Eli Clare (2017). Brilliant Imperfection: Grappling with Cure. Durham, NC: Duke University Press. ISBN 978-0-8223-6287-6

Reviewed by Viki Peer

Gender Studies, Arizona State University

vpeer [at] asu [dot] edu

Trans and disability studies scholars have long identified both the U.S. legal system(s) and the medical-industrial complex as primary sites of physical and epistemic violence; that is, as powerful mechanisms through which bodies become considered abnormal and in need of repair. The normalizing ideologies that both fuel and are fueled by these two repressive extensions of the state are highly adaptable; presenting differently depending on the circumstances. For example, as many intersex and disability activists and scholars highlight, the medical industry coerces families of intersex and/or disabled babies and children into allowing doctors to “cure” them by performing unnecessary “normalizing” procedures and hormonal therapies on their children. At the same time, the medical industry pathologizes and then seeks to “cure” people who are transgender and gender non-conforming, as well as people diagnosed with mental illness, while also creating barriers to biomedical interventions such as gender-affirming surgeries and hormonal therapies.

Brilliant Imperfection continues the discussion of how the violent and repressive medical and legal systems in the U.S. produce pain and shame. Like other critical considerations of the intersections between trans and disability experiences (e.g. Dean Spade, 2010; Jasbir K. Puar, 2017), writer and activist, Eli Clare, uses his embodied experiences to think about transness through trans disability, considering the risks and opportunities in seeking a diagnosis and highlighting the necessity of dismantling the Diagnostic and Statistical Manual of Mental Disorders (DSM) entirely.

Tobin Siebers (2008) theorizes the ideology of ability, wherein ability is socially and institutionally favored over disability. Clare, however, theorizes the ideology of cure, wherein disability, illness, and impairment are socially and institutionally understood as needing to be cured, fixed, and eradicated. In this careful examination of the violence that curative logics facilitate, Clare grapples with how the ideology of cure has the potential to help, manipulate, and harm people who live with disability and chronic illness, and how these curative logics get used in a variety of other violent normalizing projects (e.g. gay conversion therapy and skin lightening products). Throughout the book, Clare positions his examination of disability within the long history of the medical-industrial complex and the U.S. legal system(s) operating together to endorse heteronormative, ableist, and racist violence.

Clare links the eugenic arguments that legitimized Dr. John Bell’s medical intervention into Carrie Buck’s body nearly a century ago to the eugenic arguments that legalize forced genital surgeries on intersex children, legitimize white supremacist scientific inquiries, and endorse gay conversion therapies today. As a result, he exposes the far-reaching effects of the ideology of cure in terms of our how we understand disability, gender, sexuality, and race. Seeking biomedical interventions is a complex process, and these decisions are often informed not only by powerful ideologies but also by material realities, including, but not limited to, the day-to-day pain and discomfort that can accompany some chronic illnesses and disabilities and the degree to which the person has access to medical, financial, social resources. Clare exposes the violence of the ideology of cure while also accounting for the material realities that shape if, when, and how people navigate the ideology of cure.

Clare troubles notions of “natural” and “unnatural,” insisting that these concepts are historic, subjective, and complex. He also interrogates the notion of rehabilitation or “restoration” and argues that for many people who live with disabilities and chronic illnesses, a “healthy” or “non-disabled” past never existed. He draws connections between restoration in terms of cure of the body and in terms of environmental politics. Using his own experiences with gender and disability, along with some highly publicized stories of people like Terri Schiavo, Ashley (often referred to as “Ashley X”), and Carrie Buck, he shows how explicitly ableist and heteronormative sentiments get reconfigured and repackaged in the ideology of cure. This ideology is so dominant that it has allowed for, for example, the publicly-debated efforts to end Terri Schiavo's life, the permanent foreclosure Carrie Buck’s reproductive futurity, and the medically unnecessary invasive surgeries performed on Ashley’s 6-year-old body to be legally allowed as well as socially accepted. These examples not only demonstrate how notions of normality and naturalness are “made up” or, socially constructed, but that people who are deemed abnormal bear the exhausting, violent, and sometimes fatal effects.

This book draws on histories of normalizing violence in the U.S., Clare’s personal experiences of compounding medical diagnoses, and people who have been saved, harmed, and/or killed via the ideology of cure. Specifically, he showcases how women, gender non-conforming people, Black and Indigenous people, People of Colour, poor people, and disabled people have been disproportionately negatively affected by the ideology of the cure. For example, Clare draws attention to the ways in which social and geographical locations shape the degree to which people experience efforts to “fix” them. While many people in the U.S, particularly children, who are medically understood as non-normative (e.g. sick, disabled, intersex), are forced to have surgeries and therapies to “correct” or “cure” them, transgender and gender nonconforming people who seek biomedical interventions are often met with extreme hostility, making it hard or impossible to access these medical technologies. With the recent publication of Jasbir K. Puar’s new book, The Right to Maim: Debility, Capacity, and Disability (Duke University Press, 2017), which demonstrates that people all over the world do not have access to medical treatments, I wondered how social, geographic, and cultural differences affect if and how people with non-normative body-minds are understood within these curative frameworks?

Brilliant Imperfection offers a fantastic point of departure for thinking about to enhance, complicate, and nuance our understandings of the ideology of cure as it shapes how we understand and experience our body-minds and powerful ideologies like heteronormativity and ableism. Clare’s ideology of cure helps illuminate and unravel how other powerful institutions shape embodied experiences and how people resist, navigate, and embrace those experiences.

My favorite aspect of this book is the extreme care with which Clare poses important questions, no matter how politically, emotionally, and ethically charged they may be, about how intersecting social locations have shaped how people experience curative violence. The first half of chapter 7 uses Carrie Buck’s story to highlight a particular legacy of state-sanctioned violence against disabled women. Clare contrasts the inhumane conditions of White-only institutions, including the facility where Buck was locked up and forcibly sterilized, with those of busier and poorer Black-only institutions. He asks, “in what ways did Carrie’s whiteness shield her?” (p. 107), asking the reader to grapple with the intersections of race, disability, gender, and class or, put differently, white supremacy, ableism, cisheteropatriarchy, and capitalism. I hope future work will continue to pose difficult questions that illuminate and unravel how powerful interlocking institutions shape our embodied experiences and how people navigate and resist the ideology of cure.