientists to contribute thoughtfully to public discussions about gender and sexuality. Neuroscientists can perform an important service by explaining neuroscience research to the public and by reflecting on the ethical and/or policy implications of this research. To this encouragement, I would add another: neuroscientists who want to participate in public conversations about ethics and policy would do well to engage with scholars in other fields, especially the social sciences and humanities, who are working in similar areas. For example, I would encourage Young and Alexander to consider engaging with scholars in the emerging field of Transgender Studies (yes, there is a small, but growing field – check out this reader for an introduction) if they plan to continue contributing to public conversations about trans issues. I remain convinced that conversations across disciplines will lead to more thoughtful and reflective work, including more thoughtful and reflective public scholarship, on the part of all involved.



I end with a simple plea: regardless of the relative contributions of genetics, prenatal hormones, parenting, environment of rearing, social expectations about gender, or personal agency in the production of any gender non-conforming child’s sex/gender identity or presentation, all gender non-conforming children deserve love and support and they deserve to be free from harassment and bullying, especially at school. Period.







Want to cite this post?

Gupta, K. (2012). Response to “Society Does Not Make Gender” by Dr. Larry Young and Brian Alexander. The Neuroethics Blog. Retrieved on
, from http://www.theneuroethicsblog.com/2012/08/response-to-society-does-not-make.html

Gay Brains, Gay Gene, Gay Rights: The Double-Edged Sword of Essentialism

As the semester drew to an end, and Kristina Gupta and I
closed out our course on Feminism, Sexuality, and Neuroethics, I have been
thinking a lot about the science of sexual identity. Participants in our class set out to consider the ethics of separating human beings into distinct kinds and
conducting neuroscientific research into those separations. Along the way, we
all thought about what the boundaries of sexuality and gender were, how they
are culturally bound, how desire is measured (and mismeasured), both in the
contemporary era and throughout history. We considered the use of these
differences to create legislation and the effects of both medicalization and
pathologization for members of sexual minorities.

I'm sure this is exactly what happens.

(Original image from hyperboleandahalf.com)

On the last day of class, we asked our students to take into
consideration all the discussions we had had over the course of the semester
and reflect on their own opinions about the scientific study of sexuality. One
student answered almost immediately.[1] Of
course it is appropriate for science to study sexuality, said the first student. Science is
always appropriate. It is always better to know than not to know. There were
nods. Yes – we were all solidly on board with the acquisition of knowledge. But
then a second student responded. This is an area where we have to be careful. Any advance in the study of sexuality could be taken as evidence of
an essential difference between gay and straight people. The second student could think of no
positive use for such knowledge, given the prejudice towards gay people in much
of the world.  Science, the student concluded,
should not be used to make the lives of these people worse.

These two viewpoints get at a question I am often asked (this is what happens when you introduce yourself as a sexuality scholar at parties) – Do I think gay people are born that way? (I generally answer that I don’t think it matters, for reasons I hope are about
to become clear.)

To explain, I will go back a little bit to 1994, when legal scholar Janet Halley published an article in
the Stanford Law review called “Sexual Orientation and the Politics of Biology:
a Critique of the Argument from Immutability.”[2]
The article is largely a critique of a certain legal strategy in which the biological basis of homosexuality is used to argue
for making gay men and lesbian a suspect class under the Equal Protection
Clause of the constitution. I won’t go into the details of that here, both
because it isn’t really the main reason I bring up Halley’s argument and
because this strategy is less relevant than it once was,[3]
except to say that Halley argues for abandoning the use of biological arguments
as a premise for gay and lesbian rights.



Halley points out that
the argument from immutability is not, in and of itself, necessarily pro-gay.
That is, there is no correlation between ethical beliefs about homosexuality
and the supposed “naturalness” of that sexuality. Regardless of whether finding a gay gene would help secure
equal marriage rights,[4]
finding a gay gene won’t even necessarily convince people that being gay is
morally acceptable.



Halley’s article contains a clear and concise map of what she sees as four opposing positions in the argument for gay and lesbian rights. She separates theories of sexuality into two basic types: essentialist arguments, which include any theory that sexuality is fixed, whether it be material or pathological, and constructivist ones, in which sexuality is fluid. Either argument can be used in a pro-gay or an anti-gay way, leaving us with the four opposing positions: : pro-gay essentialism, pro-gay constructivism, anti-gay essentialism, and anti-gay constructivism. She argues that legal theorists should seek out the
support of pro-gay constructivist activists, because this, in the end, is the
model that would achieve the widest social change.

