Abstract
From the 1960s, when women began working together to end gender-based violence, to well into the twenty-first century, attitudes and practices have shifted in important ways, yet this social justice project is far from complete. While feminist resistance has gone public in unprecedented ways, institutional responses often lag far behind. This chapter focuses on medical contexts, arguing that gendered violence, a neglected topic in bioethics, constitutes an important issue for the field, one urgently in need of intersectional feminist bioethical analysis. Moreover, the chapter argues that this analysis requires intersectionality, such as including transgendered women and genderqueer people in the focus, while addressing race, class, disability, and other vectors of oppression. Complex inegalitarian dynamics persist as pervasive factors in healthcare, compounding the harms of violence itself when treatment is sought. Mainstream medicine often treats the symptoms of violence while ignoring or obscuring the causes. However, a feminist analysis provides guidance based on the tenets and practices of movements against gendered violence. Medical providers have a distinctive opportunity to intervene in the crisis of gendered violence, and movement-based principles point the way to equitable and effective medical responses.
A significantly revised and updated version of Abby L. Wilkerson: ‘“Her Body Her Own Worst Enemy’: The Medicalization of Violence against Women,” in Violence against Women: Philosophical Perspectives. Stanley G. French, Wanda Teays, and Laura M. Purdy, eds. Copyright ©1998 by Cornell University. Used by permission of the publisher, Cornell University Press.
I thank Lisa Heldke, Timothy Murphy, Pat McGann, and the late Sandra Bartky for painstaking readings of earlier versions of this paper, and very helpful suggestions. The chapter is also informed by the women of Sarah’s Inn, a domestic violence service agency in Oak Park, Illinois, who shared many valuable insights and experiences when I volunteered there from 1988 to 1990.
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Notes
- 1.
Sherwin (1992) was one of the first to present a systematic and convincing case that women’s interests in the area of medicine and health are likely to be undermined without a feminist analysis in bioethics, because of sexism in the health care system as well as androcentric and other biases in mainstream bioethics.
- 2.
I use the terms “intimate partner violence” and “sexual assault” as overlapping categories.
Though the medicalization of IPV and sexual assault against men is beyond the scope of this chapter, it is important to note that men—both cisgendered and transgendered—may also be the targets of these forms of violence, often as a means of establishing or maintaining intermale dominance hierarchies, as in the context of prison rape (Sabo et al. 2001: 6). This issue receives even less attention, if any, in bioethics, but is also in great need of illumination.
- 3.
The 2015 US Transgender Survey found that “more than one in three trans women and one in two trans men have been sexually assaulted – and the rates of sexual assault against non-binary people are even higher” (Arkles 2018).
- 4.
A Journal of Medicine and Philosophy (1982) special issue (ed. Whitbeck) brought early philosophical attention to this concern. Several of its authors, particularly Rawlinson, address the pathologization of femaleness.
- 5.
The nonprofit Men Can Stop Rape created an influential primary prevention model which engages men and boys to work with women to end sexual violence, promotes “healthy masculinity,” and teaches behaviors such as bystander intervention (McGann, 2015).
- 6.
Two decades after an earlier edition of this chapter appeared, attention to these concerns is still sorely needed in bioethics and feminist philosophy. A prominent bioethics center’s online bibliography on women’s health included a section on gendered violence, listing only one source in philosophy: the 1995 edition of this volume itself (“Women’s Health Bibliography” 2016). The feminist bioethics page of a prominent online philosophical encyclopedia did not mention violence in the article, and included in its extensive bibliography only one work on gendered violence (“Feminist Bioethics” 2015).
- 7.
- 8.
Moyers’s interviews (1993) with medical researchers and clinicians contributed to a groundswell of interest in the emerging research at that time demonstrating the importance of humanistic concerns in diagnosis, treatment, and prognosis. See also Goleman and Gurin (1993) and Peterson and Bossio (1991).
- 9.
- 10.
- 11.
When this textbook appeared in 1988, the Sexual Assault Nurse Examiner program, which addresses these concerns along with forensic demands, was far from well-established (“History” n.d.).
- 12.
- 13.
See Hernandez et al. on the need for “improved understanding of physician experience with IPV, and development of physician-sensitive resources and treatment approaches” (2016: 311).
- 14.
The rapist typology employed by Basson and Baram relies on a model that is far from definitive in relevant social science literature (which is not directly cited in the textbook’s typology section; citations for these claims were articles in medical journals focusing on treatment and evaluation issues in cases of IPV and sexual assault). The chapter does not address the very spirited debate and competing paradigms, including work that rejects “etiological models” of rape altogether. Even recent work within this framework such as Lussier and Cale’s (2016) meta-analysis of “four generations of research” acknowledges significant “unresolved issues” within the paradigm.
- 15.
As I write this, legislative efforts in the US to undermine the Affordable Care Act (ACA) are ongoing, while in many other wealthier nations, austerity measures erode health care access, and in still others, medical care is a luxury afforded to few. This trend has specific ramifications for medical responses to IPV and sexual assault; in the US, for example, a 2012 provision of the ACA mandates and funds IPV screening.
- 16.
Young (1990) argues that mainstream liberal philosophy is based on a “distributive paradigm” that frames the relation between health and justice in terms of access to health care. She calls for a broader approach focusing on oppression (which takes many forms beyond economic, distributive concerns) as a central aspect of injustice. See also Wilkerson (1998).
- 17.
See Heldke and Kellert, “Objectivity as Responsibility,” Metaphilosophy 26: 4 (October 1995), 360–78.
- 18.
See, for example, Illich (1977).
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Wilkerson, A.L. (2019). “Her Body Her Own Worst Enemy”: The Medicalization of Violence Against Women. In: Teays, W. (eds) Analyzing Violence Against Women. Library of Public Policy and Public Administration, vol 12. Springer, Cham. https://doi.org/10.1007/978-3-030-05989-7_10
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