Interview

Learning from feminism: Ericka Johnson on the prostate and insufficient toilets

8.3.2021 | Over the last decades women have fought for change and a more gender-balanced society. We still have a long way to go. Professor Johnson from the Linköping University spoke to us about feminist technoscience, public infrastructure and the problem with binary categories in research.
Prof Ericka Johnson
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(© Ericka Johnson)


Prof Ericka Johnson

Professor Johnson, when talking and writing about your research you often say you were strongly influenced by feminist technoscience. What is this feminist technoscience and what does that have to do with gender?


Feminist technoscience studies are a collection of approaches and theories that draw on interdisciplinary inspirations to unpick the tangled knot of technology, science, and society. These studies explore relations between the human and the non-human, between the material world and our experiences of—sometimes by questioning even the divisions we imagine between these.


How has this influenced your own research?


Much of my research has been inspired by or conducted with the help of terms and theoretical concepts from the field of feminist technoscience studies and feminist work … and feminist work doesn’t have to mean it’s women’s work. I see feminism as something that addresses power structures. My work on the prostate, for example, has been informed by and benefited from a lot of the understandings and theoretical terms that have been developed within feminist approaches to medicine.


Prostate work? What does the prostate have to do with feminist technoscience and gender?


In the early 70s and 80s there was a lot of epistemological critique by women’s activism in some parts of the global North. Activists asked whose bodies were being treated—ours—and what did we want with our bodies. How is medicine helping that or how is medicine not helping that? Those types of questions are not only helpful for women but for everyone. We can see that in research about men with their prostate: Not until men grow older does the medical communities starts to be very interested in their prostate—when the prostate becomes pathologised. This is not a coincidence—at an older age there are problems with the prostate. But I wonder if prostate patients are always receiving the care they want, especially given the side effects of some prostate treatments. Perhaps there are some lessons that could be learned from histories of women’s health activism. For example, prostate cancer patient groups for example learned a lot from breast cancer patient groups and the way breast cancer has become a concern for many social actors. Patient groups might also be inspired by the way other patient groups have demanded that medicine also take into consideration their social identity and subject positionalities in the treatments on offer. And in the way that they are being treated.


Can you elaborate a bit on that?


Look at the training medical students and young medical doctors receive about intimate internal exams: They are being taught to do the prostate exam in a specific way which is often very intrusive and invasive. But—and here is where feminist technoscience has achieved a lot in the last decades—let’s look at gynaecology as a very progressive comparison. There gynaecology students and young doctors learn straight from the start to be very aware of the fact that the examination can trigger memories from previous experiences that have been very difficult for the patient. Or that it is intrusive and invasive and that patients need to be seen with specific needs there. In short: The patient in the exam is often in a wider context of a sensitive patient.


I think there is a lot [urology students] can learn from the use of feminists’ work


An anthropologist on our research team looked at that in detail. If you follow a urology student, in contrast to the gynecology student, the way they are being taught to do the exam does not present the imaginary of a sensitive patient. The patient might be scared, scared of cancer very likely. But that’s about it. Urology students are not taught to think about the previous sexual history of these patients, for example, as they are with the gynaecology patients. Maybe men wouldn’t like the students to have a training like the gynaecology students. Maybe they would. We don’t know. But I think that to some extent, the way we imagine what a man is and then produce a medical experience for that imagined patient produces again that man. This stoic patient is just going to go and get the exam done with and go on, because that is just what you do as a “man”. But is that the only subjectivity for a patient with prostate problems that we would want to have? Can we think that through and if we can, can we address questions similar to those put forward by the feminist research that I mentioned earlier? I think there is a lot that they can learn from the use of feminists’ work. Even for an organ that we often associate with the male body.


And what in particular did you look at in your research project with the prostate and what did you find?


We were an interdisciplinary team of sociologists, anthropologists, gender studies researchers, a sexologist from a urology department, a couple of historians, people who were working in technology & science studies, etc. Together we looked at the cultural sphere of the prostate: what it is, how we think about it, what we want to do with it. We asked how we could contextualise how the prostate is imagined, what we do with the way the body is encountered in the medical experience. This interlinked with some of the work I had done on gendered drugs where we also looked at the image advertisements carried, what they made us think we should be like and how especially aging bodies were supposed to still fit the image of a young and healthy person. As a result, we each published our separate results and our team wrote a popular science book about the prostate (Prostatan – det ständiga gisslet? In Swedish, which has also been translated to German, Der Mann und die Prostata). A synthesis of the results can also be found in A Cultural Biography of the Prostate.


What did you take with you from the project?


