"Cured": What the Gay Rights Movement Can Teach Us About Grassroots Campaigns to Change Medical Practice

by David Balashinsky

In the history of the gay rights movement, certain events stand out as milestones.  First and foremost is the Stonewall uprising in 1969.  Another is the termination by Congress of the Defense Department's "Don't Ask - Don't Tell" policy in 2010 allowing lesbian, gay and bisexual people to serve openly in the armed forces.  Still another is the Supreme Court's 2015 decision in Obergefell v. Hodges recognizing the right to same-sex marriage.  

Less well known by the general public is the decision in 1973 by the American Psychiatric Association (APA) to drop its classification of homosexuality as a psychiatric disorder.  Although it's hard to believe now that gay women and men were once subjected to electroconvulsive therapy (ECT, or "shock therapy") and other "treatments," for decades the APA viewed homosexuality as a condition that needed to be "cured."  Women and men were not merely stigmatized for being gay; their homosexuality was actually defined as a pathological condition by the medical establishment.  As a result, among other interventions that would now be condemned as medical malpractice, gay people were institutionalized, subjected to"aversive therapy" (a technique that involved, in the case of gay men, exposing them to pictures of nude or semi-nude men while administering electric shocks) and even subjected to lobotomies - all in an effort to "cure" them of their gayness.

It took years of advocacy and even direct confrontation before the APA was finally persuaded by gay rights activists (from within but mostly outside the organization) to revise its official stance on homosexuality.  The story of how these activists overcame decades of entrenched thinking within the APA is movingly told in the powerful, heartbreaking yet inspiring documentary, "Cured."

Anyone who cares about human rights should watch this film.  Anyone who cars about the rights of LGBTQIA+ persons should watch this film.  And anyone who cares about ending all forms of forced genital cutting should watch this film.  Why?  Partly because the gay rights movement has been phenomenally successful and there is always something to learn from a successful human rights movement.  But, more particularly, because the battles for gay rights that have been fought over the past 60 years and more have been waged within the social sphere, within the legal domain and within the realm of medical practice.  It is precisely in this respect that the gay rights- and genital autonomy movements have so much in common.

It goes without saying that both movements represent quests for fundamental human rights.  What right is more fundamental, after all, than the right not to have healthy, erogenous tissue surgically removed from one's body without consent?  At the same time, there are other rights perhaps not as crucial as the inviolability of one's physical boundaries but that are still important enough to be regarded as fundamental.  Chief among these is the right to equal protection.  The aim of the gay rights movement is for gay people to have the same rights to housing, employment, marriage, services and public accommodations, government benefits, healthcare and the myriad other rights that (some - not all) hetero people take for granted (rights that, at least, exist on paper).  These particular rights are typically legal rights: that is, they are either codified in statutes or they are rooted even more deeply in the texts of constitutions.  Additionally, an important aim of the gay rights movement has been and continues to be for social acceptance: not just of homosexual relationships but of homosexuality itself, as something intrinsic to an individual's identity.  Gay people want what all of us want: the right to live openly as themselves and without apology for who they are.  A third domain in which gay people have had to fight for their fundamental rights is the subject of "Cured": their treatment (in both senses of the word) by the medical profession.  All of these specific rights can be distilled down to fundamental human rights but it is significant that the struggle to achieve them has taken place within each of these three domains: the law, society, and medical practice.

This is exactly the case with the movement to end nontherapeutic penile circumcision (male genital cutting, or MGC), which comprises one of the three major pillars of the genital autonomy movement (the other two being the FGM-eradication movement and the movement to end the medically unnecessary surgeries that are imposed on intersex children in a misguided attempt to "normalize" their bodies).  Just as the gay rights movement has done, the MGC-eradication movement is pursuing its aims within each of these three spheres.  For example, the groundwork is now being laid for the pursuit of creative and effective legal strategies to redress individual cases of harm while creating impact litigation that will have a positive deterrent effect more broadly on the practice of subjecting unconsenting minors to medically unnecessary, irreversible and life-altering genital surgery.  That is the focus and raison d'être of the Genital Autonomy Legal Defence and Education Fund (GALDEF).  At the same time, campaigns within the social sphere to normalize intactness and to destigmatize the penile prepuce are gaining momentum.  Within the medical sphere, more and more physicians, physicians' organizations and other healthcare providers and medical ethicists are publicly stating their opposition to the practice of MGC. 

Notwithstanding these encouraging developments, the penile prepuce continues to be disparaged and worse by the medical profession.  It is particularly within the realm of medical practice, therefore, that the penile prepuce bears such a striking similarity to the state of being gay.  Both the penile prepuce and homosexuality have an overlapping history of explicit pathologizing by the medical establishment.  Both have been regarded, therefore, by medical professionals as conditions that warranted aggressive interventions for the well-being of the "patient."  In both cases, the goal of these interventions was the same: the elimination of the offending pathological condition.

It's worth bearing in mind that none of the three domains discussed here - law, society and medical practice - is entirely walled off (or "siloed") from the other two.  There is an active interplay between all of them as the prevailing normative values of each influence and, in turn, are influenced by the others.  That is partly why the problem of MGC has proved so intractable.  The unwarranted privilege it has enjoyed within the legal realm is unquestionably due to its persistent social acceptability and the gloss of legitimacy that it continues to receive from the medical profession.  By the same token, the medical profession continues to cite societal acceptance of MGC (including parental preference and prerogative) as justifications for its continued availability (and for third-party payment for it).  And the fact that legal sanctions have yet to be imposed upon any physician for performing what is nevertheless universally understood to be a medically unnecessary surgery - in contrast to other cases in which physicians have been prosecuted for and even convicted of performing medically unnecessary surgeries - surely indirectly reinforces the continued acceptance within the societal and medical realms for MGC.  By failing to prosecute medical professionals and others for performing any medically unnecessary penile circumcision - an act that, were it to involve any other body part, would be considered not just malpractice but battery - the state implicitly bestows its imprimatur on MGC and does so explicitly in those states (and there are still 34 of them) in which Medicaid Funds are used to pay for it.

