Introduction
This book has been hard to bring to publication. One of the first problems we came across was that the authors did not know what to writeâor rather they did know, but did not know that they knew, as it were. âBut no oneâs written on this beforeâ, people would say, and, in general, they were correct. There was no jumping-off pointâno âHere is the literature and here is how I am adding to itâ, no body of work to form a firm ground from which to leap. It is notable, however, that things have changed during the time that we have been editing the book, beginning with what we believe to be the first academic conference specifically on non-binary gender in the Spring of 2016 (Vincent & Erikainen, 2016; see Bergman & Barker, Chap. 3) and ending with whatâas far as we are awareâis the first doctorate focused entirely on non-binary experience, which was awarded at the end of 2016 to Ben Vincent (one of the organisers of the conference and a contributor to this volume). During this time, there was also a call for the first journal special issue on non-binary gender (Nursing Inquiry, 2016). Given this, and the number of postgraduate and early career researchers now studying this area, hopefully the next edition of this book will have a good deal of more specific research to draw upon from disciplines as diverse as history, musicology, media studies, law, psychology, sociology, and medicine (see also Hegarty, Ansara, & Barker, 2017).
However, given the dearth of existing literature, in some senses, the authors in this volume are the giants upon whose shoulders others may stand. But while there have been no direct antecedents to the work here, there are, of course, many whose work has informed and inflected it. The surgical techniques developed for others which have been adapted for this population; the psychological modalities adjusted to suit; andâfar more so than in the other fieldsâthe theoretical bases from which academics and theorists may work. There has been work such as Bornsteinâs (1994) Gender outlaw; Queen and Schimelâs (1997) PoMoSexuals; Wilchinsâ (1997) Read My Lips: Sexual Subversion and the End of Gender; and Butlerâs (1999) Gender Trouble, to name a few. Note that the first three of these were from the so-called âgreyâ literatureânot âproperlyâ academic, but (as always?) beating us to it [by 20 years]. But we can go further back too from the Neolithic âgoddessâ ĂatalhöyĂŒk to the modern day there have been people and practices outside of the gender binary (cf. Richards, 2017), it would be foolish to assume that non-binary gender is a purely modern phenomenon and so it is to this long movementâwhich circles ever back to the truth from the obscuring hand of self-interested powerâthat this book seeks to add.
Having decided a book was needed, our main concerns were with language and the structure of the book (cf. Richards & Barker, 2015). Even the book title evolved over the time of writing as the word genderqueer became more accepted and utilised as another umbrella term for those outside of the gender binaryâand was consequently included in the title.
One of the most difficult decisions we had to make concerned how we should entitle the surgery chapters such that readers could find what they were looking for regarding surgery for different body parts and areas, while at the same time minimising incorrect assumptions and offence. Clearly, Surgery for Men would be misleading and inaccurate, whereas Surgery for Non-Binary People would not distinguish the chapters from one another. Surgery for People with a Penis related gender to a single organ too closely, where we wanted to discuss a range of operative proceduresâindeed, it also doesnât allow for the range of meanings people attribute to that body part. The least-worst option seemed to be Surgery for Bodies Commonly Gendered as Male; Surgery for Bodies Commonly Gendered as Female, and so on, shifting the view to the assignations of wider society, rather than our own.
This does feel like a bit of a cop-out, however. It would be nice if there were new terms, Androsome and Gynesome, say, which refer to the two common configurations of body parts developed under common genetic expressionâbut which do not assume a cisgender norm; and make no inference regarding meaning or genderâeither of the configuration or of the individual parts. Thus, a trans man may be Gynesome, but feel his chest is incorrect and have surgery to address it. He may feel his genitals are acceptable and that, as they are his [male] genitals, they should properly be called a manhole. A non-binary person might also be Gynesome and feel that their genitals are acceptable in that they regard them as being feminine and that they fit with the degree of femininity which is suitable for them. This non-binary person may also wish to have chest surgery to effect the correct chest contour for their sense of self. Additionally, a cisgender woman might be Gynesome in that she has a vagina, ovaries, and breastsâand further she may clarify that she is content with these and views them as a signifier of her femininity, or she may seek breast augmentation surgery to effect a better chest contour for her sense of self. Thus, we split the body parts from the meaning; allow multiple meanings and options for change as required; but also have some method of communication about commonly found bodily configurations and parts which make no a priori assumptions. Our hope is that by the time of a second edition of this book, society, and the language it uses, will have moved so that the words we use are generally understood in this way.
