Affirmation, Transformation, Freedom
My 2021 fieldwork explored mind–body dualisms among transmasculine (female-to-male and non-binary) young adults in urban Finland. On the basis of the material collected, I argued that the malleability of the Finnish term sukupuoli (which can mean ‘biological sex’, ‘gender’ or ‘gender expression’) informs contingent experiences of bodily distress or ‘dysphoria’. I described how my informants oscillated, sometimes within the space of a single sentence, between defining sukupuoli as a state of mind-over-matter, as separately informed by mind and body, and, in some instances, as a series of cultural signifiers through which femininity, masculinity and androgyny are enacted (Franklin 2022). A focus on ‘care’ – to which the Finnish terms hoitaa (‘to provide care’), hoito (‘care provision’), hoiva (‘“non-medical” care’) and välittää (‘to care about’) are roughly equivalent – augments these findings. The conceptions are, I suggest, informed by three distinct and often contradictory interpretations of when and how ‘care’ qualifies as beneficial and humane. In turn, these logics inform and are informed by dualistic understandings of the relationship between mind and body, all of which shapes my informants’ navigation of friendship, healthcare and family life. Scholarship involving typologies of care-related “repertoires” or “logics” (see e.g., Pols 2006; Mol 2008) has often focused on how to ‘best’ facilitate care. By contrast, my interest here is in pinpointing the ways in which discrete ontological understandings of care might generate interpersonal and internal dissonance.
The three clashing logics of care that correspond to three conceptions of sukupuoli were particularly visible in my conversations with Niko, a trans student in his late teens. In the first case, defining sukupuoli as a matter of psychological self-definition, as advanced with particular vigour by Seta (LGBTI Rights in Finland) and other activist bodies (Seta 2023), presupposes that ‘care’ for transgender people entails affirming sukupuoli-identity (sukupuoli-identiteetti) independently of medical transition or aesthetic performativity. When discussing his experience of “coming out”, Niko presented his grandparents’ willingness to call him by his chosen name (pre-medical transition) as proof that they “really truly cared about me” (ihan oikeesti välitti musta) despite the generational divide between them making the change “a lot to swallow”. Similarly, for Niko, whenever his friends linguistically affirm his status as a ‘man’, they are enabling him to maintain a healthy social life both ensuring that he need not “prove myself to them” and also demonstrating that “their views on sukupuoli are much like my own.”
In the second case, defining sukupuoli as formed by minds and bodies – which, for trans people, do not align with one another, hence the necessity of medical transition – assumes that transgender care is a facilitation of the process of ‘fixing’ (korjata) one’s physiology. Medical transformation, then, is not what is ultimately meant by ‘care’ in this context. Rather, hormonal and surgical interventions serve as a means to the end that is mind/body alignment. The notion of needing to heal a mismatch between mind and body would, in turn, not be conceptually possible without implicit reference to Cartesian dualism. This understanding of care was as central to Niko’s account as was his focus on verbal affirmation. Before being given the diagnosis of Gender Dysphoria (GD, sukupuolidysforia) required for government-funded medical treatments, Niko was first diagnosed with Moderate Depression and Generalised Anxiety Disorder, both of which he views as “linked to my sukupuoli” because “my mental wellbeing degenerated when I experienced bad dysphoric days.” However, the doctors and psychologists deliberating whether or not to prescribe him masculinising hormones entertained the possibility that Niko’s discontent in his body might be informed by his depressive symptoms. For Niko, their initial hesitancy to encourage bodily transformation constituted a failure to provide adequate care: “They just wanted a so-called medical explanation for my transness, rather than to actually care for me.”
Finally, on the occasions that sukupuoli is equated with a series of performative gestures and products encompassing, for instance, clothing, cosmetics and mannerisms, transgender ‘care’ becomes a form of negative liberty centred around the freedom to engage in acts often broadly termed ‘self-expression’ (itseilmaisu). Niko invoked this definition in reference to his behaviour as a child, stating that “I was already different in many ways from the other ‘girls’ my age – I liked to play and dress the way I liked […] I was never very girly.” After grappling with doubts about his sukupuoli at the age of twelve, Niko started identifying as trans within the following year, as it was only by resisting the “societal norm” to adopt feminine gendered signifiers such as long hair and makeup that he was able to reign in his feelings of “extreme anxiety”. While some peers and strangers made their scorn for his masculine presentation known, his immediate family and friends did not interfere with his preference for a short haircut and clothing designed for men. This freedom to detach his looks and behaviour from contemporary Finnish notions of ‘girliness’ was, for Niko, a signal that he was lucky to have loved ones who cared about his “wellbeing” (hyvinvointi).
In each facet of Niko’s account, we see that ‘care’ is construed as a means to a somewhat different end. If sukupuoli is an innate state of mind unrelated to sexed physiology or gendered performance, ‘care’ for transmasculine youth is a series of practices that affirms a fundamental separation of the self from womanhood. The use of chosen names and (English) gendered pronouns (often displayed on social media and discussed with friends even in Finnish, in which no pronouns are gendered) becomes highlighted as a means to care for a trans friend or family member. If sukupuoli is a dual composite of minds and bodies, it is by assuming that it is the latter that may require transformation that medical providers can ensure care. If sukupuoli rests on performativity, care is a facilitation of negative liberty centred around the freedom to adopt the gendered signifiers of one’s choosing.