But if each one of these three domains supports the other two and, together, all of them undergird the practice of nontherapeutic penile circumcision, it is also true that, like a three-legged stool, without any one of them, the stool must inevitably fall down.  Therein lies cause for hope.  That is why it is imperative that the struggle to eradicate MGC be waged in the legal sphere (in courts and in legislatures), in the public sphere (through media and online forums, through one-on-one engagement and through public protest) and in the medical sphere (through outreach to medical school faculties and students and to medical professionals, through efforts to defund nontherapeutic circumcision by eliminating third-party payments for it, such as Medicaid, through education aimed at new parents and through vociferous advocacy with medical organizations and regulatory bodies).  

Fortunately, not only has exactly this sort of three-pronged approach been employed before but it has succeeded.   To see how, we need only look to the gay rights movement.  In particular, the medical prong - the campaign by gay rights activists targeting the APA's pathologizing of homosexuality - is a paradigm of effective grassroots advocacy.  That is the story told by "Cured," which is why this documentary is must-see viewing for those who support the cause of genital autonomy. 

 

 

This post was originally published as a promotion for a fundraising event to benefit GALDEF that took place on 17 September 2023 which included a special screening of "Cured."  It has now been revised, accordingly. You can learn about distribution efforts for "Cured" by following it on Facebook, Instagram and X.  If you're interested in contacting the flimmakers, they can be reached at "Cured"'s website.  The producers of "Cured" have also created a Resource List.  Finally, if you would like to learn more about GALDEF or donate, please visit our website.

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About me: I am originally from New York City and now live near the Finger Lakes region of New York.  I am a licensed physical therapist and I write about bodily autonomy and human rights, gender, culture, and politics.  I currently serve on the board of directors for the Genital Autonomy Legal Defense & Education Fund, (GALDEF), the board of directors and advisors for Doctors Opposing Circumcision and the leadership team for Bruchim.

GALDEF Statement in Support of the 2023 WWDOGA

by David Balashinsky

May 7th, 2023 is the eleventh anniversary of the ruling by the Regional Court of Cologne recognizing that nonconsensual, non-therapeutic penile circumcision constitutes an illegal act of bodily harm.  That ruling has been commemorated every May 7th since as the Worldwide Day of Genital Autonomy.

The Worldwide Day of Genital Autonomy, or WWDOGA, calls for the State Parties to the United Nations Convention on the Rights of the Child to honor their commitment to "take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children."  WWDOGA also calls for legislative initiatives to protect all children, regardless of sex, against non-therapeutic genital surgeries.  It calls for the protection of children with atypical sex characteristics from genital surgeries when not medically indicated; it calls for an immediate end to the campaign of mass circumcision of African boys; and it calls for a program of publicly-funded research and education on the consequences of genital cutting for children in all its various social contexts.  These objectives are so basic to any rational definition of fundamental human rights that WWDOGA has now grown into an annual observance that is supported by over 90 organizations around the world. 

One of these is the Genital Autonomy Legal Defense and Education Fund (GALDEF) which is proud to support of the eleventh annual Worldwide Day of Genital Autonomy.

GALDEF's Mission is "to promote impact litigation by providing the resources needed for our clients to win legal cases involving medically unnecessary genital cutting."  Our Vision is "to create a world where the rights of children to bodily integrity and future autonomy over their genitals and their sexuality are respected and legally protected."  

Although our strategies may differ, the ultimate goals of WWDOGA and GALDEF are the same.  Both organizations are working to create a world in which the right of every individual to ownership of their own genitals is recognized and respected.  Like WWDOGA, GALDEF believes that this right is absolute, fundamental and belongs to every human being regardless of sex or any other individual- or group identification.  For us at GALDEF, that means helping those who have been deprived of this right seek redress through the judicial process.  But our mission is much broader, much deeper and much more ambitious than fighting for this cause on an individual, case-by-case basis.  We believe that strategic and targeted legal actions can result in precedent-setting and high-profile judgments that will reverberate throughout the legal landscape, across the country and beyond.  This will have the effect of discouraging others from violating or assisting others in violating the right to genital autonomy of every child everywhere.

It is not a coincidence that both WWDOGA and GALDEF have the phrase "genital autonomy" in their names.  The principle of genital autonomy is the moral foundation of both organizations; the universal safeguarding of this right, the cause to which both organizations are committed. 

Nor is it a coincidence that a judicial remedy for forced genital cutting lies at the heart of both organizations.  For as long as there have been law codes, charters and constitutions, courts have been the place of last resort where those who have been aggrieved can seek justice.  Courts have been the place where statutes that violate human rights have been struck down and where previously unrecognized rights have been recognized.  Throughout the history of jurisprudence, courts have been one of the most important tools that civilized societies have to insure justice and equality for every citizen within their jurisdiction.  On May 7th, 2012, it was one regional court in Cologne, Germany that issued the ruling that we now commemorate every May 7th as the Worldwide Day of Genital Autonomy.

The essential holding of the Cologne ruling is that "a [medically unnecessary] circumcision, 'even when done properly by a doctor with the permission of the parents, should be considered [a] bodily harm if it is carried out on a boy unable to give his own consent.'"

The essential fact of the Cologne ruling is that it was symbolic: it had little or no practical effect because the German Bundestag shortly thereafter passed legislation explicitly permitting non-therapeutic penile circumcision - legislation that, of course, superseded the ruling. 

The essential significance of the ruling, however, is that it represented the first time that a legally-instituted body officially recognized that people with penises actually have a right to decide for themselves what part of their penises they may keep and what part gets cut off.  It was the first time that a court recognized that non-therapeutic penile circumcision is a harm in and of itself and that, when imposed on a child without his consent, his right not to be physically harmed is violated.  Thus, while this may have been one legal decision by one regional court with little or no practical effect, for the genital autonomy movement it was the legal shot heard round the world.

 

The deeper significance, then, of the Cologne ruling is that it transcended the personal interests of the child whose medically unnecessary penile circumcision led prosecutors to bring charges against the physician who had committed it.  The Cologne ruling was a vindication of the rights not only of that child but of every child born with a penis.  And, although the Cologne ruling pertained strictly to penile circumcision, the Worldwide Day of Genital Autonomy, to its credit, regards the right to genital autonomy as universal, meaning that it is a right that belongs to every human being irrespective of sex, gender, nationality, religion and irrespective of the particular shape or structure of an individual's genitals.

