Sexualizing governance and medicalizing identities: The emergence of ‘state-centered’ LGBT health politics in the United States.
Epstein, S. (2003). Sexualizing governance and medicalizing identities: The emergence of ‘state-centered’ LGBT health politics in the United States. Sexualities, 6(2), 131-171.
This work by Steven Epstein outlines the history of LGBT health advocacy from the 1970s to the early 2000s, and seeks to illustrate the implications of this history. Epstein notes that since the 1980s and 1990s, federal United States health institutions (e.g., NIH, DHHS and CDC) that formerly relied largely on the White, male, heterosexual body as the basis for all of their health research, began paying attention to previously ignored minority groups (i.e., women and people of color). By tracking the ways in which LGBT movements began incorporating themselves within this “state-centered” health inclusion, Epstein explores the politics of multicultural “inclusion” in health research when such research remains epistemologically, politically and institutionally organized by “state-centered,” racist, heterosexist structures.
Rather than using interviews or surveys to explore “state-centered” structures in the United States, Epstein takes a historical and analytical approach in this work. He begins by presenting a brief policy-based history of U.S. health institutions, which illustrates the increased research on and incorporation of concerns about minority groups. After this account, Epstein also highlights the history of LGBT health advocacy, drawing upon the ways that groups like ACT UP have both contributed to, and strayed from, the state-centered nature of health. For example, Epstein notes that lesbian groups were especially successful at convincing health officials that sexual minorities (i.e., LGB individuals) warrant special study and attention, perhaps because these groups focused on a diverse array of specific health issues—such as breast cancer—for which lesbian women may be at a higher risk. However, Epstein argues that the political move toward making LGBT identities state-centered and biomedical has its drawbacks. Most importantly, it allows policy-makers and healthcare professionals (who are not directly involved with LGBT social movements) to define and essentialize what it means to be “LGB” (as the “T” in the acronym is not often included in such studies), thus taking away from the voices of “lay” LGBT community members. Epstein notes that such political moves, which emphasize pathological similarities between LGBT people (i.e., “this group is all susceptible to the same diseases in the same ways”), may create strict boundaries (and thus ultimately, limited bounds of social acceptance) of LGBT community membership. These limitations could ultimately serve to exclude some who self-identify as LGBT from being recognized as “legitimately” LGBT because they lack certain “pathological” traits, and reinforce in-group/out-group differences between LGBT people and heterosexuals.
In outlining some of the early histories of LGBT health advocacy, Epstein offers insights on the political moves and possible problematic aspects of the “inclusion” of sexual minority groups into major health institutions in the U.S. Despite the fact that Epstein expresses that “inclusion” is probably inevitable for some groups, his conclusions offer a pushback against the logic and practice of including certain minority groups in biomedical research without changing the structure of the institutions that conduct that research. For example, while LGBT movements have made considerable strides in making state-centered research accountable to certain LGBT-specific health concerns (namely, AIDS), they may have done so at a significant price. First, they have allowed state health institutions (which often have little insight on LGBT movements) rather than “lay” LGBT groups, to define who counts as “LGBT.” Second, they have put themselves at the center (rather than at the margin) of federal health institutions, which they had previously pushed against, therefore potentially losing some of the perceived social legitimacy that came from their previous position as the “oppressed” group at the margins of the state. Thus, by making LGBT groups to move from the margins to the center of state health institutions that have the power to (usually inaccurately) define minority groups, the practice of “inclusion” may detract from LGBT groups’ authority and ability to advocate for their own well-being. In this sense, Epstein’s article is important to understanding at least one way in which certain minority groups interact with larger state institutions—even when state institutions seem inclusive, it can be to the detriment of minority groups.