In Medical Entanglements; Rethinking Feminist Debates about Healthcare, Kristina Gupta tells us another world is possible. Drawing extensively on scholarly and popular health literature, Gupta demonstrates that in arguments about hotly debated medical interventions – for gender-affirming care, sexual satisfaction, and weight management – feminists circumvent comprehensive social justice possibilities when we dismiss individual needs or structural critiques. Gupta argues that the value of a medical intervention should be measured not in terms of whether it is good or bad for feminism's aims, but whether the intervention promotes livability, fulfillment, and flourishing for the consumer. To determine this, Gupta argues we must support individual health-related decision-making and enable a feminist democratic process for approving and funding medical interventions, all while engaged in social justice advocacy to eliminate systems of oppression (e.g., sexism, racism, ableism, and others). In other words, we must set up individual consumers to make choices for their own flourishing while actively creating a world in which they can flourish.
For Gupta, a feminist should not be unilaterally for or against any particular medicine. In making this argument, she brings a critical disability studies insight to feminist healthcare debates long occupied by, in her assessment, binary opposing camps. For example, in her chapter on transition-related care, Gupta cites arguments against the medicalizing/normalizing impulse that would pathologize transgender individuals and those that frame medical transition as reifying binary gender; she positions these against the ways in which medically supported transition many times dramatically improves, even saves, trans folks' lives. In the debates on sexuopharmaceuticals – specifically the drug Addyi, prescribed to treat female sexual dissatisfaction – Gupta reviews arguments primarily concerned with the medicalization of desire, and particularly the ways in which diagnoses of "excess" or "diminished" desire might implicate asexual folks unwillingly. At the same time, many feminists argue that Addyi, like Viagra, has radical sex-positive and queer possibilities by creating opportunities for satisfying sex where they were otherwise absent. In her chapter on fat, feminist body positive and Health At Every Size activists are situated apart from food, environmental, and public health scholars who address the systemic obstacles many communities face to health (in all forms). In this chapter, too, Gupta invokes a middle ground: one upon which individual choices about body size are contextualized by the social conditions that activate or prohibit those choices.
In each of her examples, Gupta's emphasis on individual decision-making raises a bit of alarm, but she toes the line by consistently underscoring a promise of the new, more just social world in which these choices would occur. Coupled with democratic feminist governance and a world free of cissexism, for example, individual choices regarding gender transition would have only to do with self-fulfillment and living one's most flourishing life, rather than conforming to or reifying binary gender, as critics might have it. Moreover, in each of her examples, Gupta points to the queer, crip, and otherwise radical potential of medical interventions once the embodiments with which they are associated are depathologized. For example, while she does not advocate for the demedicalization of trans in the current moment (noting that diagnosis remains an access point for affirming care for many trans folks), she points to the ways in which the elimination of stigma might usher in broad recognition of the multiplicity of trans and gender non-normative embodiment.
Gupta thus brings to feminist and queer healthcare debates a crucially crip insight: namely, that while the social context is indeed the site for the (re)production of oppressive and limiting bodily norms, many embodied experiences of pain, pleasure, discomfort, or delight cannot necessarily be attenuated or amplified via the social alone. We live in bodies. Critical disability studies scholarship has taught us that the elimination of ableism, for example, will not eliminate some forms of pain or distress. Moreover, while crip activism and scholarship has forced a reckoning of medicine's eugenicist logics and socially constructed truths, as Gupta dutifully echoes in Medical Entanglements, disability justice has long advocated for medical interventions that promote livability, fulfillment, and flourishing. Medical Entanglements, then, can be read as contributing to a more expansive understanding of disability's social and or political/relational model(s) to include bodies that are not necessarily constructed in terms of disability (though sometimes are) but are produced through medicalized knowledge about the body.
At times, Medical Entanglements reads like a literature review, which, while perhaps leaving a reader wanting a bit more synthesis from Gupta, is also a necessary part of the project of "rethinking debates." In this way, the text's archive and format together make it an excellent text for broadly introducing undergraduate students to feminist healthcare debates and those around fatness, sexuality drugs, and transition-related care specifically. Moreover, as students often complain that authors introduce problems without instructions for repair, they will appreciate Gupta's suggestions to bring about medical and social change included at the end of each chapter. These suggestions are occasionally vague, e.g., "Our priority as feminists should be to work to end discrimination and stigma against fat people while altering the unjust aspects of our world that differentially distribute fatness" (110), and elsewhere quite concrete: "[we must require] physicians prescribing sexuopharmaceuticals to first provide patients with information about asexual identities" (85). In either case, they invite further conversation.
Overall, Medical Entanglements makes an important intervention into feminist debates – or perhaps feminist entanglements – in its refusal to untangle the threads. The knottiness is not the problem, Gupta argues; the problem is the insistence on disentangling individual needs from the social context that creates and pathologizes them. Instead of isolating our rhetoric and activism to the consumer or the world in which she lives, we must embrace entanglement. For Gupta, it is only in addressing the personal and the political simultaneously that we can increase possibilities for broadscale human flourishing and actually move towards the creation of a more socially just world.
