Alice Dreger: Is anatomy destiny?

124,549 views ・ 2011-06-10

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00:15
I want you to imagine two couples in the middle of 1979
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on the exact same day, at the exact same moment,
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each conceiving a baby, OK?
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So two couples each conceiving one baby.
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Now I don't want you to spend too much time imagining the conception,
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because if you do, you're not going to listen to me,
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so just imagine that for a moment.
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And in this scenario, I want to imagine that, in one case,
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the sperm is carrying a Y chromosome,
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meeting that X chromosome of the egg.
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And in the other case, the sperm is carrying an X chromosome,
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meeting the X chromosome of the egg.
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Both are viable; both take off.
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We'll come back to these people later.
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So I wear two hats in most of what I do.
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As the one hat, I do history of anatomy.
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I'm a historian by training, and what I study in that case
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is the way that people have dealt with anatomy --
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meaning human bodies, animal bodies --
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how they dealt with bodily fluids, concepts of bodies;
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how have they thought about bodies.
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The other hat that I've worn in my work is as an activist,
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as a patient advocate --
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or, as I sometimes say, as an impatient advocate --
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for people who are patients of doctors.
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In that case, what I've worked with is people who have body types
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that challenge social norms.
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So some of what I've worked on, for example,
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is people who are conjoined twins --
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two people within one body.
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Some of what I've worked on is people who have dwarfism --
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so people who are much shorter than typical.
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And a lot of what I've worked on is people who have atypical sex --
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so people who don't have the standard male or the standard female body types.
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And as a general term, we can use the term "intersex" for this.
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Intersex comes in a lot of different forms.
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I'll just give you a few examples of the types of ways you can have sex
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that isn't standard for male or female.
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So in one instance,
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you can have somebody who has an XY chromosomal basis,
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and that SRY gene on the Y chromosome
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tells the proto-gonads, which we all have in the fetal life,
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to become testes.
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So in the fetal life, those testes are pumping out testosterone.
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But because this individual lacks receptors to hear that testosterone,
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the body doesn't react to the testosterone.
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And this is a syndrome called androgen insensitivity syndrome.
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So lots of levels of testosterone, but no reaction to it.
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As a consequence, the body develops more along the female typical path.
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When the child is born, she looks like a girl.
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She is a girl, she is raised as a girl.
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And it's often not until she hits puberty and she's growing and developing breasts,
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but she's not getting her period,
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that somebody figures out something's up here.
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And they do some tests and figure out
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that, instead of having ovaries inside and a uterus,
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she has testes inside, and she has a Y chromosome.
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Now what's important to understand
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is you may think of this person as really being male,
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but they're really not.
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Females, like males,
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have in our bodies something called the adrenal glands.
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They're in the back of our body.
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And the adrenal glands make androgens, which are a masculinizing hormone.
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Most females like me -- I believe myself to be a typical female --
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I don't actually know my chromosomal make-up,
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but I think I'm probably typical --
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most females like me are actually androgen-sensitive.
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We're making androgen, and we're responding to androgens.
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The consequence is that somebody like me
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has actually had a brain exposed to more androgens
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than the woman born with testes who has androgen insensitivity syndrome.
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So sex is really complicated --
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it's not just that intersex people
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are in the middle of all the sex spectrum --
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in some ways, they can be all over the place.
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Another example:
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a few years ago I got a call from a man who was 19 years old,
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who was born a boy, raised a boy,
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had a girlfriend, had sex with his girlfriend,
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had a life as a guy,
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and had just found out that he had ovaries and a uterus inside.
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What he had was an extreme form
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of a condition called congenital adrenal hyperplasia.
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He had XX chromosomes,
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and in the womb, his adrenal glands were in such high gear
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that it created, essentially, a masculine hormonal environment.
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And as a consequence, his genitals were masculinized,
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his brain was subject to the more typical masculine component of hormones.
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And he was born looking like a boy -- nobody suspected anything.
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And it was only when he had reached the age of 19
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that he began to have enough medical problems from menstruating internally,
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that doctors figured out that, in fact, he was female, internally.
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OK, so just one more quick example of a way you can have intersex.
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Some people who have XX chromosomes develop what are called ovotestis,
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which is when you have ovarian tissue with testicular tissue wrapped around it.
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And we're not exactly sure why that happens.
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So sex can come in lots of different varieties.
