In Already Doing it: Intellectual Disability and Sexual Agency, disability, gender, women's, and sexuality studies scholar Michael Gill explores the sexual regulation of people with intellectual disabilities in the contemporary United States. This important and engaging book builds upon the recent work of feminists and crip/queer disability studies scholars such as Robert McRuer, Margrit Shildrick, and Allison Kafer—as well as the work of queer of color theorists such as Roderick Ferguson and David Eng—to identify, expose, and critique what Gill coins "sexual ableism." Sexual ableism describes the cultural and historical processes, juridical logics, institutional norms, and spatial practices that comprise "the system of imbuing sexuality with determinations of qualifications to be sexual based on criteria of ability, intellect, morality, physicality, appearance, age, race, social acceptability, and gender conformity"(3).

Gill analyzes popular films, radio and television programs, and social media depicting the sexuality of people with intellectual disabilities alongside legal case studies, educational training materials, and the professional and medical discourses of sexuality and intellectual disability deployed by care givers, educators, and legal authorities. These archives suggests a dialectical relationship between cultural representation and social policy around sex and disability and help Gill to explain how and why ableist, heteronormative assumptions about sexuality, pleasure and desire, and consent and competency continue to structure and constrain life choices and sexual expression for people with intellectual disabilities.

One of the book's central arguments is that the sexual epistemologies, identities, experiences, and desires of people with intellectual disabilities need to be heard, acknowledged, and respected on their own terms and not erased, controlled, or narrated by others according to the concerns of "an ableist, racist, classist, sexist, and heteronormative society"(105). Already Doing It is a title meant to highlight how people with intellectual disabilities "are already and always active sexual agents, in a sense already doing it and knowing it" (80). This reality, Gill argues, requires us to reexamine and challenge the ableist, heteronormative assumptions that frame established understandings of sexuality and intellectual disability.

Such assumptions include the idea that intellectually disabled people are not qualified to marry, form families, or raise children, that sexual pleasure is "risky" and "inappropriate" for intellectually disabled people, that IQ is a reliable register of sexual knowledge and capability and that LGBTQ identities and sexual practices in particular—and sexual activity in general—is not pertinent to the lives, needs, and aspirations of people with intellectual disabilities except, perhaps, in the context of managing risks. According to Gill, challenging sexual ableism also entails naming the power that comes from age, ability, gender, class, and race in order to facilitate negotiations between individuals and give voice to the diverse wants and needs of people with intellectual disabilities so that negative sexual experiences and abuse can be avoided while sexual agency, reproductive justice, and sexual pleasure can be supported and encouraged.

Chapter One, "Questions of Consent," examines the case of 18 year-old Kalie McArthur, a young white woman with an intellectual disability who was sexually abused by a fifteen year-old white male "peer-trainer" named Robert Harris. Harris, who was successfully prosecuted for sexual assault, was responsible for assisting McArthur with janitorial duties at a Colorado high school. Gill's nuanced analysis of the case, and the media coverage surrounding it, calls into question the utility of using intellect to assess whether adults with intellectual disabilities are eligible to engage in consensual sex. At the same time, the chapter probes the ways in which white, heteropatriarchal assumptions about race, gender, and sexuality work with institutional norms and cultural expectations of disability to frame McArthur as a victim and Harris as a "hormone-filled" predator. "Instead of learning what her peers were learning," Gill notes, McArthur "was cleaning the school"(25) a situation that enforced her unequal social status, systematically denied her access to knowledge and education, and also sequestered her in ways that created opportunities for sexual abuse.

Meanwhile, whereas attorneys for the school district argued in a civil trial that McArthur's experience was "pleasurable, not traumatic" and that it "ignited her female desires" (26), McArthur's parents and the media asserted that she was a sexually naive, innocent victim in need of protection, "loving like a toddler," and incapable of giving consent since she was "functioning at the level of approximately a 3 or 4 year old"(29). Gill convincingly contends that "Mental age" is a medical and ableist construction that prioritizes professional expertise at the expense of individual knowledge; actively discrediting individual choice and perpetuating "assumptions about incompetence, childhood, and the need for protection"(38). Gill's analysis also shows how McArthur's intellectual disability, gender, and racial status were used to construct her as "pure" while self-serving attempts by school officials to affirm McArthur's sexual agency relied on patriarchal understandings of women's sexuality as submissive, and subordinate to, male sexual aggression framed as a "gift" that "ignites" "female" (hetero)sexual desires.