	Pro-Gay	Anti-Gay
Essentialism	Born This Way!	Aberration!
Constructivism	Sexual Freedom!	Corruption!

Looking at Halley’s four categories, we can see that some of
them are pretty straightforward, while others are a bit more complicated. One
particular brilliant part of Halley’s system is how quickly these categories
can unfold. For example, if we consider the idea of anti-gay constructivism, it
allows us to see how the arguments that homosexuality is a choice or a
lifestyle are related to arguments for how legalizing
same-sex marriage undermines different-sex marriage. That is, the mutability of
heterosexuality is implicit in any argument that “promoting the gay lifestyle”
is eroding family values because this argument assumes that straight people could choose to become gay.



However, these categories are not absolute, nor do they map perfectly onto our current understanding of sexuality. For Halley, seeing homosexuality as a psychological perversion is a form of anti-gay essentialism because it assumes gayness can be cured under treatment by a doctor. This always makes sense to me initially, but then I think, wait, if sexuality can be changed by talk therapy, is it an essential material truth? What if it requires medication? Shock therapy? Exorcism? The line here is much harder to see, which, of course, belies the true aim of this article: that actual human sexual behavior is too complex to fit into discreet categories.

Anti-gay Essentialism...?

Now- what does this have to do with the science of
sexuality? It comes down to this: our student expressed a concern about
doing research in an area of current social and moral debate where it was possible scientific knowledge could be used in a way the researchers had not intended.
If neuroscientific research were to uncover a biological basis for sexuality,
or a correlation between a certain brain region and certain sexual thoughts,
there is no question that there would be some people who would see this as an
opportunity to control homosexual behavior.

Yet, at the same time, greater understanding of human sexual
behavior does lead to wider acceptance. Take that anti-gay therapy I just mentioned.
There has been a recent spate of news articles about the widespread failure of
what was once promoted as a cure for homosexuality.[5]
There is a feeling of triumph of nature (whatever that may mean to each of us)
over nurture, that is, it seems that many assume the reason psychological
treatments and behavioral modification therapies do not work is because gayness
is innate, and innate in a way that cannot be reached psychologically. This is a monumental triumph for many, many men and women who
suffered in silence in these treatment programs, who internalized their
inability to change and viewed it as their own personal failure. To people in
these situations, scientific proof of innate sexual difference would come as a
reprieve.

Pro-Gay Essentialism

And this is the double-edged sword of biological determinism.
On the one hand, proof that gay people are born this way could put the final
nail in the coffin of the Exodus movement, and could, perhaps, begin to build
the foundation for a new form of sexual ethics. On the other hand, material
difference in sexuality could lead to a whole new form of gay cures and
treatments. For some, this treatment may come as a different kind of reprieve.
Others might not be given a choice.

In the end, the question “Are gay people born that way?” matters because whether or not someone is gay matters, and why it matters has more to do with people's ethical beliefs about sexual practice than with any concept of the natural. What dictates the acceptability of material proof of sexuality is the acceptability of sexuality, not the form of material proof. Further, although these discussions tend to break down into deciding the difference between "gay" and "straight," the fact of the matter is that there is a staggering array of diversity in sexual practice and sexual identity. It is not as simple as deciding
what we should or should not do about the “gay gene” or the “gay brain:”[6]
not only because of the complexities of genes, brains and gayness, but also
because it is impossible to imagine a one-size-fits all ethics for the study of
sexuality. As we close out another school year, I imagine, or at least I hope, the participants in our class this semester go out into the world with a greater appreciation for this complexity. I wish you all enjoyable and restful summers!

Want to cite this post?


Cipolla, C. (2012). Gay Brains, Gay Gene, Gay Rights: The Double-Edged Sword of Essentialism. The Neuroethics Blog. Retrieved on
, from http://www.theneuroethicsblog.com/2012/06/gay-brains-gay-gene-gay-rights-double.html

---

[1] I paraphrase here because my memory is not perfect and my note-taking skills leave something to be desired. I believe I have gotten
the spirit of their comments right if not the exact form.

