The Metaphysics of Gender: A Glossary

androcentric vs. gynocentric metaphysics – as described by Sally Haslanger (2000), 1. the distinction between a theory that takes males or masculinity as the norm and females or femininity as the exception and a theory that takes females or femininity as the norm and males or masculinity as the exception. Also, 2. the distinction between a theory that emphasizes or is dominated by male perspectives, to the extent that female perspectives are marginalized or excluded, and a theory that emphasizes or is dominated by female perspectives, to the extent that male perspectives are marginalized or excluded.¹ 

anti-essentialism – 1. the theory that there is no essential characteristic that defines what it means to be a woman. 2. the theory that women don't share any essential characteristics without which they would not be women. 

anti-naturalism – 1. the theory that women don’t have certain natural qualities that aren’t possessed by men, and that men don’t have certain natural qualities that aren’t possessed by women. 2. the theory that women don't naturally have certain qualities that distinguish them from men, and that men don't naturally have certain qualities that distinguish them from women. 

anti-realism – 1. the theory that gender has no reality that is independent of its being experienced, perceived, or socially constructed. 2. the theory that there is nothing other than social construction, norms, or convention that determines a person’s gender.

biological determinism – 1. the theory that gender is biologically determined, rather than socially constructed (through socialization, assigned social roles, learned behaviors, etc.).

biological reductionism – 1. the theory that gender differences can be reduced to biological differences.

biologism – 1. the theory that gender differences are biological in nature. 2. the theory that women, by their biological natures, tend to possess certain psychological or social traits to a greater extent than men, and that men, by their biological natures, tend to possess certain psychological or social traits to a greater extent than women.

essentialism – 1. the theory that there is at least one characteristic shared by all women, possession of which is necessary for someone to be considered a woman. 2. the theory that there is at least one essential characteristic that makes someone a woman. 3. the theory that the gender of an individual is determined by at least one characteristic that is shared by all individuals of that gender. 4. the theory that gender is essential to a person’s identity, and that a given person would not be the same person if she were of a different gender. 

      Charlotte Witt (2000) distinguishes between individual essentialism (the theory that there are properties essential to an individual’s identity) and kind essentialism (the theory that there are properties essential to belonging to particular kinds or classes of individuals).² 

      Gender essentialism may take the form of biologism or naturalism.³ 

gender performativity – as described by Judith Butler, 1. the theory that gender attributes are performative, rather than expressive in nature, and that they themselves constitute the identity they are said to express or reveal.⁴ “Gender ought not to be construed as a stable identity or locus of agency from which various acts follow,” says Butler. ”Rather, gender is an identity...constituted...in an exterior space through a stylized repetition of acts.”⁵ 
      This theory has been attacked by Martha Nussbaum (1999), who accuses Butler of being pessimistic and politically disengaged regarding the self’s powers of agency prior to cultural construction, and thus also of being pessimistic and politically disengaged regarding the self’s capacity to effect cultural change.⁶   
      Butler's conception of gender performativity has also been criticized by Seyla Benhabib (1995), who says 
      

      “Butler also maintains that to think beyond the univocity and dualisms of gender categories, we must bid farewell to the “doer beyond the deed,” to the self as the subject of a life-narrative…If this view of the self is adopted, is there any possibility of changing those “expressions” which constitute us? If we are no more than the sum total of the gendered expressions we perform, is there ever any chance to stop the performance for a while, to pull the curtain down, and let it rise only if one can have a say in the production of the play itself? Isn’t this what the struggle over gender is all about? Surely we can criticize the supremacy of presuppositions of identity politics and challenge the supremacy of heterosexist and dualist positions in the women’s movement. Yet is such a challenge only thinkable via a complete debunking of any concepts of selfhood, agency, and autonomy? What follows from this Nietzschean position is a vision of the self as a masquerading performer, except of course we are now asked to believe that there is no self behind the mask.”⁷

      Butler (1995) responds to Benhabib's critique (as well as to Nussbaum's subsequent polemic) by saying

      “To claim that politics requires a stable subject is to claim that there can be no political opposition to that claim. Indeed, that claim implies that a critique of the subject cannot be a politically informed critique but, rather an act which puts into jeopardy politics as such…
      The critique of the subject is not a negation or repudiation of the subject, but, rather, a way of interrogating its construction as a pregiven or foundationalist premise…
      We may be tempted to think that to assume the subject in advance is necessary in order to safeguard the agency of the subject. But to claim that the subject is constituted is not to claim that it is determined; on the contrary, the constituted character of the subject is the very precondition of its agency. For what is it that enables a purposed and significant reconfiguration of cultural and political relations, if not a relation that can be turned against itself, reworked, resisted? Do we need to assume theoretically from the start a subject with agency before we can articulate the terms of a significant social and political task of transformation, resistance, radical democratization?...We need instead to ask: what possibilities of mobilization are produced on the basis of existing reconfigurations of discourse and power? Where are the possibilities of reworking that very matrix of power by which we are constituted, of reconstituting the legacy of that constitution, and working against each other those processes of regulation that can destabilize existing power regimes? For if the subject is constituted by power, that power does not cease at the moment the subject is constituted, for that subject is never fully constituted, but is subjected and produced time and again.”⁸ 