The concept of universal human rights is important not only because it means that the rights apply to everyone equally but because the concept itself provides a moral framework in which each of us can extrapolate from our own unique situations to those of others from whom we differ.  That is why WWDOGA seeks to bring together advocates from every genital autonomy movement: not just those of us working to end male genital cutting but those working to end female genital cutting and intersex genital cutting, too.  Likewise, we at GALDEF believe in the universality of the cause of genital autonomy and we also recognize the strategic importance of making common cause with other genital autonomy movements.  This is reflected in our Values Statement in which GALDEF expresses its "solidarity with female and interesex victims of genital cutting. . . ."  

Sooner or later the world will recognize what the regional court in Cologne recognized eleven years ago.  Either there is a fundamental right to genital autonomy that applies to everyone regardless of sex or there isn't.  And, if there is, sooner or later that right must be recognized by unbiased courts in the constitutions and statutes that already exist or it must be enshrined in constitutional amendments or codified in new legislation.  Whatever course this campaign takes and however long it takes, GALDEF will be fighting for the right of every child to grow up with their genitals uncut, unharmed and intact. 

             

 

 

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David Balashinsky is originally from New York City and now lives near the Finger Lakes region of New York. He is a licensed physical therapist and writes about bodily autonomy and human rights, gender, culture, and politics.  He currently serves on the board of directors for the Genital Autonomy Legal Defense & Education Fund, (GALDEF), the board of directors and advisors for Doctors Opposing Circumcision and the leadership team for Bruchim.

Some Thoughts on "They" as a Singular Pronoun and Other Linguistic Pet Peeves

by David Balashinsky

 

I had the good fortune to be off from work yesterday and so had the opportunity to listen to Here and Now which, where I live, airs on WSKG radio at 12:00 noon.  Yesterday's show featured an interview with sociolinguist and author Valerie Fridland who was there to discuss her new book, Like, Literally, Dude: Arguing for the Good in Bad English.  

I was not aware of the fact that so many people become so exercised about their linguistic pet peeves or what they believe to be misuses of the English language as to become impelled to write indignant emails about them to radio shows.  However, this phenomenon formed the backdrop not only of yesterday's interview but also (at least to some extent) of Fridland's book which on her site is described as "A lively linguistic exploration of the speech habits we love to hate - and why our 'like's and 'literally's actually make us better communicators."  

 

For my part, I do not object to "like" nearly as much as I object to "you know" but that phrase did not come up during the interview.  (I do not know whether Fridland addresses "you know" in her book and, if she does, whether she is as forgiving of it as she is of "like," "literally," "um" and ""uh.")  However, I found myself experiencing my own outrage at certain usages that did come up during the broadcast.  Not coincidentally, these happen to be several of my own favorite pet peeves so, like any indignant language lover who fires off an angry email, I am sharing them now - except, of course, that I get to vent spleen here on my blog. 

First is the use of the singular "they." I loathe the use of "they" as a singular pronoun not because I oppose the existence of a gender-neutral pronoun but simply because "they" is already taken (as a plural) and its use as both a singular and a plural is often confusing and grates on the ears like fingernails on a chalkboard.  There really should be a better alternative and I hope someone can come up with one.  In the interview, Fridland claims that "hundreds" of alternative, gender-neutral singular pronouns have been tried but that none has caught on in the way that "they" has.  Fridland attributes this to the fact that the use of "they" as a singular pronoun is "an organic development."  Not having read her book, I do not know how Fridland defines this term but it's probably safe to assume that by "organic development" she means a change in language that is unconscious and "natural."  I understand that English is always changing but I also know that people misuse words all the time and how we speak is inevitably influenced by what we hear and learn from others.  For this reason, common misuses of words tend to spread and become even more common until at last, through the alchemy of semantic change, a frequently misused word becomes a legitimate way of expressing the idea that it was formerly improperly used to convey.  

 

Is that a good thing or a bad thing?  Well, after contacting Fridland directly and receiving not one but two very gracious and hugely enlightening responses, I believe it is fair to say that, at least from Fridland's perspective, it is neither.  A sociolinguist views the evolution of language much as a biologist views evolutionary changes in a species over time: these changes are neither "good" nor "bad" but merely adaptive.  As Fridland pointed out in her first email, the pronoun "you," exactly like "they," is used in both a singular and plural sense and this does not seem to bother anybody - at least not now.  I hadn't considered this and, honestly, this got me 98 per cent of the way there. 

 

And yet it is hard for me to let go of the idea that not every change is for the better.  Isn't it possible that, while language may be characterized by "organic development," like everything else it also tends to degrade from sheer entropy?  Over time, a building will begin to sag and its foundations give way until the building collapses.  At room temperature, food will decay and what once might have been dinner is now slimy and putrid.  That might be great for bacteria but it's not so great for the larger, more complex organism who was hoping to make a meal out of that rotting food.  This illustrates the principle that, depending upon one's point of view, change can be either "organic development" or simply organic decay. 

 

But this is where the view of the sociolinguist can actually be liberating.  As Fridland explained to me in her second email,

Over the long haul, language evolves in ways that meet the needs of speakers, but not always in ways that meet the social desires of those who have come to feel tied to the conventions of use at any one point in time on the long continuum of a language's history.  This is the crux of why people are so vehement in their views about language - it is a resource both intensely personal (communicating our own views and experiences) and, at the same time, communal (based on a set of conventions and usages that arise via collective agreement).  When people start messing with what we feel is established as normative use - especially when those speakers belong to groups less valued or well thought of socially, economically and politically (be it due to age, gender, ethnicity or region) - it irks us that they are changing the conventions we have helped to establish.  Toss in the fact that these norms have been taught to us every year in grammar class and so are validated in that way that these new forms are not and you get fierce opposition.  I think what is key is to realize that many of the forms that one or two centuries ago really angered people are now the things we all say without the dissolution of our ability to communicate having resulted.  One great example is that we now are not only using 'you' for both singular and plural but also using it as a subject pronoun (as in "You went home") when 'you' historically was only used for objects, and 'ye' was used exclusively for subjects.  In the 16th century, 'you' and 'ye' seem to have started to fall together, likely because in fast speech they sound similar and because in certain sentences it was a bit hard to tell which one should be used.  For instance, "ye know that man" becomes 'Know ye that man" where the subject 'ye' now is in a position that 'you' typically occupies, i.e., following the verb. Thus 'you' started to get used in that case instead, creeping into 'ye' territory one grammatical inch at a time.  The result?  Now all we say is 'you' and 'ye' is nowhere to be seen.  Has language been destroyed because of this change we didn't even know had happened?  Not really.  But when someone today does something similar such as saying "him and I are going to the party," we get upset with this grammatical infraction - one which we actually commit every time we use 'you' as a subject.  We might socially disfavor it, but that is . . . [no] worse . . . than what we did with 'you' and 'ye.'