We also made few allowances for readers unfamiliar with technical terms. With the Internet ready to handâindeed with some e-readers having inline lookup functionsâit feels unnecessary to continually define terms. In part, this was because we wanted the book to be technically specific, rather than being for a very general readerâalthough general readers should find much to interest them, and hopefully not overmuch they need to search online to define. Further, we wanted different sections of the book to be of interest to specific professions, and it feels unreasonable to ask surgeons to define simple surgical terms for the non-surgical reader when their surgical colleagues will read the chapter; or queer theory academics to do the same. Hopefully, people reading cross-discipline will enjoy the dip into another world.
The next issue concerned how best to split the book such that it has an accessible structure for all readers. We therefore decided to split it into three main sections, which nominally represented the rough areas of endeavour concerning non-binary and genderqueer folkâthese being Societies, Minds, and Bodies. This covers the usual biopsychosocial approach to human being, but also highlights our main omissionâSpiritualitiesâwhich will therefore be addressed in future editions as non-[gender]binary aspects of spirituality may be found in most major religions and a vast number of spiritual practices (cf. Richards, 2014). Therefore, the sections of the book are as follows:
In the Societies section, S. Bear Bergman and Meg-John Barker wrote on Activism and its place in moving the whole field forward; Ben Vincent and Ana Manzano-Santaella wrote about History and Cultural Diversity, giving an excellent overview of how gender has been understood across time and space in a way which alerts us to the unusual status of the current high GDP Western understanding of gender as a binary opposite; Rob Clucas and Stephen Whittle detail the current legal position in Law; and Jay Stewart eloquently explains Academic Theory in this area. In the Minds section, we, as editors and colleagues, each took our specialty, with Meg-John Barker and Alex Iantaffi exploring Psychotherapy with non-binary people; Christina Richards meditating on the philosophy and practice of Psychology; and Sarah Murjan and Walter Pierre Bouman giving a thoughtful overview of Psychiatry. In the Bodies section, Leighton Seal explains what may and may not be done in Adult Endocrinology; with Gary Butler similarly detailing this for Child Endocrinology. James Bellringer explains what genital surgical options are available in Surgery for Bodies Commonly Gendered as Male; David Ralph, Nim Christopher, and Giulio Garaffa similarly examine genital surgical options in Surgery for Bodies Commonly Gendered as Female; Andrew Yelland then explains surgical possibilities in Breast Surgery; and finally, Alex Iantaffi considers where we might go from here in Future Directions.
Non-binary People: Who Are We Talking About?
Who then are we talking about when we consider non-binary people? And how many non-binary people are there? Essentially, of course, genderqueer or non-binary people are simply people who are not male or female; but as ever things are more complex than that. In general, non-binary or genderqueer refers to peopleâs identity, rather than physicality at birth; but it does not exclude people who are intersex or have a diversity/disorder of sexual development who also identify in this way. Whatever their birth physicality, there are non-binary people who identify as a single fixed gender position other than male or female. There are those who have a fluid gender. There are those who have no gender. And there are those who disagree with the very idea of gender. You will find out more about all of these groups in the chapters to come.
It follows from thisâand from the fact that most research still only offers binary choices for genderâthat the proportion of the general population who are non-binary is very difficult to measure. For example, one recent review of the UK literature in this area defined non-binary as âAn umbrella term for any gender (or lack of gender) that would not be adequately represented by an either/or choice between âmanâ or âwomanââ (Titman, 2014). Under this definition, Titman reported that at least 0.4% of the UK population defines as non-binary when given a three-way choice in terms of female, male, or anoth...