[2] Janet E. Halley, "Sexual Orientation and the Politics
of Biology: A Critique of the Argument from Immutability," Stanford Law Review 46, no. 3 (1994). http://www.jstor.org/stable/1229101

[3] Lawrence v. Texas; Evan Gerstmann, The
Constitutional Underclass : Gays, Lesbians, and the Failure of Class-Based
Equal Protection (Chicago ; London: University of Chicago Press, 1999).

[4] Spoiler
alert: It probably wouldn’t, see note 3.

[5] See Gabriel Arana’s
account of his own experience in ex-gay therapy, and Robert
L. Spizter apologizing for backing the idea.

[6] Both of
which seemed much more plausible in 1994, when Halley’s article was published.

Almost Ten Years On: Why are we still talking about The Essential Difference?

Simon Baron-Cohen’s book, The Essential Difference: The Truth About The Male And Female Brain (2003), is almost a decade old now, but his thesis keeps popping up in various places. For example, in a recent (and truly delightful) book on neuroscience and religion, Why Religion is Natural and Science is Not (2011), Robert McCauley uses Baron-Cohen’s work to suggest that researchers looking for “hyper-empathetic” subjects might want to check out the local convent.

Baron-Cohen’s main argument is that, on average, men and women have different cognitive strengths and weaknesses: men are more adept at “systematizing” and less adept at “empathizing,” while women are more adept at “empathizing” and less adept at “systematizing.” He goes on to argue that people with autism have “hyper-male” brains (in other words, they are especially good at systemizing and particularly poor at empathizing). According to Baron-Cohen, these differences in cognitive abilities are likely to be the result of genetic differences (both in the case of men and women and in the case of people with autism and people without autism).

I will leave it to others with more knowledge about autism to continue to debate Baron-Cohen’s thesis that autism is characterized by an aptitude for systematizing and by deficits in empathizing abilities, and will focus instead on his argument about sex/gender difference. His argument that these differences are primarily genetic or “hardwired” has been ably critiqued by Lesley Rogers. On average, men and women may have different ways of thinking, but these differences are undoubtedly influenced by gender role socialization (in addition to genetic factors). In societies in which women were denied access to education and were given primary responsibility for childcare, differences in patterns of thinking were most likely exaggerated. In theory, we could further reduce differences (or even reverse the averages) if we sent boys to schools in which only language and social etiquette skills were taught and if we sent girls to schools in which only math, science, and motor skills were taught.[1]

I see an even bigger problem
with Baron-Cohen’s argument in how he uses the constructs “empathizing” and “systematizing.”
When looking at averages, researchers have found small sex/gender differences in
cognitive, motor, and personality characteristics. Yet, these differences have
been found in very specific domains (i.e. on average, men may be better at some
types of visual-spatial processing while women may be better at some aspects of
language processing and some aspects of empathizing).[2] Baron-Cohen chooses to amalgamate
all of these different domains under the two constructs of empathizing and
systematizing; thereby suggesting that a number of small differences in degree should
be seen as two differences in kind (empathic vs. non-empathic and systematizing
vs. non-systematizing). By arguing that more men are good systematizers and
poor empathizers, and more women are good empathizers and poor systematizers,
he thereby suggests that male and female brains (on average) don’t differ from
each other by degree in some domains but in fact constitute two different
kinds.



 

And although Baron-Cohen
denies it, his definition of what counts as “systematizing” seems highly
reliant on gender stereotypes. When talking about boys and men, he sees their
interest in memorizing sports statistics as evidence of their systematizing
ability. He also sees their preoccupation with gaining social status through
force as evidence for their lack of empathizing abilities and as
evidence for their abundance of systematizing abilities because, in this case,
“social hierarchies are systems” (36). Yet, when talking about girls and women,
he interprets their preoccupation with gaining social status through covert
actions as evidence of their empathizing abilities but he does not see this as
evidence of their systematizing abilities (in this case, social hierarchies are
apparently not systems?). Elsewhere, he argues that girls are better at gaining
access to a group of strangers because girls are “more likely to stand and
watch for awhile in order to find out what is going on, and then try to fit in
with the ongoing activity” (42). Again, this is interpreted as evidence for
empathizing abilities but not as evidence for systematizing abilities. Why
wouldn’t we interpret this, sans evidence to the contrary, as support for the
idea that girls are both empathic and systematic?