That got me the rest of the way there - at least, intellectually.  And yet I still have a visceral antipathy for the singular "they."

 

There is another dimension to the question of whether "they" ought to be accepted as both a singular and a plural pronoun.  In realms such as language, where education, skill, artistry and rules figure prominently (and aren't these precisely what give language its charm, beyond its strictly utilitarian function?), changes over time can be either conscious and inorganic or unconscious and organic.  An example of a conscious, inorganic change in language - and one, for the better, in my opinion - would be the now ubiquitous title "Ms." as an alternative to "Miss or "Mrs."  There was nothing at all natural or "organic" about the way "Ms." was incorporated into everyday usage.  Its adoption and popularization were the result of very conscious and deliberate campaigns which arose in response to the inherent sexism of the use of either "Miss" or "Mrs."  

 

A further development along these lines would be to abandon "Ms." and "Mr." altogether in favor of a gender-neutral title such as "Mx.," which is now the leading choice among those expressing a preference.  To me, however, "Mx." seems inelegant and awkward in the same way that "Latinx" does.   On the other hand, "Ms." undoubtedly seemed unnatural and awkward when it was introduced, also.  And while there is a certain logic and even validity to "Mx.," the same, apparently, cannot be said of "Latinx." 

"They," as a singular pronoun, falls somewhere in between the organic development that Fridland talks about and the inorganic change in language that is consciously advocated as a way to rectify inequity, as in the case of "Ms."  I do not dispute that "they" has a long history of use as a singular pronoun but the organic development by which it came to be used was not a result of gender consciousness or of a rejection of heteronormativity and sexual-binary normativity.  People have misused "they" when they meant to say "he" or "she" for decades.  It is only recently that advocates for a more inclusive language have argued for the use of "they" specifically as a gender-neutral singular pronoun.  That is certainly a much more valid reason for its use than sheer carelessness or ignorance.  

 

That said, and aside from my longstanding objection to the use of "they" as a singular pronoun on strictly grammatical and aesthetic grounds, my argument has been that, if we are going to use "they" as a singular pronoun, we should at least follow the rule of grammar that a pronoun and a verb must agree in number.  In other words, we should be consistent, especially if there is any hope of the singular "they" acquiring any grammatical legitimacy.  Thus, for example, one ought to say "they is," not "they are."  Here are several additional examples of the correct way to use "they" as a singular pronoun in a sentence: "They is the president and CEO of that organization," or, "They writes for The Guardian and is a frequent contributor to other publications," or, "They is going to be delivering a lecture on semiotics which you won't want to miss because they is the leading expert on this topic."  Admittedly, using the correct verb forms, as in these examples, grates on one's ears, but no more so than the singular "they" does.  And if we are being asked to get used to "they" as a singular pronoun, don't we have a right to expect the champions of the singular "they" to get used to conjugations such as "they is"?

 

On the other hand, though, there is the powerfully convincing example that Fridland cites in which "you" is used as either a singular pronoun or a plural pronoun but always with a verb form as though it were a plural.  We never say "you is."  Yes, maintaining agreement in number between the singular "they" and the accompanying verb would serve the purpose of making it clear that one is speaking about one person and not more than one and so avoid the confusion that may occur with the use of the singular "they," as in this example: "The committee members and the chair could not come to an agreement about the budget because they were afraid that the funds would not be allocated properly."  In that sentence, does "they" refer to the committee members, to the chair of the committee, or to all of them?  Now try this: "The committee members and the chair could not come to an agreement about the budget because they was afraid that the funds would not be allocated properly."  Awkward, yes, but at least we understand that it is the chair of the committee and not the committee members who has reservations about approving the budget.   

 

Of course, all this awkwardness and confusion could be avoided by using a different, gender-neutral pronoun altogether.  However, if we are to use the singular "they," using it in a way that preserves agreement in number between the pronoun and the verb would, over time, as our ears become accustomed to it, have the added virtue of conferring more legitimacy on the use of "they" as a singular, specifically gender-neutral pronoun because it would make it unambiguous that the speaker used "they" deliberately as an affirmation of the non-binary gender of the person being spoken about rather than that the speaker used "they" simply out of carelessness.

 

To be clear, I am not objecting here to a person's choice of pronouns but to the inappropriate use of the verbs that accompany them.  As I have written elsewhere, I respect the right of everyone to identify herself, himself, or themself in any way that she or he or they chooses to.  Indeed, I do not regard it as "woke" so much as common courtesy to respect the wishes of each person to be addressed and identified as she, he or they wishes.  (And I say this not only as someone who bristles when people presume to call me "Dave" rather than by my real name - David - but as someone who legally changed his last name as an act of public repudiation of what I had long regarded as the ethnic self-abnegation of my forebears.)