One really succinct moment in my research occurred during my interviews with aging men. I realised that they were not only speaking about problems with their prostates, they were speaking to core problems with our public infrastructure. Many of the men I interviewed had experienced an “Aha”-moment in a negative way then they started having prostate issues or their bodily needs were no longer a good fit with public toiled infrastructure: We have all heard these critiques of how the city is planned for healthy young male bodies. From having been healthy young male bodies for most of their lives and having had therewith an infrastructure that had become invisible to them, as aging men, particularly those with prostate issue, became bodies with completely different needs. They suddenly became very aware of which bus rides were very long, which busses had no stops, which cafés had bathrooms in town that they could use, which gas stations had bathrooms that they could make it to. But the public infrastructure as an entirety was no longer meeting their needs because their needs had changed.


This is one of the things that I think we can talk about when we talk about the way that having ideal types in a design or planning practice (be those gendered or raced or classed—and of course these are intersecting) produces particular infrastructures. All the time we reinforce those ideal types and knowledge and understandings with our marketing imagery. Or with our discourse around what bodies we are designing for. This can also shape the material world that we build around us, be that building regulations or city planning regulations or merely commercial interests who allow us to have the majority of the population as a focus and allows them to not build for the others. Whatever that be it’s going to produce some material, physical incarnation of those norms that we have in our society. Public toilet infrastructure is a very good way to start thinking through that and articulate that. The men with prostate issues in my interviews were valuable because their body had suddenly changed from having been within the invisible norm to being in an outside positionality.


Not just men. Pregnant women are outside the visible norm, too, when it comes to public toilets.


Exactly. Our public toilet infrastructure is not made for pregnant bodies. Not for post-partum bodies. Not for young children’s bodies who are trying to learn how to control their bladders. It is not made for older bodies, be those men’s bodies or women’s bodies. So, who is our public toilet infrastructure made for then? Not for bodies who need wheelchairs or bodies who need other forms of assistance. It’s not made for bodies who have a physical assistant with them. In some countries we are also still dealing with the fact that it is not made for bodies who are not binary. All of these bodies together are actually quite a large group of bodies.


We tend to build our world for just one type of person


We have a similar problem in medical research, don’t we? Until the 1990s we often completely ignored women in drug studies because their bodies behave differently than male bodies and are more difficult to control for. But even now we still often only accommodate for male and female bodies. How does this binary understanding of gender affect medicine and medical research?


I think it severely affects medicine because it severely affects what questions are being asked in the research and what categories are produced by the research. We talked about my prostate research where you can clearly see that we tend to build our world for just one type of person. But we can’t blindly assume that we are trying to include everyone in our studies by using just categories such as “male” and “female”. Or adding “age”, “ethnicity”, etc. and believing this is enough.


Steven Epstein writes about this in his book about the difference-and-inclusion-paradigm. It is assumed there are differences. We see differences, we have categories for differences and we try to include those differences in our research. Yet, we still often think binary in “male” and “female”, for example, and we often take social categories and assume they can be overlayed onto biological categories. This is a paradigm that became messed up in language and spreads and spreads and grows as you see in medicine, including our prostate example.


The inclusion and difference paradigm of course has produced some very interesting and valuable results. However, I think there are a couple of things that are maybe good to keep in mind when thinking through that paradigm. One of is that assuming differences we see in our social experience are related to something that we would be able to call biological or biomedical is fraught. There sometimes is a direct overlap between what we think of as gender for example—which is often imagined as binary—and the biological or biomedical differences in the group or material that we are studying. It doesn’t necessarily mean that that’s the case.


The same thing with race. Of course we should not just be producing medicine for white bodies. But at the same time, what type of understanding of race are we reproducing when we start to use that as a category and as a category for inclusion into a study? And what are we actually reproducing when we take in bodies of what we say are different races and putting them into different races. That is extremely complex and problematic. And yet we are still thinking and using it … and some of our regulatory boards are still thinking that it is very important to include.


What could be a solution to the binary categorisation in research studies?


We could also ask ourselves what are we even doing with the categories, for example sexgender, in the first place? Why is that interesting to the study? Is it actually interesting? Is it saying something of value at all? Does it need to be included? Maybe not. Or maybe yes. And if so, to what end and how? What way of thinking about sexgender would be useful?


Sounds like there is still a lot of work to do. What will your next project be on?


I will be looking further into how medicine shapes our identities. We talked about the prostate and what kind of image we have of a man during the prostate exam. Another project we did was on how different drugs address us as subjects and our identity at the two extremes of the life course. But that is a different story.


And maybe a good one for another interview one day. Thank you very much, Professor Johnson, for this interesting interview.

  (© Sonja Klein / AcademiaNet / Spektrum.de)
Questions were asked by Sonja Klein for AcademiaNet and Spektrum.de

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