How You Can Think Clearly About Identity, Medicine, and the Machinery of Belief

Outside the Frame: How You Can Think Clearly About Identity, Medicine, and the Machinery of Belief

I sat across from the Oranje School in Philipsburg and overheard a Black History Month lesson. A child said, “I learned that black people are equal to white people.” The teacher followed with: “You can be anything if you study hard.” In that moment, I felt the weight of an education still anchored in colonial binaries. But that was only the first act. The debate that followed pulled me into deeper waters—where anthropology forces one question: what does a child understand when you tell them "you can be anything"  if you study hard? "ANYTHING?" - Please read the entire article carefully, and you will understand the far-reaching consequences of such narratives without placing them in the proper context for our young minds

Dear to step outside and see the big picture

Dr. Clifford A. E. Illis · Honoray Doctor of Philosophy (Anthropology) · February 2026

Anthropology is not a hobby of outrage; it is a discipline of frames. It asks how societies build categories, how institutions gain momentum, and how moral language becomes a kind of machinery. In this essay, I’m not trying to “win” a culture war. I’m trying to model a different habit: step outside the frame, examine the premises, and keep the human being in view.

“It was not the doctor that assigned gender at birth. From inception, the assignment was made by a force we yet have to understand.” — my interlocutor, after hours of honest argument

FACT: In medical ethics, irreversible interventions are typically evaluated using core principles such as autonomy (informed consent), beneficence (net benefit), non-maleficence (avoid harm), and justice (fair access and non-discrimination). Tensions appear when evidence is uncertain, risks are irreversible, or access is unequal.

I · The Provocation

A trans woman sues her surgeon because a uterus was not part of the gender-affirming surgery. The internet erupts. Most rush to one trench or the other. But I saw something else: a chance to ask anthropological questions about informed consent, institutional gravity, and the difference between treating suffering and servicing a system.

The easy story: “This is just bigotry.” The other easy story: “This is just mutilation.” I reject both easy stories. I wanted to understand why the machinery around one person’s inner experience has grown so vast—lawyers, psychologists, surgeons, hospitals, pharmaceutical lines, billion-dollar markets. Why does one person’s sense of self require hundreds of outsiders and billions of dollars to validate? That is not a hateful question. It is an anthropological one.

II · The Anatomy of a Discussion

I do not believe in cheap polemics. So I sat with someone who sees this issue from a place I once considered unreachable. We argued for hours. They held firm: “Surgical alteration of healthy tissue based on subjective experience is not medicine—it is something else.” I countered with evidence, with ethics, with the architecture of compassion. They did not bend. But something more valuable happened: we both sharpened.

At one point, they retracted the word “misaligned” because it conflicted with their own principle: everyone has the right to live and feel as they do, as long as they do not harm others. That retraction matters. It separates the person from the procedure, the identity from the intervention.

Practical tip: If you want a real conversation, refuse to collapse a person into a procedure. Keep dignity intact while you examine the intervention.

III · The Machinery Question

Let’s talk about the apparatus. One person’s inner conviction that they are not who they were born to be now mobilizes:

• Psychologists for assessment and letters
• Endocrinologists for lifelong hormones
• Surgeons for mastectomies, vaginoplasties, phalloplasties
• Hospitals with entire gender clinics
• Lawyers for name changes and legal recognition
• Pharmaceutical companies manufacturing hormones
• Medical device firms building surgical tools
• Insurance companies processing claims
• Non-profits, media, universities, government agencies

This is not a conspiracy. It is an institutional complex. Every industry builds momentum, stakeholders, and interests. The question is: does the machinery serve the person, or does the person serve the machinery?

That question is not answered by pointing to profit alone—chemotherapy also generates profit—but by asking whether the intervention is inherently healing or inherently harmful. My interlocutor insists that removing healthy tissue from a person who experiences gender dysphoria belongs in the second category. That is a coherent position, even if I weigh the evidence differently.

They said: “You did not address the billions flowing to institutions that support the beliefs of one individual.”

I answer: The global LGBTQ+ health market is real. Surgeries can cost tens of thousands. Hormones can become long-term revenue streams. None of this proves the intervention is wrong—but it does obligate us to ask: are we healing, or are we selling?

IV · The Fork in the Road: Capability vs. Legitimacy

“Because we have medical procedures to do things unthought 200 years ago, does that give the system the right to do it?” This question landed like a stone in still water. We can now reshape flesh, edit genes, and transplant faces. Capability is not the same as wisdom.

Every culture draws lines. The lines shift. But the question of who decides remains. My interlocutor pointed to something beyond the doctor, beyond the parents, beyond any human assignment: “From inception, the assignment was made by a force we yet have to understand.” From that vantage, the body is not just biology—it carries an original signature. To surgically alter it is not affirmation, but defiance of the giver. You may call that theology. I call it a sincere framework that deserves respect, not mockery.

V · Countries That Restrict, Countries That Expand

They asked, with a laugh: “Then why are there entire countries that have banned this practice? And I hope you are not going to tell me the whole country needs educating.” Fair. But the global map is more complicated than slogans.

European restrictions have often focused on minors and reflect evidence reviews that demand higher thresholds for irreversible treatment. That can be legitimate scientific caution. Meanwhile, other jurisdictions emphasize autonomy and self-determination more strongly. In other words, it’s not “the world is banning it”—it’s a fragmented picture, and context matters.

Practical tip: When you see a headline about bans or expansions, ask three questions: Is it about minors or adults? Is it about evidence thresholds? Is it tied to broader politics?

VI · Where We Landed

After hours, my companion said something I will not forget: “I am not opposing that everyone has the right to live and feel as they do as long as they do not harm others.” That is a creed big enough to hold pluralism. They oppose surgery—and still call it mutilation—but they no longer confuse the person with the procedure. They see the machinery, the money, the momentum. And they ask: by what authority does this machinery claim to know what is true about a human being?

“You are outside the frame. You see the play. You see the money. You see the institutions. Now look again: who is not in the room?”

That question lingers. The poor. The uninsured. The ones who cannot access the lawyers, the therapists, the surgeons. The ones for whom this machinery is only a distant rumor. They are not in the room. And any system that forgets them has lost its way—regardless of which side of the debate it sits on.

VII · The Only Honest Conclusion

I did not convince them. They did not convince me. But we both stepped outside the usual frame. We saw each other’s premises. They acknowledged the right to exist and feel; I acknowledged that the medical-industrial complex deserves scrutiny, not worship. That is not a draw—it is a mutual enlargement.

Anthropology teaches that every culture has its orthodoxies, its rituals, its expensive machines for making meaning. Ours is no different. The question is whether we can look at our own machinery with clear eyes and still treat each other as humans. I think we can. I think we must.

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Epilogue (for the Minister of Education, and anyone still reading):

Whatever you believe about gender, about surgery, about identity—please, teach our children to think outside the frame. Teach them that a person is more than any single category. Teach them to question the machinery, including the machinery that agrees with them. And above all, teach them that the child in front of them is not an abstraction, not a pawn, not a debate topic. The child is a child.

If we can do that, we might not agree—but we might stop hurting each other long enough to listen.

Written from outside the frame, in the green light of early morning.

References:

1) World Medical Association (WMA) – core medical ethics principles (autonomy, beneficence, non-maleficence, justice).
2) American Anthropological Association (AAA) – resources on social categories and human variation (race and classification as cultural frameworks).
(If you want the country-by-country table with years reinserted, I can rebuild it with verified citations.)

Hashtags: #Anthropology #MedicalEthics #Identity #Culture #InformedConsent