The patient wears no pants


October 16, 2015 by Dr. Geyser

In this post, I use a medical logic of the body to answer the question burning in everyone’s minds:

Why do men wear the pants?

Although it may not be immediately obvious why doctors are better suited to resolve this question than, say, an anthropologist who studies Man in his natural habitat, there are cultural factors at play here. The physician has access to the patient’s body in ways that are usually denied to those outside of medicine or the fields of allied health. Our access to the body is limited to fairly precise situations, even with respect to the anatomy which we must either embody or forget. The anthropologist, the psychologist, the sociologist, and even the biologist, are in the same intellectual situation.

When it comes to the question of pants, only the medically educated thinker is truly prepared to provide an answer that incorporates the entire experience of the body. But most physicians are deficient in the abstract intellectual resources provided by instructors in the humanities, either due to a lack of time, or arrogance, or the influence of ‘biochemical determinism,’ the mask draped over the network of pharmaceutical power in the United States.

Well, boo hoo. That’s no fun. Let us raise a toast wherever we can surmount our manifestos, and move on. It is time to undress the patient.

You are a doctor. Or whatever, the patient doesn’t care about your credentials right now and neither do I and neither should you. There is a patient in the second exam room. Before entering, before knocking on the exam room door, you will need to create a dynamic version of the patient’s body within your mind. Gender/sex/phenotype is essential knowledge, though for less than obvious reasons. For the purpose of this essay, assume that the patient is male, and that his name is XY.

Imagine the patient’s immediate presentation, the sexual phenotype of XY. The patient is ‘naked,’ his penis is shrunken by the imminent presence of the doctor’s cold hands, or perhaps by the coldness of the exam room. There is a sense of uncertainty and exposure, as well as the relief of no longer wearing any pants. For men, pants are kind of a big deal, though not to be exceeded by the largeness of their comradery.

So far, we are only skin deep. While we were fantasizing about our patient’s naked body outside of the exam room, the nurse instructed the patient to change into a medical gown laying on the exam table, emphasizing that he must be completely disrobed, including his underwear. She leaves the room, and the patient obeys. Sheepishly, we step aside, fearful of exposing our scalpelling minds.

For this charade is precisely for the comfort of the patient, not for us. It is merely ceremony, something we may have to dispense with if, for instance, we suspect the patient has hemorrhoids or a swollen prostate. The initial absence of the physician is only a consequence of what is known about the patient. Disrobing is an act that occurs at the precise ligature separating the personal experience from the cultural norm. It is a biopsychosocial act that must be performed in a ritual space, such as the one we have provided in the exam room, in order to be considered ‘normal.’ In order to access the patient’s normal mode of expression, and thus to be able to differentiate the wince of potential pathology elicited during the physical exam from the excruciatingly painful act of the malingerer, the physician must seek to engage with the patient’s sense of normal, whatever that happens to be.

To paraphrase this scene acted out in the previous paragraph, the body of the patient is situated within a clinical framework designed by the physician in collaboration with the legal system, the clinical staff, and a tradition of medical experience dating back to Socrates. The physician himself is not concerned with managing each historical trajectory on an individual basis, but rather with eliminating them prior to his engagement with the medical body. The body of the patient has been constructed long before the physician enters the exam room. As doctors, we should be relieved at having to explain this entire scheme to our patients. As patients, we should be relieved to not have to think about the violence that we would otherwise have had to endure.

Having run his hands through the body of a corpse in his first year of medical school, the physician experiences the body of the patient as a hard relief. It is real, warm, and capable of responding to his commands. The materiality of the patient is not deterministic, but rather is the very substance of life itself. The selfhood of the patient is inferior to the materiality which encompasses and empowers it to act. Most of this materiality is hidden from the patient, from society, from all but the most hidden insinuations of the mind. For the physician, the distance between mind and body supplies the entire value of the medical enterprise.

What does XY think about all of this? The effect of sexual politics (or ‘gender politics’ if that is your preference, or perhaps only ‘politics’ if that is your goal) is that the physician must assume to a greater degree than ever before that the patient is serious about their sexuality. This means assuming a great deal less about gender based upon the seemingly ‘objective’ factors of sex that come along with the biological dichotomization of the body. In the initial intake of the patient, the imagination of the doctor receives the sex of the patient as a medical phenotype, the set of possible presentations associated with the visible manifestation of the patient’s karyotype – nothing more.

To answer the question from the previous paragraph, XY cannot talk about the materiality of his sex without first engaging with the physician on the topic of his health. This is even more true for XY’s physician, who may have to guide XY if he attempts to break through the biopsychosocial structure within which his status as patient is defined. For the materiality of sex cannot be separated from the body itself, once the patient’s clothes have been removed. This is not an arbitrary statement. A desire to separate sexuality from the body is what drives the practice of sperm-banking, placentophagia, and even masturbation.

It is, in fact, unethical to engage XY directly on the topic of sexuality. The physician must begin by masking his approach to the body with the cloak of sexual health. The center of this discussion is the male organ, the penis, and its receptacle, the vagina. This is the precise limit of medical sexuality, although this is often expanded to questions or examinations related to the rectum and the mouth. Sexuality, however, continues to center upon the genitals of the patient, for these are the primary material elements by which children are conceived and diseases shared. This is a cover, an obtuse medical argument, which seems irrefutable because it is has buried within itself the cultural materiality that constitutes our social norms. Yet biomedical materialism is the ideal of the physician, since it establishes an operable interface between the body of the patient and the body of the physician. What it ignores, however, is the social interface between bodies that establishes the meaning of sexuality. The physician averts his eyes as the patient changes from a social materiality governing the contact between bodies to the medically operable materiality made accessible by the medical gown.

Because the social interface between patient and physician has been eliminated, it is no longer possible to examine the patient’s sexuality in a social setting. The doctor can only medicalize the sexuality of the patient, an act which the patient is culturally bound to resist. There is embarrassment on both sides as the physician attempts to penetrate the stiff body that he himself has played a role in generating, albeit a hitherto unconscious one. The success of biomedical materialism helps explain the decreasing importance of the white coat, and the ceremonial appendages hanging from the lapels of the medical expert. The range of this success has been limited to the body because of the looseness of its material containers. Thus, before entering the room to examine the patient, we must first add back those layers that our institutional mandates initially forced us to remove. In performing this operation, we shall discover what it truly means when someone says that they ‘wear the pants.’

Hello, Ma’am. I am Dr. Physician, M.D., but you can just call me The Doctor.

Well, folks, that’s all for now. Tune in next Friday for the second leg of our journey, when the truth will be revealed about why our patient isn’t wearing any pants, and what this means for those who do. In the meantime, you can submit a question to be answered by Dr. Geyser, post comments, and otherwise promote the health and well-being of this blog on your favorite social media platform.

Update: The second part of this essay is now online. “Why men wear the pants.


One thought on “The patient wears no pants

  1. […] our previous discussion, we removed the patient’s pants with our imagination in order to help clarify the boundaries of […]


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