Abstract
This article analyzes how trans health was negotiated on the margins of psychiatry from the late 1970s and early 1980s. In this period, a new model of medical transition was established for trans people in Norway. Psychiatrists and other medical doctors as well as psychologists and social workers with a special interest and training in social medicine created a new diagnostic and therapeutic regime in which the social aspects of transitioning took center stage. The article situates this regime in a long Norwegian tradition of social medicine, including the important political role of social medicine in the creation of the postwar welfare state and its scope of addressing and changing the societal structures involved in disease. By using archival material, medical records and oral history interviews with former patients and health professionals, I demonstrate how social aspects not only underpinned diagnostic evaluations but were an integral component of the entire therapeutic regime. Sex reassignment became an integrative way of imagining and practicing psychiatry as social medicine. The article specifically unpacks the social element of these diagnostic and therapeutic approaches in trans medicine. Because the locus of intervention and treatment remained the individual, an approach with subversive potential ended up reproducing the norms that caused illness in the first place: “the social” became a conformist tool to help the patient integrate, adjust to and transform the pathology-producing forces of society.
Highlights
The history of psychiatry is often told through the metaphor of the pendulum
Psychiatrists and other medical doctors as well as psychologists and social workers with a special interest and training in social medicine created a new diagnostic and therapeutic regime in which the social aspects of transitioning took center stage. The article situates this regime in a long Norwegian tradition of social medicine, including the important political role of social medicine in the creation of the postwar welfare state and its scope of addressing and changing the societal structures involved in disease
This article analyzes how self-conscious approaches to psychiatry as a form of social medicine became a mode of clinical practice in the field of trans medicine
Summary
The history of psychiatry is often told through the metaphor of the pendulum. It is described as a profession that swings between ‘‘biological’’ and ‘‘psychological’’ theories and therapies. Historians of psychiatry, have pointed out the limitations and deficiencies of this historiographic lens: Rather than being two distinct and opposing camps, there are numerous historical examples of interaction, cooperation and mutual learning between advocates of somatic interventions and talking cures (Pickersgill 2010; Rasmussen 2006; Raz 2013; Sadowsky 2005).2 By looking beyond this notion of waterproof professional hegemonies and of a pendulum swinging between them, one gains a richer and more complex picture of porous professional ‘‘trading zones.’’3 When the history of psychiatry is reduced to a struggle between psychoanalysts and biologically oriented psychiatrists, the role of ‘‘the social’’ in psychiatry writ large often disappears. Beginning in the 1950s, following the high-profile and tabloid-scrutinized medical transition of celebrity patient Christine Jorgensen (1926–1989) in Copenhagen, a small number of experts—psychiatrists, endocrinologists and plastic surgeons—in Norway began to examine and treat people whose gender identities did not match their birth sex This practice was carried out in an unregulated fashion by experts who exercised fairly free discretion in their therapeutical decisions (Sandal 2017). The article concludes with a consideration of this specific historical example’s implications about the broader relationship between psychiatry and social medicine
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