 

So much for "they."  Secondly, I was flabbergasted to hear Professor Fridland use the expression "flash forward" (at 4:40 in the interview). No! No! No! It is "fast forward" - not "flash forward." This expression is used metaphorically - as Fridland used it - but comes, unless I am completely mistaken about this, from tape cassette players which included a "Play" button, a "Stop" button, a "Rewind" button and - you guessed it - a "Fast Forward" button.  If one wanted to quickly advance the tape, one would press "Fast Forward," hence the use of this phrase to mean rapidly advancing and skipping over the contents of something in order to get to the desired location much later on or farther along in the sequence.  "Fast forward" is therefore now used synonymously with phrases such as "skipping ahead to the present time. . .," or "bringing us up to the present moment. . . ."   "Flash forward" seems to be a corruption of "fast forward" and it also seems to be used exclusively by young people - at least, I have only ever heard young people use it.  This tends to confirm what I suspect is the cause of the change from "fast forward" to "flash forward," namely, the fact that most young people nowadays have never even seen, let alone operated, a tape cassette player.  They are, however, familiar with flash drives.  It is my hypothesis, therefore, that their familiarity with this more contemporary recording technology is the source of the corruption of "fast forward" into the increasingly prevalent "flash forward."  I also have to infer from her use of "flash forward" that Fridland falls into the category of post-boomer.

 

The broader point of Fridland's comments and, I assume, of her recent book, is that, because language is always changing and because this change reflects a natural process - the organic development of language cited above - one should respect neologisms and new constructions and be less dogmatic about English.  Fair enough.  But this raises another point which is my third pet peeve. Namely, if language is always changing, including its grammatical rules, the meaning of words, etc., then why even bother teaching grammar in the first place?   Why teach English as a subject to native English speakers?  When I was in elementary school, we all laboriously diagrammed sentences and learned what words to use, how to use them and how not to use them.  Was that all a gigantic waste of time?  It seems as though what Fridland is arguing is that every usage is valid.  Anything goes.  This would be consistent with what one of my English professors back in college stated, namely, that dictionaries are descriptive, rather than prescriptive.  As it happens, though, this is emphatically not what Fridland is arguing.  As she explained to me,

Language is self-sustaining and a remarkable and highly rule governed system - just not by the rules we tend to think of when we talk about 'language rules' typically.  People often mistake linguists to be saying there are no rules, but this is far from true.  Language can't operate without cognitive and articulatory rules that are deeply tied to how we understand and produce language. . . .  Natural inherent linguistic rules . . . allow language to keep thriving and changing without losing meaning or utility. . . .

These "inherent linguistic rules" differ, then, from "the social rules that have just become what we like to do [but do not reflect] what we need to do as language speakers."

 

So perhaps it's not unreasonable to say that, at least to some extent, the rules of grammar that we all struggle with are constructs (and, therefore, artificially rigid) in a way that the "cognitive and articulatory rules" to which Fridland refers are not.  If I understand her correctly, what Fridland is saying is that the formal rules of grammar - as taught - differ from the inherent logical rules of language itself.  I can accept that.  But if that is true, then I still maintain that no professor or grade-school teacher should ever again wield the red pen when grading a student's paper and criticize or "correct" her grammar, spelling, punctuation or (alleged) misuse of a word.

 

One last point - you'll notice that I used the pronoun "her" rather than "their" just now to refer to an individual of unspecified sex or gender.  As much as I loathe the use of "them," "they" and "their" in the singular, I also appreciate that the universal "he" or "him" when used to refer to an unidentified individual reflects the patriarchal and sexist roots of our society and actually perpetuates patriarchy and sexism by reinforcing the concept that maleness is the standard or the default in relation to which everything else is a subsidiary variation.  Accordingly, for decades now I have (with rare exceptions) used "her" or "she" instead of "him" or "he."  It's true that feminine pronouns are not inclusive and therefore "privilege" females, however, I figure that white males have enjoyed the benefits of affirmative action in language as in most other things for at least 5,000 years so it's probably time to give someone else a chance.

Revised, and with grateful acknowledgement to Professor Valerie M. Fridland, Ph.D., on 30 April 2023

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About me: I am originally from New York City and now live near the Finger Lakes region of New York. I am a licensed physical therapist and I write about bodily autonomy and human rights, gender, culture, and politics. I currently serve on the board of directors for the Genital Autonomy Legal Defense & Education Fund, (GALDEF), the board of directors and advisors for Doctors Opposing Circumcision and the leadership team for Bruchim.

You Say "Tetra-"; I Say "Quadri-". . . Let's Call the Whole Thing Off

by David Balashinsky

As a physical therapist, one of my responsibilities - to my patients and to the profession - is to keep learning.  Whether it's to learn about new developments in the field or treatment techniques with which I might not be familiar, I am obligated to take continuing education courses.  (I am also legally required to do so, just as most licensed healthcare professionals are, as a condition for renewal of my license every three years.)  These are generally lectures online or in person that can last from as little as a couple hours to several days and that cover myriad topics related to physical therapy.  

Physical therapy, incidentally, is a great field, not least because it is so rewarding for the therapist and beneficial to the patient but because it addresses so many different types of diagnoses and encompasses so many different types of treatment techniques.  Physical therapists treat patients with strokes, cancer, fractures, joint replacements, pelvic-floor dysfunction, neuropathies, vestibular problems, amputations and many other conditions, as well.  They treat the young and the old, female, intersex, male, gay, straight, transgender, cisgender and everything in between and beyond.  The number and type of continuing "ed" courses available, therefore, is as vast and diverse as the diagnoses and patient populations it is our privilege to serve.

One of the most serious types of injuries that physical therapists treat are spinal cord injuries.  Most people are fortunate enough not to have to cope with the day-to-day challenges of living with a spinal cord injury (SCI) or even to think about what that might be like.  The statistics, by themselves, do not adequately convey a sense of the gravity of this condition.  For that, I encourage you to listen to first-person accounts of people living with SCI.  But, for what it's worth, there are roughly 300,000 people with SCIs living in the United States.  Interestingly, the sex identification of about 78% of all new reported cases of SCI (since 2015) is male.  Motor vehicle accidents are the leading cause of SCI followed by falls, but other "common" causes are acts of violence (primarily gunshot injuries) and injuries resulting from sports and recreational activities.  

The type and severity of SCIs are categorized according to a system of classification established by the American Spinal Injury Association (ASIA).  This system, which is known as the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) is used throughout the United States and abroad and is considered "the gold standard" for SCI classification.  (The ISNCSCI includes the ASIA Impairment Scale [AIS] but, although the AIS classification of SCI is derived from and, therefore, constitutes just one part - a major part but, still, only one part - of the battery of sensory and motor testing that comprise the ISNCSCI, in the jargon of healthcare "the ASIA" has come to be used to refer broadly to the ISNCSCI itself.)