 

It seems to me that
Baron-Cohen simply takes everything that girls and women do as evidence for
their empathizing and “theory of mind” abilities but not as evidence for
their systematizing abilities, while taking everything that boys and men do as
evidence for their systematizing abilities and as evidence for their
lack of empathizing and theory of mind abilities. In this way, Baron-Cohen is
simply drawing on the centuries-old association of masculinity with rationality
and femininity with emotionality. For me, this raises the question: why do so
many scholars, both within cognitive science and within those fields that
connect cognitive science to the social sciences and humanities, remain so
enamored with Baron-Cohen’s thesis?

--Kristina Gupta

Emory Women's, Gender, and Sexuality Studies Ph.D. Candidate,

Emory Neuroethics Scholars Program Fellow

Want to cite this post?


Gupta, K. (2012). Almost Ten Years On: Why are we still talking about The Essential Difference? The Neuroethics Blog. Retrieved on
, from http://www.theneuroethicsblog.com/2012/01/almost-ten-years-on-why-are-we-still.html

---

[1] For an example of how these differences might be attenuated through learning, see the article“Playing an Action Video Game Reduces Gender Differences in Spatial Cognition” by Feng, Spence, and Pratt (2008).

[2] For a recent review of sex/gender differences in cognitive, motor, and personality characteristics, see Hine 2010. Many studies have tested sex/gender differences in empathy using different measures and have found statistically significant differences between men and women (for a review of sex/gender differences in empathy, see Schulte-Rüther et al 2008). A number of studies have found that on average, men are better at tasks such as targeting, mental rotation, and visuospatial processing (for a recent study of sex/gender differences in targeting abilities, see Moreno-Briseño et al 2010).

Neuroethics journal club: Right-brained, wrongly reasoned

Who’d believe there’s a liberal professor (he freely acknowledges he belongs to this group) that’s willing to admit that conservatives might be right about something? Don't get too excited; he also thinks the reasoning that many conservatives use to decide what’s right is all wrong. What’s more, he thinks that neuroscience proves the way that many conservatives reason is wrong. The professor, Dr. John Banja, led a discussion of one of his articles last Wednesday at the second meeting of the Neuroethics Journal Club hosted by the Neuroethics Program at the Emory Center for Ethics.



I had this great idea to summarize Dr. Banja's message with music videos. It turned out to be harder than I thought (but I'm still peppering this post with pop)--there is not one song that has the words "virtue essentialism" in the title, although those words are in the title of Dr. Banja’s article: “Virtue Essentialism, Prototypes, and the Moral Conservative Opposition to Enhancement Technologies: A Neuroethical Critique”. Banja describes virtue essentialism as a type of argument often employed by scholars like Leon Kass, Gilbert Meilander, and Michael Sandel. According to Banja, there are three characteristics of “virtue essentialist” arguments: (1) they invoke concepts like “dignity” as if those concepts have an essence--i.e., definition--that everyone agrees upon, (2) they adopt absolutist positions, because their positions supposedly are based on clearly-defined concepts and, (3) they attack anything that smacks of moral relativism.



You might wonder why you should be worried about this virtue essentialism that Dr. Banja describes. Consider this: virtue essentialist arguments make up the backbone of many of the publications authored by President George W. Bush's President's Council on Bioethics (PCB). W announced he was creating the PCB back in 2001, during the same speech in which he announced he would only allow embryonic stem cell research to be carried out on cell lines already in existence. Bush promised that the council would "consider all of the medical and ethical ramifications of biomedical innovation," and appointed Leon Kass to be the head of the council.



You might still be wondering why this is relevant in today’s political atmosphere. We talked about that at the journal club, too. First I’ll explain how we got there. Banja is not alone in his concern about the arguments made by Kass and others. Ruth Macklin, writing in 2006, dissected just the sort of reasoning--or lack thereof--that Banja wants to attack, all neuroethics style. According to Macklin, issues in bioethics were not black nor white before these self-styled "conservatives" came along; she explicitly links their appearance to the polarized political climate of the Bush regime during which you were either one of us or one of them. Macklin also observes that Kass and others who call themselves "conservatives" in bioethics are characterized largely by being against anything "artificial: artifical reproduction, artificial life extension, artificial intelligence and artificial life, and, in general, making ourselves 'artificially better'."



Didn't I promise there would be rock? Here's David Byrne on "making ourselves 'artifically better'":

Byrne continues the tradition of rockers confounding us all by writing from a perspective that seems a little--gulp--conservative (cf., Graham Parker's You Can't Be Too Strong.)