      Butler also explains, in a 2002 interview with art historian and writer Liz Kotz, 

      "What's not enough read in my work is the emphasis on power and the intense normativity that governs gender. I was trying to interrogate the painful ironies of being implicated in the very forms of power that one explicitly opposes, and trying to understand what kinds of agency might be derived from that situation. I think that it's inevitable that there's no position outside power, and in that way I'm linked with Foucault; but I don't think that means one is determined by power relations."⁹

      

naturalism – 1. the theory that women naturally possess certain characteristics that distinguish them from men. 2. the theory that women act according to their natures, and that they don’t act in ways that are contrary to their natures.

nominalism – 1. the theory that there is no universal property that belongs to all women. 2. the theory that women do not share any universal characteristics, and that they may merely resemble one another in various ways (resemblance nominalism).

realism – 1. the theory that gender is a real property that exists independently of any social construction. 2. the theory that there is something other than social construction that determines a person’s gender.

sex/gender distinction – 1. roughly, the distinction between the biological components of a person’s sexual identity and the psychological, social, and cultural components of their gender identity. 2. the distinction between biological sex (as defined by chromosomes, anatomy, hormones, secondary sex characteristics, and so on) and gender (as defined by experiences, perceptions, attitudes, and behaviors).
      This distinction is controversial. It has been criticized for being misleadingly dualistic, insofar as there may be cultural aspects of sex difference (impacting how individuals are assigned to different sexes) and biological aspects of gender difference (impacting how individuals experience their gender identity). It has also been criticized for implying that both sex and gender may be unequivocally described as male or female. It has also been criticized for implying that gender is fixed and stable, and that it can’t be fluid and variable.
      Judith Butler (1999) says that 

      “Taken to its logical limit, the sex/gender distinction suggests a radical discontinuity between sexed bodies and culturally constructed genders…Further, even if the sexes appear to be unproblematically binary in their morphology and constitution (which will become a question), there is no reason to assume that genders ought also to remain as two, The presumption of a binary gender system implicitly retains the belief in a mimetic relation of gender to sex whereby gender mirrors sex is or is otherwise restricted by it.”¹⁰

We have no reason to believe that gender is strictly binary in nature, says Butler. And if the sex of a person is itself something culturally constructed (at least to some extent), perhaps there is no real distinction to be made between sex and gender at all.¹¹    

social constructionism (or constructivism) – 1. the theory that gender is socially constructed, rather than biologically determined.
      Weak constructionism may not see gender (or the gendered self) as totally a matter of social construction, and may be realist in holding that gender (or the self) has some reality prior to, or apart from, its social construction. On the other hand, strong constructionism may see gender (or the gendered self) as totally a matter of social construction, and may be antirealist in denying that gender (or the self) has any reality prior to, or apart from, its social construction. 


FOOTNOTES

¹Sally Haslanger, “Feminism in Metaphysics: Negotiating the Natural,” in The Cambridge Companion to Feminism in Philosophy, edited by Miranda Fricker and Jennifer Hornsby (Cambridge: Cambridge University Press, 2000), p. 109.
²Charlotte Witt, The Metaphysics of Gender (Oxford: Oxford University Press, 2011), pp. 5-13.
³Elizabeth Grosz, “A Note on Essentialism and Difference,” in Feminist Knowledge: Critique and Construct, edited by Sneja Gunew (London: Routledge, 1990), p.334.
⁴Judith Butler, Gender Trouble: Feminism and the Subversion of Identity (New York: Routledge, 1999), p. 180.
⁵Ibid., p. 179.
⁶Martha Nussbaum, “The Professor of Parody,” in The New Republic, Feb 22, 1999, online at https://faculty.georgetown.edu/irvinem/theory/Nussbaum-Butler-Critique-NR-2-99.pdf.
⁷Seyla Benhabib, "Feminism and Postmodernism," in Feminist Contentions: A Philosophical Exchange, by Seyla Benhabib, Judith Butler, Drucilla Cornell, and Nancy Fraser (New York: Routledge, 1995), pp. 1-16.
⁸Judith Butler, "Contingent Foundations," in Feminist Contentions: A Philosophical Exchange, pp. 4-13.
⁹Judith Butler, "The Body You Want: An Interview with Judith Butler," ArtForum, November 1992, online at https://www.artforum.com/print/previews/199209/the-body-you-want-an-inteview-with-judith-butler-33505.
¹⁰Butler, Gender Trouble, p. 10.
¹¹Ibid., p. 11.