I was introduced to the ISNCSCI and the AIS in physical therapy school but it was only an introduction.  In a class on inpatient rehabilitation, we watched a video that demonstrated how to perform the elements of "the ASIA," one of which is to insert a gloved index finger into an anus in order to check for sensation to deep anal pressure and voluntary contraction of the external anal sphincter.  (The thing I remember most about this is one of my classmates asking if he could please watch that part of the video again.)  Like much if not most of what one learns in a physical therapy program, this was just an introduction to material that one cannot possibly hope to master without additional training and, above all, experience - preferably under the guidance of more experienced therapists.  Although I have worked with SCI patients over the years, the inpatient rehabilitation facility (IRF) where I work does not typically receive patients during the acute phase of their (newly diagnosed) spinal cord injuries.  Largely for this reason, I have not had occasion to use the ISNCSCI and have never acquired what I felt was a sufficient grasp of how to administer it and how to interpret its results.  This is why I chose, a couple weeks ago, to enroll in a series of continuing ed courses devoted to SCI and to "the ASIA."

It was while taking these courses that I was reminded that there has been an effort underway by the leading authorities on SCI to replace the term "quadriplegia" - which is how most of us, at least here in the United States, know it - with "tetraplegia."  These words mean the exact same thing and are defined as

impairment or loss of motor and/or sensory function in the cervical segments of the spinal cord due to damage of neural elements within the spinal canal.  Tetraplegia results in impairment of function in the arms as well as typically in the trunk, legs, and pelvic organs. . . .

For a long time, I have been dimly aware of the fact that there is an official policy of preference for "tetraplegia" over "quadriplegia."  Revisiting these topics, I discovered that the ISNCSCI explicitly says so.  What I have not known is why.  Seeing "tetraplegia" used again and again in these courses rekindled my interest in understanding the reason for this change in nomenclature.  I was finally able to find an explanation for it on the website of the online organization, facingdisability.com:

We get asked about this subject a lot, “What’s the difference between quadriplegia and tetraplegia?” 

Surprisingly, there isn’t any difference in meaning. Both words apply to paralysis of all four limbs.  And both terms are used interchangeably these days.

The difference is in the derivation of the words.   The word “Quadri” means four in Latin; the word “Plegia” means paralysis in Greek.  So the roots of the word “quadriplegia” which means paralysis in all four limbs, come from both Latin and Greek. It combines two different languages.

The Greek word for four is “Tetra.”  Combine that with “plegia” and you have a word with Greek roots for both halves.  The British have always used the term “Tetraplegia” for four-limb paralysis, so they are not combining Latin and Greek words.

Such distinctions are important to the English, but Americans don’t seem to mind. Although there was a movement in the 1990’s to try to adopt “tetraplegia” in America, it never really caught on outside of the medical literature.

That’s why most Americans still continue to refer to “quad rugby,” for example, and why the word “quadriplegia” remains in common use.

Incidentally, since “para” is the Greek word for two, and “plegia” is Greek for paralysis the word “paraplegia” all comes from the same language of origin—Greek.

As much as I revere (and generally comport myself with due deference to) experts and expertise, I am also, by nature, highly skeptical of (and even hostile to) neologisms.  This holds as much for those that fall from the spires of ivory towers as it does for those that arise from the propagation bed of vernacular.  Learning the reason, therefore (and at long last), for the use of "tetra-" versus "quadri-"elicited from me an especially large eye-roll.  Could the clash of civilizations that threatened to result from the pairing of the Latin "quadri-" with the Greek "-plegia" possibly matter less?  Are the Barbarians - with their battle axes and their "quadri-" - not just at the gate but inside, and in need of expulsion?  (Except, of course, that the Barbarians, in this case, are not the Greeks but the Romans themselves.  And, in any case, the civilizations of antiquity frequently learned and borrowed from one another.)  

I am a language purist as much as anyone but I am also an American: after this initial reaction, my patriotism took hold of me.  I take pride in the fact that every person in this country is or is the descendant of immigrants, including Native Americans who were themselves "immigrants" in the Americas (long before they were "the Americas") many thousands of years before the Vikings and the Europeans were, and that, perhaps more than any other nation on Earth, the United States is woven from the myriad cultures, ethnicities, races and nationalities that make up the ornate tapestry of the American body politic.  I admit it: I am one of those who believe that diversity is a positive good.  When I was young, the concept of "the melting pot" was instilled in us as part of our civics instruction in elementary school.  After Alex Haley (and many others) and the recognition that what "melting pot" really meant was Anglo-conformity, that metaphor was replaced by one which was much more apt.  This one - "a gorgeous mosaic" - was popularized by David Dinkens, although apparently it was coined by Mario Cuomo, who referred to my home town, New York City, and to the United States as "a magnificent mosaic."  This concept - the mingling of people and cultures as coequals in which their individual identities are retained and honored yet, at the same time, are subsumed within a single whole for the greater good - I believe is epitomized by the word "quadriplegia."  It is a word that marries two languages and two cultures; it is like Cleopatra and Mark Antony.  Opposition to the use of "quadriplegia" on the basis of its impurity seems as contrary to my view of people and America and is almost as offensive to my values as are anti-miscegenation laws.

Then, there is the problem that well-meaning efforts to change terminology often just fall flat for other reasons.  The prefix "tetra" is undeniably beautiful in and of itself.  It elicits associations with such naturally elegant structures as tetrahedrons and such beautiful creatures as "tetras" (short for tetragonopterus).  Contrast "tetraplegia," however, with another recent effort to change the medical nomenclature from "stroke" (or cerebral vascular accident - CVA) to "brain attack."  Yes, that really happened.  A number of years ago, there was a similar effort to begin using "brain attack" to describe a stroke on the principle that the etiology (at least in the case of an ischemic stroke, which is caused by the obstruction of blood flow through an artery) is the same as that which results in a heart attack.  (In contrast, a hemorrhagic stroke results from the rupture of a blood vessel so it's unclear to me whether "brain attack" advocates intended that this should refer to both ischemic and hemorrhagic strokes or merely to those that had in common with heart attacks a mechanism involving an arterial blockage.)  Like "tetraplegia," "brain attack" never caught on, possibly because it sounds less like a medical diagnosis than like the title of a trashy 1950s science fiction movie.  Still, this example should stand as a warning to all who would attempt to change diagnostic terms from those that are near and dear to our hearts to those that are alien.