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The reason that children with these kinds of bodies --
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whether it's dwarfism, or it's conjoined twinning,
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or it's an intersex type --
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are often "normalized" by surgeons
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is not because it actually leaves them better off in terms of physical health.
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In many cases, people are actually perfectly healthy.
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The reason they're often subject to various kinds of surgeries
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is because they threaten our social categories.
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Our system has been based typically on the idea
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that a particular kind of anatomy comes with a particular identity.
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So we have the concept that what it means to be a woman
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is to have a female identity;
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what it means to be a black person is, allegedly, to have an African anatomy
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in terms of your history.
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And so we have this terribly simplistic idea.
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And when we're faced with a body
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that actually presents us something quite different,
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it startles us in terms of those categorizations.
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So we have a lot of very romantic ideas in our culture about individualism.
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And our nation's really founded on a very romantic concept of individualism.
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You can imagine how startling then it is
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when you have children who are born who are two people inside of one body.
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Where I ran into the most heat from this most recently
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was last year when South African runner, Caster Semenya,
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had her sex called into question at the International Games in Berlin.
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I had a lot of journalists calling me, asking me,
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"Which is the test they're going to run
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that will tell us whether or not Caster Semenya is male or female?"
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And I had to explain to the journalists there isn't such a test.
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In fact, we now know that sex is complicated enough
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that we have to admit:
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Nature doesn't draw the line for us between male and female,
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or between male and intersex and female and intersex;
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we actually draw that line on nature.
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So what we have is a sort of situation where the farther our science goes,
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the more we have to admit to ourselves that these categories
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that we thought of as stable anatomical categories,
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that mapped very simply to stable identity categories
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are a lot more fuzzy than we thought.
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And it's not just in terms of sex.
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It's also in terms of race,
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which turns out to be vastly more complicated
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than our terminology has allowed.
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As we look, we get into all sorts of uncomfortable areas.
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We look, for example, about the fact
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that we share at least 95 percent of our DNA with chimpanzees.
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What are we to make of the fact
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that we differ from them only, really, by a few nucleotides?
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And as we get farther and farther with our science,
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we get more and more into a discomforted zone,
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where we have to acknowledge that the simplistic categories we've had
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are probably overly simplistic.
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So we're seeing this in all sorts of places in human life.
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One of the places we're seeing it, for example,
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in our culture, in the United States today,
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is battles over the beginning of life and the end of life.
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We have difficult conversations
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about at what point we decide a body becomes a human,
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such that it has a different right than a fetal life.
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We have very difficult conversations nowadays --
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probably not out in the open as much as within medicine --
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about the question of when somebody's dead.
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In the past, our ancestors never had to struggle so much
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with this question of when somebody was dead.
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At most, they'd stick a feather on somebody's nose,
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and if it twitched, they didn't bury them yet.
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If it stopped twitching, you bury them.
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But today, we have a situation
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where we want to take vital organs out of beings
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and give them to other beings.
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And as a consequence,
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we have to struggle with this really difficult question
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about who's dead,
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and this leads us to a really difficult situation
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where we don't have such simple categories as we've had before.
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Now you might think that all this breaking-down of categories
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would make somebody like me really happy.
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I'm a political progressive, I defend people with unusual bodies,
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but I have to admit to you that it makes me nervous.
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Understanding that these categories
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are really much more unstable than we thought makes me tense.
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It makes me tense from the point of view of thinking about democracy.
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So in order to tell you about that tension,
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I have to first admit to you a huge fan of the Founding Fathers.
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I know they were racists, I know they were sexist,
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but they were great.
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I mean, they were so brave and so bold and so radical in what they did,
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that I find myself watching that cheesy musical "1776" every few years,
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and it's not because of the music, which is totally forgettable.
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It's because of what happened in 1776 with the Founding Fathers.
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The Founding Fathers were, for my point of view,
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the original anatomical activists,
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and this is why.
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What they rejected was an anatomical concept
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and replaced it with another one
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that was radical and beautiful and held us for 200 years.
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So as you all recall,
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what our Founding Fathers were rejecting was a concept of monarchy,
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and the monarchy was basically based on a very simplistic concept of anatomy.
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The monarchs of the old world didn't have a concept of DNA,
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but they did have a concept of birthright.
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They had a concept of blue blood.