The Metaphysics of Race: A Glossary

anti-eliminativism - 1. the theory that the concept of race should not be eliminated from our thinking about personal or social identity, or from our discourse, social policy, public documents, etc. It may be expressed as conservationism (retentionism) or reconstructionism.

anti-objectivism - 1. the theory that race is not an objective biological or social category. Anti-objectivist positions include subjectivism (the theory that all racial categories are subjectively, rather than objectively defined) and relativism (the theory that all racial categories are relative to a particular society, culture, or time in history).

anti-realism - 1. the theory that race is not a real biological or social category.

conservationism (retentionism or preservationism) - 1. the theory that the concept of race should be conserved (retained or preserved), rather than eliminated.

deflationary realism - 1. a minimalist, social constructivist, nonracialist theory of race, according to which race is seen as a real social, but not fundamentally biological category.¹

eliminativism - 1. the theory that the concept of race is false and misleading, and that it should be eliminated from our thinking about personal and social identity, as well as from our discourse, social policy, public documents, etc.

essentialism - 1. the theory that racial categories are defined by certain essential (physical, behavioral, and sociocultural) features, and that all members of a particular category possess those defining features.

geographical minimalism - 1. the theory that races are defined by various physical characteristics that correspond merely to differences in geographical ancestry.

objectivism - 1. the theory that race is an objective biological or social category. 2. the theory or assumption that race can be objectively determined or evaluated.

populationism - 1. as defined by Michael O. Hardimon (2017), "a nonracialist (nonessentialist, nonhierarchical) candidate scientific concept that characterizes races as groups of populations belonging to biological lines of descent, distinguished by patterns of phenotypic differences, that trace back to geographically separated and extrinsically reproductively isolated founding populations.”²

racialism - 1. the theory that races have essential characteristics, that they are distinguished by certain biological and social differences, and that they're also defined by ancestry and geographical origins. 2. the racist theory that races are distinguished by different physical and mental capabilities, different sets of skills and levels of intelligence, and different social and cultural behaviors, according to which they may be regarded as superior or inferior. Racialism may thus be closely associated with racism.³

realism - 1. the theory that race is a real biological or social category. Realist positions include conservationism and retentionism. However, social realism (the theory that race is a real social category) doesn't necessarily entail biological realism (the theory that race is a real biological category). Indeed, social realism may be associated with biological anti-realism (the theory that race is not a real biological category).

reconstructionism - 1. as defined by Joshua Glasgow (2009), is a substitutionist rather than eliminativist mode of discourse, in which the term "race" refers only to a social, and not to any biological category.⁴

social constructionism (or constructivism) - 1. the theory that racial categories are socially constructed. Albert Atkin (2012) distinguishes between strong and weak constructionism: while strong constructionism sees race as a real social category, weak constructionism may not see the sociocultural and sociohistorical impact of race as conferring upon it any basic underlying reality. Weak constructionism may thus be skeptical about the basic reality of race.⁵


FOOTNOTES

¹Michael O. Hardimon, Rethinking Race: The Case for Deflationary Realism (Cambridge: Harvard University Press, 2017), p. 95.
²Ibid., p. 3.
³Ibid., p. 17.
⁴Joshua Glasgow, A Theory of Race (New York: Routledge, 2009), p. 139.
⁵Albert Atkin, The Philosophy of Race (Durham: Acumen, 2012), pp. 64-71.


OTHER SOURCES

Charles W. Mills, Blackness Visible: Essays on Philosophy and Race (Ithaca: Cornell University Press, 1998).

Jeremy Pierce, A Realist Metaphysics of Race: A Context-Sensitive, Short-Term Retentionist, Long-Term Revisionist Approach (Lanham: Lexington Books, 2015).