Of course, most of the medical terminology that has come down to us comes from both Greek and Latin.  Moreover, there are plenty of words in common use that combine Greek and Latin elements.  Words such as "appendicitis," dehydration," and "mononuclear."  "Mononucleosis" is created from first a Greek element (monos), then a Latin element (nucleus), and then another Greek element (osis).  I don't see anyone rushing to purify these terms by converting them to either all-Greek-based or all-Latin-based elements.

For me, what matters most - what should matter most - is what people living with SCI themselves prefer.  I sought the answer to that by joining several SCI support groups on Facebook, identifying myself as a physical therapist and posting a query as to whether anyone had a preference for either "quadriplegia" or "tetraplegia" and, if so, why.  Although I did not get a large response (so my informal survey has no scientific validity whatsoever), the consensus seemed to be that we should leave well enough alone and stick with "quadriplegia."  I did receive one particularly thoughtful and illuminating reply from someone who, though she had not herself sustained a spinal cord injury, was a close family member of someone who had.  As it happens, she also identified herself as a Latin teacher and a classicist and she therefore began her response by acknowledging her familiarity "with the problematic Greek-and-Latin combining phenomenon in English words," adding that "it bothers some language fans more than others."  (I replied that I could hardly imagine anyone being better suited to answer my question.)  This respondent ultimately expressed a preference for "tetraplegia," explaining that "I favor 'tetraplegic' because it is unfamiliar-sounding and the first feeling I have on hearing it is curiosity, not fear."

What is notable about that response is that it validates this person's own feelings and lived experience relative to SCI, rather than falling back on deference to authority.  That puts her sentiments in line with those who express a preference for "quadriplegia."  Both are equally valid and it is my intention, going forward, to respect that preference, whichever it may be.  None of what I have learned recently has undermined my belief that the right of patients and of all individuals to choose their own identifiers, names and designations (and, yes, even their own pronouns) should always be respected.

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About me: I am originally from New York City and I now live near the Finger Lakes region of New York.  I am a licensed physical therapist and I write about bodily autonomy and human rights, gender, culture, and politics. I currently serve on the board of directors for the Genital Autonomy Legal Defense & Education Fund, (GALDEF), the board of directors and advisors for Doctors Opposing Circumcision and the leadership team for Bruchim.

GALDEF STATEMENT ON THE INTERNATIONAL DAY OF ZERO TOLERANCE FOR FEMALE GENITAL MUTILATION

by David Balashinsky 

February 6, 2023 is the twelfth anniversary of the International Day of Zero Tolerance for Female Genital Mutilation.  This annual observance was established by the United Nations General Assembly as an occasion "to raise awareness, renew commitments and reiterate that female genital mutilation is an unacceptable harmful practice and a violation of women and girls' basic human rights."

The Genital Autonomy Legal Defense and Education Fund (GALDEF) supports the United Nations' goal of ending female genital cutting (FGC) worldwide.  We agree that FGC is an inherently harmful practice that violates the fundamental right to bodily integrity of those who are subjected to it.  As our Values Statement makes clear, GALDEF stands in full "solidarity with female and intersex victims of genital cutting. . . ."  Likewise, the United Nations' goal of eradicating FGC is consistent with GALDEF's Vision: "To create a world where the rights of children to bodily integrity and future autonomy over their genitals and their sexuality are respected."

In light of our Values and Vision, GALDEF believes that it is incumbent upon us to join the many voices around the globe on February 6 calling for an end to FGC and we are proud to do so.  At the same time, we believe that it is equally incumbent upon us to point out - and equally incumbent upon the international community to recognize - the ongoing disparity between the widespread condemnation of genital cutting of girls (or people with vulvas) and the continued tolerance of genital cutting of boys (or people with penises) and intersex children.  

We believe it is necessary to call attention to this disparity in part because of the harmful effects it is having on efforts to end FGC, itself.  As the universal right (irrespective of sex) to genital autonomy has gained popularity, the position that genital cutting of girls should be prohibited under all circumstances while genital cutting of boys should continue to be permitted has become untenable.  In recognition of this changing cultural landscape, defenders of male genital cutting (MGC) are therefore increasingly arguing that certain "benign" forms of FGC should be permitted.  At the same time, the widespread medicalization of MGC in the United States has provided a convenient model for proponents of FGC.  The result is that, more and more, FGC is being performed by medical professionals, undermining efforts to eliminate this practice.  In both of these ways, then, the continued tolerance for MGC will only undermine efforts to end FGC.

Apart from these practical, strategic concerns, however, is the matter of basic fairness and equitable treatment.  Paradoxically, the United Nations' official theme for this year's observance of the International Day of Zero Tolerance for Female Genital Mutilation is "Partnership with Men and Boys to Transform Social and Gender Norms to End Female Genital Mutilation." Yet, while it is estimated that about 250 million girls and women worldwide have been subjected to genital cutting, it is also estimated that about one billion boys and men worldwide have been subjected to genital cutting.  It is unknown how many intersex individuals worldwide have been subjected to intersex genital cutting (IGC).

We do not believe that a moral distinction can be made between the medically unnecessary genital cutting of children based upon nothing more than a child's sex or the appearance of that child's genitals.  GALDEF believes that all children, regardless of sex, have a fundamental and inherent right not to have their genitals cut, scarred or surgically modified in any way without their consent and when not urgently and medically indicated.  By the same token, we do not believe that the goal of ending FGC is "trivialized" or efforts to end it undermined in any way by making common cause with the movements to end MGC and IGC but, rather, will only be strengthened by doing so.  A moral principle is always more powerful when applied universally.  If the United Nations is to succeed in situating its campaign of zero tolerance for FGM on a solid moral foundation and if it is to succeed in its goal of ending FGM, it will have to revise its policy of tolerance for male genital cutting and adopt a position of universal respect for genital autonomy, regardless of sex.