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They had the idea that the people who would be in political power
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should be in political power because of the blood being passed down
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from grandfather to father to son and so forth.
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The Founding Fathers rejected that idea,
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and they replaced it with a new anatomical concept,
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and that concept was "all men are created equal."
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They leveled that playing field and decided the anatomy that mattered
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was the commonality of anatomy, not the difference in anatomy,
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and that was a really radical thing to do.
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Now they were doing it in part
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because they were part of an Enlightenment system
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where two things were growing up together.
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And that was democracy growing up,
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but it was also science growing up at the same time.
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And it's really clear, if you look at the history of the Founding Fathers,
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a lot of them were very interested in science,
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and they were interested in the concept of a naturalistic world.
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They were moving away from supernatural explanations,
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and they were rejecting things like a supernatural concept of power,
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where it transmitted because of a very vague concept of birthright.
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They were moving towards a naturalistic concept.
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And if you look, for example, in the Declaration of Independence,
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they talk about nature and nature's God.
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They don't talk about God and God's nature.
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They're talking about the power of nature to tell us who we are.
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So as part of that, they were coming to us with a concept
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that was about anatomical commonality.
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And in doing so, they were really setting up in a beautiful way
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the Civil Rights Movement of the future.
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They didn't think of it that way, but they did it for us, and it was great.
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So what happened years afterwards?
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What happened was women, for example, who wanted the right to vote,
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took the Founding Fathers' concept of anatomical commonality
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being more important than anatomical difference
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and said, "The fact that we have a uterus and ovaries
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is not significant enough in terms of a difference
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to mean that we shouldn't have the right to vote,
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the right to full citizenship, the right to own property, etc."
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And women successfully argued that.
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Next came the successful Civil Rights Movement,
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where we found people like Sojourner Truth
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talking about, "Ain't I a woman?"
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We find men on the marching lines of the Civil Rights Movement
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saying, "I am a man."
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Again, people of color appealing to a commonality of anatomy
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over a difference of anatomy, again, successfully.
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We see the same thing with the disability rights movement.
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The problem is, of course,
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that, as we begin to look at all that commonality,
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we have to begin to question why we maintain certain divisions.
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Mind you, I want to maintain some divisions,
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anatomically, in our culture.
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For example, I don't want to give a fish the same rights as a human.
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I don't want to say we give up entirely on anatomy.
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I don't want to say a five-year-old
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should be allowed to consent to sex or consent to marry.
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So there are some anatomical divisions
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that make sense to me and that I think we should retain.
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But the challenge is trying to figure out which ones they are
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and why do we retain them, and do they have meaning.
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So let's go back to those two beings conceived at the beginning of this talk.
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We have two beings, both conceived
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in the middle of 1979 on the exact same day.
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Let's imagine one of them, Mary, is born three months prematurely,
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so she's born on June 1, 1980.
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Henry, by contrast, is born at term, so he's born on March 1, 1980.
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Simply by virtue of the fact
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that Mary was born prematurely three months,
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she comes into all sorts of rights three months earlier than Henry does --
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the right to consent to sex, the right to vote, the right to drink.
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Henry has to wait for all of that,
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not because he's actually any different in age, biologically,
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except in terms of when he was born.
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We find other kinds of weirdness in terms of what their rights are.
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Henry, by virtue of being assumed to be male --
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although I haven't told you that he's the XY one --
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by virtue of being assumed to be male is now liable to be drafted,
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which Mary does not need to worry about.
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Mary, meanwhile, cannot in all the states have the same right
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that Henry has in all the states,
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namely, the right to marry.
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Henry can marry, in every state, a woman,
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but Mary can only marry today in a few states, a woman.
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So we have these anatomical categories that persist,
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that are in many ways problematic and questionable.
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And the question to me becomes:
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What do we do, as our science gets to be so good in looking at anatomy,
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that we reach the point where we have to admit
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that a democracy that's been based on anatomy
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might start falling apart?
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I don't want to give up the science, but at the same time,
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it feels sometimes like the science is coming out from under us.
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So where do we go?
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It seems like what happens in our culture is a sort of pragmatic attitude:
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"We have to draw the line somewhere, so we will draw the line somewhere."
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But a lot of people get stuck in a very strange position.
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So for example, Texas has at one point decided that what it means to marry a man
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is to mean that you don't have a Y chromosome,
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and what it means to marry a woman means you have a Y chromosome.