Treating Patients who have Substance Abuse Disorders and Chronic Pain

As a primary care physician, I see many patients who complain of chronic pain and who want me to prescribe pain medication. Many of these patients also have a history of substance abuse, however, and when I test them for active substance abuse by obtaining urine drug screens, the urine screens often come back positive for cocaine, methadone, fentanyl, marijuana, benzodiazepines, and other street drugs. So I must tell these patients I can't prescribe any opioid medication for their pain, because they're taking street drugs and need to stop taking dangerous, habit-forming drugs.
      Although my initial impulse may sometimes be to feel a little angry or disappointed that patients have tried to deceive me by lying to me about their substance abuse or by asking me for prescriptions for opioids when they knew they already had opioids and other illicit substances in their bloodstream, I think that denial, dissemblance, and concealment of active substance abuse may also be part of the substance abuse disorders that many patients suffer from. 
      I don't think the most caring or tactful way to tell patients I can't prescribe opioids for their pain is to say bluntly, "I can't prescribe opioids for you, because you're a substance abuser." This kind of response is likely to anger them, and seems rather callous, uncaring, and condescending.
      Some of the possible reasons why people might not want to be seen or described as substance abusers are that
      (1) It may hurt their sense of pride.
      (2) It may violate their sense of selfhood and individuality (they may feel they're being seen as just like everyone else who takes street drugs, and that everyone who takes street drugs is being seen as the same by the person who describes them as a substance abuser).
      (3) It may make them feel that the person who sees them as a substance abuser feels that he or she is better than them, and that they are being seen as somehow less worthy of respect (it may make them feel marginalized and disrespected, and it may violate their sense of equal worth and personal dignity).
      (4) They may in fact be in a state of denial that they are habitual substance abusers, and that their habit is in some ways dysfunctional.
      (5) They may be wary of losing various legal and welfare rights to which they are entitled and which they may be in danger of being denied if they're seen merely as substance abusers.
      (6) They may resent being labeled or dismissed as something they don't see themselves as (they may resent being assigned the label of "substance abuser" without their consent).
      (7) It  may make them feel they're being stereotyped, and that the uniqueness of their own life story, personal history, and social situation is being denied.
      (8) It may make them feel they're being told that whatever distress of misfortune they're suffering from is their own fault (they may feel that being told they're substance abusers is an example of "blaming the victim").
      (9) It may seem like an attempt to make them feel guilty about something they may or may not feel guilty about.
      (10) It may seem like an intrusion on their personal or social space (they may not welcome a wake-up call about their substance abuse disorder).
      (11) They may feel they're simply "self-medicating" (a term I think is often mistaken and misplaced. For someone to say "I was self-medicating" may often be a convenient way for them to try to disregard, deny, or justify their substance abuse disorder).

      So physicians must respond compassionately to patients who suffer from substance abuse and chronic pain, not by allowing themselves to be misled into prescribing drugs that such patients will abuse, and not by treating such patients as if they were any less worthy of respect than other patients, but by approaching them as individuals and developing treatment plans with them that will recognize and respond to their personal health care needs.

      The Maryland Board of Physicians guidelines for opioid prescribing include that before opioid prescribing, physicians should consider non-opioid therapies. Physicians should evaluate and inform patients of the risks and benefits of opioid use. They should establish a treatment plan and only continue prescribing opioids if the pain and functionality improvement outweigh the risks. They should screen for substance use disorders. They should consider red flags regarding potential abuse, misuse, and diversion of opioids. They should check the Prescription Drug Monitoring Program (PDMP) to review patient medical history of Controlled Dangerous Substances prescriptions. They should perform patient urine screening to confirm presence of prescribed medication and for undisclosed prescription drug or illicit substance use. And they should schedule a patient follow-up appointment 1-4 weeks after initial prescribing.¹
     The Maryland guidelines also include, regarding dosages and duration of opioids, that physicians should start low and go slow by prescribing the lowest effective dosages for the shortest possible duration. Physicians should avoid prescribing opioids and benzodiazepines concurrently. They should calculate the morphine milligram equivalent (MME) dosages, and if prescribing > 50 MME per day should increase appointment follow-up frequency and offer naloxone for overdose risk, should avoid prescribing > 90 MME per day if possible, carefully consider and justify such doses, and consider referring patients to a pain management specialist.²
     The Maryland guidelines also include, regarding continued treatment with opioids, that physicians should reassess treatment goals and determine if opioids continue to be the best option. Physicians should reassess no less frequently than every three months. They should consider whether there are clinically meaningful improvements in pain and function that outweigh the risks or harms of opioid prescribing. They should consider whether any new red flags of substance abuse disorder or diversion are present. They should perform periodic urine toxicology screenings. If over-sedation or increased overdose risk is present, they should taper opioid prescribing while considering patient psychosocial support. If tapering opioids, they should monitor for withdrawal symptoms.³
      The Maryland guidelines also include that for patients with substance abuse disorders, physicians should refer them for substance abuse treatment, should consider referring them to a pain management specialist, should consider medication-assisted treatment (MAT) such as buprenorphine, methadone, and naltrexone in combination with behavioral therapies, and should consider offering naloxone for those patients with high risk of overdose.⁴

      A complete statement of the Maryland Board of Physicians guidelines can be found at the Maryland.gov website.



FOOTNOTES

¹Maryland.gov Maryland Board of Physicians, "Board Guidance," at https://www.mbp.state.md.us/resource_information/res_con/resource_consumer_od_board_guidance.aspx
²Ibid.
³Ibid.
4Ibid.