Contradictions of Care
My informants’ social lives and medical negotiations were heavily informed by the contradictions between these three logics of care. Firstly, the logic of care-as-affirmation conflicts with that of care-as-transformation. Where the former severs sukupuoli from bodies, the latter assumes that a trans person’s sukupuoli is realised through corrective processes enacted on the flesh of a patient. The resulting conundrum is apparent in the fact that while Niko’s frustration with his healthcare providers was based on their expectation of a “medical explanation for my transness”, his own expectation that testosterone injections would salvage his mental health implies a need for bodily change inconsistent with care-as-affirmation. When I asked Niko if his decision to start injecting testosterone involved a sense of being “born in the wrong body”, he grew visibly uncomfortable, stating in an apologetic tone that “I really can’t come up with anything sensical for that”. In an attempt to reassure him, I mentioned that many other informants had also struggled with the question, a pattern which in itself indicates an overarching interpersonal and internal clash between a sense of care as metaphysical affirmation and care as transforming parts that are, by implication, in need of ‘fixing’.
Care-as-affirmation also sits in some tension with care-as-freedom. For Eina, a non-binary activist, entering a new social circle of artists in 2020 brought with it a freedom to experiment with androgyny that contrasted with the sanctions of their religious upbringing. Eina has particularly vivid memories of getting a buzzcut: “I felt so strongly that my femininity fell to the floor along with my hair… it’s funny, how powerful that was, because it’s only hair… if hair is all it takes, it really didn’t take much.” Equally central to this period was the company of a friend who, in the past, had introduced Eina to the basics of feminine care. As young adults, ‘care’ took on a different form, with the friend, now a Gender Studies undergraduate, reassuring Eina that desiring medical care and experiencing “distress” at being “misgendered” is not the only “valid” way to be trans. However, Eina simultaneously presents their parents’ ongoing habit of referring to them as a “daughter” as a failure to give care: “My mum misgenders me every fucking time, and when I correct her, she’s like, I’ve seen you as a girl for 21 years… it’s really embarrassing that my mum can’t bring herself to care about this […] I cut [my family holiday] short last year, that’s how much this was pissing me off.” Ultimately, by juggling the view of sukupuoli as defined by performativity with that of sukupuoli as psychically innate, Eina must also juggle conceptions of care as an individual freedom to self-style, and care as entailing external validation for which loved ones are particularly responsible.
Let us now turn to the relationship between care-as-transformation and care-as-performance. Miro, a trans man in his thirties, began his medical transition in 2013 after several years of confusion: “What scared me the most was the idea of ending up as an interminable hybrid… but the effects of trans care [transhoidot] seemed desirable, and being sometimes read as a man when I dressed like one felt good. Eventually I realised that if I want the care, I have the right to the care, whether or not I fit the mould of a trans person that doesn’t despise their body.” In the wake of receiving ‘trans care’ (testosterone injections and surgical chest masculinisation) Miro realised that “being trans is mostly a medical thing for me”. Despite his view of himself as ‘trans’ being catalysed by his delight at being read as male on the basis of masculine stylistics – not by any intense need to modify his body – Miro believes that his brain chemistry is “different from the majority of people”. On one hand, his nod to performativity is logically inconsistent with his eventual emphasis on care-as-transformation. Nonetheless, it is also worth noting that Miro’s experience with sukupuoli-related care has primarily been a positive one. He is, in his own words, “in better health on testosterone”.
Understanding the significance of logics of care to Finnish gendered language, common-sense Cartesianism and transmasculine embodiment shows that the overlapping tensions involved are implicated in my informants’ pursuits of bearable bodiliness and ‘caring’ social relationships. Two concluding remarks are appropriate here, the first of which concerns contestations over trans identity and healthcare. On one hand, political debates between transactivists, medical professionals and party politicians have declined in fervour following the reform of Finnish transgender legislation last April, which separated the legal recognition of sukupuoli from medical transition. However, the question of whether the same can be said of more intimate conflicts over care and sociality in the lives of transgender youth is a far more open one, and should not be subsumed into discourses of legal case-closure. Secondly, anthropological studies of gender diversity are poised to exceed their current contributions to the anthropology of care. In turn, existing awareness of the relevance of care to the articulation of hierarchy and belonging (see e.g., Mulla 2014; Yarris 2017; Mody 2020) is a worthwhile resource for a field of anthropology that would do well to approach queer activist logics as one potential facet of transgender life among many.
Tarina Franklin is an MPhil student in Social Anthropological Research at the University of Cambridge, whose current research is centred on body modification. She has previously written on transmasculinity and embodiment in Finland, and on discourses on race and the far right. Beyond the academy, she has worked in publishing and political consultancy in Helsinki, as well as in clinical consultancy in London, and contributed to projects such as the Uralic Languages and Peoples Website and the Festival of Political Photography.
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Ministry of Social Affairs and Health 2023. Act on Legal Recognition of Gender enters into force on 3 April 2023 [Press Release] (available online: https://valtioneuvosto.fi/en/-//1271139/act-on-legal-recognition-of-gender-enters-into-force-on-3-april-2023, accessed 20 December 2023).
Mody, P. 2020. “Care and Resistance.” Anthropology and Humanism 45(2):194–201.
Mol, A. 2008. The Logic of Care: Health and the Problem of Patient Choice. London: Routledge.
Mulla, S. 2014. The Violence of Care: Rape Victims, Forensic Nurses, and Sexual Assault Intervention. New York and London: New York University Press.
Pols, J, 2006. “Washing the Citizen: Washing, Cleanliness and Citizenship in Mental Health Care.” Cult Med Psychiatry 30(1): 77–104.
Seta. 2023. LGBTI Rights in Finland – Seta (available online: https://en.seta.fi/, accessed 18 December 2023).
Yarris, K. 2017. Care Across Generations: Solidarity and Sacrifice in Transnational Families. Stanford: Stanford University Press.