It is in this spirit of universal respect for genital autonomy and in observance of the International Day of Zero Tolerance for Female Genital Mutilation, February 6, 2023, that GALDEF reiterates its support of the right of genital autonomy for girls and for all children and calls upon all people of good will who value human rights to do the same.

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David Balashinsky is originally from New York City and now lives near the Finger Lakes region of New York. He is a licensed physical therapist and writes about bodily autonomy and human rights, gender, culture, and politics.  He currently serves on the board of directors for the Genital Autonomy Legal Defense & Education Fund, (GALDEF), the board of directors and advisors for Doctors Opposing Circumcision and the leadership team for Bruchim.
 

 

One Cat's Short Life and Thoughts for 2023

by David Balashinsky

On New Year's Day, 2023, my wife received a call from the office manager of the animal hospital where she works as a veterinarian.  The day before, after hours, someone had dropped off a sick stray or feral kitten.  The kitten had been placed in a cloth carrier and left outside by one of the entrances.  (Note to people who dump animals, including Good Samaritans: leaving a sick animal in a carrier overnight in the dead of winter without food or water is a terrible idea.)  Although the hospital was closed for the holiday weekend, by chance, the office manager had gone in to attend to some outstanding clerical work.  That is the only reason the kitten was still alive when she found him.  By then it was obvious that the kitten needed either urgent veterinary care to save his life or euthanasia to spare him needless suffering.  After placing him in a cage with food and water and covering him with towels, the office manager called my wife.  When the call came, we were both hunkered down, so we thought, for the rest of the day.

If you have dogs and cats living with you, as we do, one of the fringe benefits of being married to a veterinarian is free house-calls.  On the other hand, being married to a vet has imposed obligations on me that I never imagined I would have to assume.  For example, I always  accompany my wife whenever she goes to the animal hospital on an emergency call in the middle of the night.  I do this not only for her safety and to provide moral support but because there are no overnight staff at the hospital.  Accordingly, there are times when I have to assume the role of veterinary assistant, also.  Once, many years ago, my wife had to go in at about 2:00 in the morning in order to euthanize a hopelessly ill, elderly dog.  I had to assist her while she ran the IV and injected the drug.  My wife dealt with this almost as if it were nothing.  For an experienced vet, this was standard protocol: the dog was beyond hope so euthanizing him was the only humane course of action.  I, however, had never even witnessed a euthanasia, let alone having assisted in one.  My job was to restrain the dog and apply pressure to one of the veins in his right foreleg while my wife inserted the needle (although he was so docile that it was more like embracing him than restraining him).  He was about forty pounds, had grey shaggy fur and large brown eyes.  I will never forget the searing emotional conflict between the pity that I felt for this dog and the guilt that I felt for my role in ending his life.  And I will never forget how trusting, innocent and unknowing of his fate he seemed in his final moments.  When it was done, I sobbed and sobbed and sobbed.

I wonder if the public fully appreciates the toll being a veterinarian can take on someone.  What emotional fortitude must it take to end an animal's life, even though euthanasia is almost always the ethical choice (and my wife has a strict policy against performing "convenience" euthanasias).  What degree of commitment and self-sacrifice are required to get up at 2:00 in the morning or simply to drop everything on a crappy New Year's day in order to attend to an animal in need.  I am reluctant to cheapen these reflections with any mention of money but I also think, in fairness to veterinarians everywhere (and to my wife), that it should not go unacknowledged that, in cases like this, there is no compensation because there is no bill.  (Who would it be sent to?)  The ministrations with which my wife rang in the new year were performed strictly for the sake of the kitten's welfare.

Here is a picture of him:

These are the most likely and obvious conditions from which, according to my wife, this kitten was suffering.  He had an upper respiratory tract infection (the mucus dripping from his nose is visible in the picture above).  He had pneumonia.  He had fleabite anemia (fleas do not just cause itching and irritation to the skin but feed on their host's blood).  He had hypothermia.  He was malnourished and emaciated (he weighed under two pounds yet, based upon his likely age, which my wife was able to gauge by his teeth, he should have weighed five or six).  He had diarrhea and his gut had likely been colonized by intestinal parasites.

Here are some pictures of my wife attending to him:

My wife quickly got to work providing the emergency treatments that would be needed to save the kitten's life.  All I could do, besides petting him and trying my best to comfort him when my wife wasn't working on him, was look on in awe.  I felt privileged, although it came at an enormous cost for the kitten, to be a witness to the drama unfolding before me.  I was reminded of the enormous admiration I have for my wife's skill and dedication.  I allowed myself to hope that she could save the kitten's life and it occurred to me that watching her do it was probably among the best possible ways I could spend New Year's Day.  This entire holiday season, after all, is my favorite time of year because I regard it as a time of renewal, rebirth, and new beginnings.  I am always on the lookout for the deeper meaning in things and this kitten's struggle to survive and my wife's valiant efforts to save him seemed the ideal source for a homily about what the holiday season really means.  I had already begun mentally composing it - the kitten's new lease on life would serve as a metaphor for the new year while my wife, by virtue of her diligence, generosity, and steadiness under trying circumstances, would serve as a paragon of how we ought to approach the new year, and life in general -  when the kitten commenced his death throes and suddenly, quickly and quietly expired.

Nature is heartless.  Life itself sometimes seems sadistically cruel.  What I had hoped would serve as an uplifting story with which to inaugurate 2023 became, instead, like so many other stories, one that ended in defeat and in death.  I was ready to forget the whole miserable episode. 

But maybe the more important meaning in this is that, although success is never guaranteed, we still have to try.  What if the Good Samaritan, misguided as she or he was, had not even bothered to try to rescue the kitten?  Its fate would have been sealed.  What if my wife had not intervened with emergency measures to try to save his life?  It would have ended just the same but without the modicum of comfort that we were able to provide the kitten during its final hours.  If 2023 doesn't look all that promising, that only means that we need to muster more resoluteness, more courage and more commitment to ending suffering, saving lives, expanding rights and making the world a better place, even though, sometimes, we will fail.  Because, sometimes, we succeed.  That's the thought I intend to carry with me into 2023.