Although Harris claimed in local media reports that nothing illegal or inappropriate occurred and that his relationship with McArthur was based on mutual feelings, McArthur's own thoughts and perspectives on her encounter with Harris were, as Gill points out, consistently "lost and ignored" (31) amid the ableist, heteropatriarchal narratives surrounding her case. Instead, those around McArthur interpreted her knowledge and spoke for her; describing her as a "victim," denying her agency and subjectivity, and casting her as pitiful and helpless.

Chapters two and three—respectively titled "Pleasure Principles" and "Sex Can Wait, Masturbate"—utilize sex education literature to reveal how the sexual knowledges and desires of people with intellectual disabilities are not only occluded and discredited, but also, purposefully re-directed to address the fears and concerns of parents and professionals and serve the bureaucratic interests of residential facilities for disabled people. Chapter 2 argues that the myriad pleasures and purposes of sex are ignored in favor of discourses of "stranger danger" and disease prevention that frame sex as either risky or improper and present monogamous, heteronormative relationships as the "safest" and most appropriate setting for sexual expression. These strategies are predicated on a presumption of incompetence and on the erasure and degradation of sexual diversity. Such narrow approaches to sexual education are also particularly problematic for a population that has been, and continues to be, systematically disqualified for participation in monogamous, heteronormative, (i.e. "appropriate") relationships.

Chapter 3 critiques ostensibly "progressive" efforts to incorporate sexual pleasure into sex education for intellectually disabled people in the form of masturbation. As Gill demonstrates, masturbation is often presented to service providers as a "safe," "healthy," and non-reproductive form of sexual release that can create a more docile and compliant clientele. In addition, although Gill shows that alternatives abound, educators emphasize that masturbation should be done alone and in private. Such directives are difficult to accomplish in facilities where no functional privacy exists; especially for people whose disabilities may prevent them from being able to masturbate without assistance.

Chapters four and five address ongoing battles over forced sterilization and the denial of parental rights to people with intellectual disabilities. Despite research indicating that individuals with intellectual disabilities are capable of successful parenting, concern for the well-being of children continues to justify the sterilization of intellectually disabled people—especially women—as well as the removal of children from intellectually disabled parents. States frequently apply tougher standards for retaining custody to parents with intellectual disabilities versus their "nondisabled" peers. Gill compellingly advocates in these chapters for a cross-coalitional, intersectional approach to addressing these inequities. He notes, for instance, how discourses of parental fitness have historically extended well beyond the presence or absence of an intellectual disability. "The rhetoric of the rights of children," observes Gill, "has long attempted to demonize those constructed as unfit to parent." This includes "sex workers, women of color, gays and lesbians, prisoners, and immigrants" (114).

Although Already Doing It powerfully illustrates the need to honor the sexual knowledges and desires of people with intellectual disabilities, the voices of intellectually disabled people themselves remain eclipsed by the professional perspectives critiqued in the book or else mediated by the popular cultural forms such as films, television, and radio that Gill analyzes. In addition, Gill's use of visual media and popular culture is not always effective. It is not clear, for example, how the Hollywood and made-for-TV movies Gill analyzes in chapter six actually function as "historical texts" (150). Gill also fails to make clear how these films differ from other cultural texts examined in the same chapter such as radio broadcasts of the Howard Stern Show, blog posts, and an independent "documentary" featuring nondisabled actors having sex while pretending to be disabled that Gill unpersuasively characterizes as having "transgressive potential" (170).

Already Doing It nonetheless opens space from which to begin confronting and challenging the social, cultural, and historical forces that have attempted to imagine, control, and manage the sexuality of people with intellectual disabilities in the United States; including, as chapter 7 implies, processes of colonization, U.S. imperialism, and global capitalist expansion. As such, the book is a valuable starting point for dialogue and debate among students, scholars, and professionals.

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