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In practice they don't test people for their chromosomes.
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But this is also very bizarre,
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because of the story I told you at the beginning
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about androgen insensitivity syndrome.
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If we look at one of the Founding Fathers of modern democracy,
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Dr. Martin Luther King,
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he offers us something of a solution in his "I have a dream" speech.
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He says we should judge people "based not on the color of their skin,
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but on the content of their character,"
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moving beyond anatomy.
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And I want to say, "Yeah, that sounds like a really good idea."
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But in practice, how do you do it?
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How do you judge people based on the content of character?
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I also want to point out
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that I'm not sure that is how we should distribute rights in terms of humans,
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because, I have to admit, that there are some golden retrievers I know
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that are probably more deserving of social services than some humans I know.
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I also want to say there are probably also some yellow Labradors that I know
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that are more capable of informed, intelligent, mature decisions
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about sexual relations than some 40-year-olds that I know.
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So how do we operationalize the question of content of character?
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It turns out to be really difficult.
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And part of me also wonders,
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what if content of character
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turns out to be something that's scannable in the future --
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able to be seen with an fMRI?
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Do we really want to go there?
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I'm not sure where we go.
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What I do know is that it seems to be really important
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to think about the idea of the United States being in the lead
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of thinking about this issue of democracy.
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We've done a really good job struggling with democracy,
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and I think we would do a good job in the future.
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We don't have a situation that Iran has, for example,
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where a man who's sexually attracted to other men
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is liable to be murdered,
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unless he's willing to submit to a sex change,
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in which case he's allowed to live.
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We don't have that kind of situation.
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I'm glad to say we don't have the kind of situation with --
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a surgeon I talked to a few years ago
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15:58
who had brought over a set of conjoined twins
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in order to separate them, partly to make a name for himself.
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But when I was on the phone with him, asking why he'll do this surgery --
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this was a very high-risk surgery -- his answer was that, in this other nation,
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these children were going to be treated very badly, and so he had to do this.
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My response to him was, "Well, have you considered political asylum
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instead of a separation surgery?"
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The United States has offered tremendous possibility
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16:21
for allowing people to be the way they are,
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without having them have to be changed for the sake of the state.
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So I think we have to be in the lead.
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Well, just to close, I want to suggest to you
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that I've been talking a lot about the Fathers.
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And I want to think about the possibilities
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of what democracy might look like, or might have looked like,
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if we had more involved the mothers.
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And I want to say something a little bit radical for a feminist,
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and that is that I think that there may be different kinds of insights
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that can come from different kinds of anatomies,
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particularly when we have people thinking in groups.
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For years, because I've been interested in intersex,
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I've also been interested in sex-difference research.
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And one of the things that I've been interested in
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is looking at the differences between males and females
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in terms of the way they think and operate in the world.
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And what we know from cross-cultural studies
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17:09
is that females, on average --
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not everyone, but on average --
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17:13
are more inclined to be very attentive to complex social relations
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and to taking care of people
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17:19
who are, basically, vulnerable within the group.
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And so if we think about that,
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we have an interesting situation in hands.
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17:27
Years ago, when I was in graduate school,
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1966
17:29
one of my graduate advisors who knew I was interested in feminism --
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17:32
I considered myself a feminist, as I still do,
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asked a really strange question.
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He said, "Tell me what's feminine about feminism."
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And I thought, "Well, that's the dumbest question I've ever heard.
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Feminism is all about undoing stereotypes about gender,
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so there's nothing feminine about feminism."
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But the more I thought about his question,
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2025
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the more I thought there might be something feminine about feminism.
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That is to say, there might be something, on average,
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17:54
different about female brains from male brains
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that makes us more attentive to deeply complex social relationships,
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18:02
and more attentive to taking care of the vulnerable.
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So whereas the Fathers were extremely attentive
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18:08
to figuring out how to protect individuals from the state,
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it's possible that if we injected more mothers into this concept,
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what we would have is more of a concept of not just how to protect,
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18:19
but how to care for each other.
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And maybe that's where we need to go in the future,
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18:24
when we take democracy beyond anatomy,
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18:26
is to think less about the individual body in terms of the identity,
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18:30
and think more about those relationships.
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So that as we the people try to create a more perfect union,
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we're thinking about what we do for each other.
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Thank you.
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(Applause)
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Original video on YouTube.com
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