What's wrong with virtue essentialism and why do we need neuroscience to figure it out? Banja began by discussing "essentialism," which as you might guess is the view that everything has an essence. There is something about Lady Gaga that is essentially Lady Gaga. You might say she was "born this way" (bad joke, sorry). Essentialism, explained Dr. Banja, has been around at least since the time of Plato, who captured it essence (again, sorry) in the Socratic dialogue with Euthyphro, in which Socrates asks what the essence of “holiness” or “piety” is. Socrates runs into Euthyphro down at the courthouse and, thinking that it might help him defend himself in his upcoming court case, asks Euthyphro for a definition of “piety”. As Dr. Banja emphasized, the best Euthyphro can do is come up with some examples. He fails to define it in a way that Socrates can’t deconstruct. Here’s the moral of the story: if it were true that concepts like "holy" had some essence, then we could somehow discern that essence and know when our actions were holy (or "fair" or "just", etc.).



Then Wittgenstein came along and dared to suggest that we might not classify things based on their essence that our god-given reason is supposed to somehow have access to. Instead, he suggested we categorize things based on "family resemblances"--things that they have in common. Wittgenstein's insights spelled the beginning of the end for essentialism. He was implying that there might not be any source of morals outside of humanity. Maybe there's no right or wrong outside of what we say is right or wrong.



Song time again! Perhaps Stereolab can use their perfect pop powers to help us understand the source of the morals that form the backbone of a society.



The once-firm moral foundation that Wittgenstein started to undermine really crumbled once neuroscience and psychology came into the picture, said Dr. Banja. In the 70s, psychologists like Eleanor Rosch began to test how people categorize. These experiments gave rise to prototype theory, a theory that holds that we are able to classify things not because our reason has access to their essence, but because our brains build prototypes. Such prototypes are the “statistical central tendency of a body of concrete exemplars,” to recycle Dr. Banja’s quote from philosopher Andy Clark. In other words, we supposedly classify things by keeping a running average for every category and by measuring the distance of any item we are classifying from the average. I would show you an image from a study Dr. Banja described so that we could understand prototype theory, but in the spirit of this semi-musical post, I think I have to link to songs that neuroscience grad student Laura Mariani mentioned at the journal club. This music, composed by Komar & Molamid and David Soldier, is based on the results of an on-line survey. Click on the links to hear the “prototypes” of what people consider to be the "most wanted song" and "most unwanted song".



Prototype theory, concluded Dr.Banja, presents some problems for virtue essentialist arguments as defined above. It holds that there can be no completely objective definition of concepts like "dignity". Hence, anyone who argues against something like cognitive enhancement because they feel it degrades dignity will have to accept that their idea of what dignity means might not be agreed upon by everyone. This is a good result. It replaces the moral majority with a democratic process of ethics.


In closing, we discussed why virtue essentialism seems to work, even if it is flawed. Dr. Banja recalled the points he made at the end of his article: it works because it appeals to people. It plays their heartstrings. The excesses of the Bush administration showed that Republicans had learned how to hit the right notes to get all the votes, according to Dr. Banja. My labmate Lukas Hoffman countered that you could say the same thing about the Democrats. With the Tea Party on one hand and Occupy Wall Street on the other, it’s certain that people are feeling like something is wrong more and more, and believing that they know what that is. How can they be reminded that everything might not be what it seems? Education is key, offered MD/PhD student Orion Kiefer. And he's right. Anyone who has a sound grasp of science will understand that theories can sometimes be overturned, even theories about right and wrong, and that there’s always room for debate.



Next month's meeting of the journal club will take place November 16th from 1-2pm. You can RSVP by sending an e-mail to neuroethics@emory.edu. Dr. Paul Root Wolpe, director of Emory's Center for Ethics, will facilitate a discussion on emerging technologies and lie detection.



-- David Nicholson

Neuroscience Graduate Student (Sober Lab)



I leave you with one last tune to inculcate you against the siren song of anybody that would make appeals to your gut feelings about what’s right and what’s wrong.





Want to cite this post?


Nicholson, D. (2011). Neuroethics journal club: Right-brained, wrongly reasoned. The Neuroethics Blog. Retrieved on
, from http://www.theneuroethicsblog.com/2011/10/neuroethics-journal-club-right-brained.html