To get us started, take a listen to some of Lady Gaga’s “Born This Way.” A few warnings:

There’s skin. If you’re at work, it might not be appropriate. The music video itself deserves a Nursing Clio post, but there isn’t space here. Leave some comments if you’d like us to deal with it in the future. It’s kind of long, so start at the bridge, at 5:17 or so.

In the past few weeks I’ve heard the “born this way” argument pop up all over the place in classes and everyday conversation. I quite appreciate its value as a strong, proud anthem of self-empowerment in the face of an unaccepting world. It’s also a pretty sweet jam. The foundation associated with it seems also to be up to some great things, and I certainly agree with their mission “to foster a more accepting society, where differences are embraced and individuality is celebrated.”

I’m not here to critique the song. But it is a handy jumping-off point for a larger issue: “born this way,” like other more explicitly biology-based or culture-based arguments, is at root a justification. It’s similar to some of what Tiffany K. Wayne noted in her “Same-Sex Marriage Does Threaten ‘Traditional’ Marriage” post from the other day. She points out, regarding marriage equality, that “it’s not just a matter of a ‘right to privacy’ or live and let live. We are trying to argue it as such. But it’s more foundation-shaking than that.” The “born this way” position is very much like the “right to privacy” and “live and let live” justifications for same-sex marriage. All are largely missing the more radical goal of making human relations — sexuality, marriage, employment, etc. — more gender neutral.

Saying “I was born this way” in the context of sexual orientation still suggests that there is something about “this way” that needs to be explained, excused, or justified. Sexual orientation should require no more justification than hair or eye color, music preference, or height.

The problem is, “born this way” is complicated and hard to take a step back from. Why?

First, biology is quite convincing and difficult to get past. This is an issue the disability rights community has been dealing with perhaps even more than the gay rights community. It is very hard for us, embedded as we are in our culture, to step back and see how many of our assumptions aren’t “natural” or “obvious” — two words that often denote biological explanations.

Historian and disability rights activist Paul K. Longmore argued that “for the vast majority of people with disabilities, prejudice is a far greater problem than any impairment: discrimination is a bigger obstacle for them to ‘overcome’ than any disability.”[1] This perspective on the border between “difference” and “disease” is similar to arguments against sexual orientation discrimination. Eve Sedgwick notes, for example, that there is almost no strong or explicit defense of being gay or lesbian as a positive good; at best it is often accepted only as a tolerable reality. Most efforts to “understand” or find the “cause” of homosexuality are often based in a desire to “fix” it.[2] Neither sexuality nor disability is a “natural state of corporeal inferiority, inadequacy, excess, or a stroke of misfortune.”[3] The tendency to link such characteristics to particular embodiments is the result of a set of cultural processes with a long history.

Society has not historically perceived sexual orientation as culturally defined. The most recent example is so recent as to be hardly history. In June 2010, Alice Dreger, Ellen K. Feder, and Anne Tamar-Mattis published an essay on The Hastings Center’s Bioethics Forum about the practice of offering dexamethasone (“dex”), a steroid, off-label to pregnant women carrying female fetuses suspected of having congenital adrenal hyperplasia (CAH). These doctors, and researchers who support their experiments, believe that dex received prenatally might prevent the “masculinization” characteristic of CAH and other conditions that lead to prenatal androgen exposure.

Some researchers, though, link “masculine” biological features with “masculine” social behaviors and sexual orientation. They theorize that “gender-related behaviors, namely childhood play, peer association, career and leisure time preferences in adolescence and adulthood, maternalism, aggression, and sexual orientation become masculinized” in women with higher androgen levels. “These abnormalities,” the researchers continue, “have been attributed to the effects of excessive prenatal androgen levels on the sexual differentiation of the brain and later on behavior.” This study recommended that these outcomes may be reduced with fetal dex.[4] There is also a long history before the twenty-first century, including sexology research and eugenics, of doctors and psychologists who pathologized homosexuality and sought ways to identify it, predict it, and eliminate it.

Don’t be a drag, just be a queen

Whether you’re broke or evergreen

You’re black, white, beige, chola descent

You’re lebanese, you’re orient

Whether life’s disabilities

Left you outcast, bullied, or teased

Rejoice and love yourself today

‘Cause baby you were born this way

No matter gay, straight, or bi,

Lesbian, transgendered life

I’m on the right track baby

I was born to survive

No matter black, white or beige

Chola or orient made

I’m on the right track baby

I was born to be brave

On the bright side, many more people today than in the past recognize that the “cause” of homosexuality is unclear and, like most things, probably rooted in an indistinguishable combination of biology and culture. Culture makes meaning of biology, and physical realities shape our lives. The problem, then, lies in the cultural definition of homosexuality as a problem that needs to be explained. Same-sex desire, for many Americans, is still neither neutral nor celebrated.

A second reason “born this way” is hard to step back from is that it resonates; it is personally powerful. Revisit Gaga’s bridge on the right.

Saying “I was born this way” feels empowering because it feels so true. It’s not as theoretical as cultural arguments often feel, and it can celebrate differences we feel we’ve lived with all our lives. But does it undermine the argument that these identities are culturally constructed? I don’t think it does, but I do think we need to work hard to find a way to both celebrate diverse identities that culture makes real at the same time we don’t fall back on biological determinism — the explanation that has traditionally been used to try to prevent homosexuality.

And we shouldn’t let “nurture” explanations off the hook either. A variety of groups and professionals today (though thankfully not including the American Psychiatric Association) still advocate efforts related to conversion or “reparative” therapy. This technique for “fixing” homosexuality falls somewhere between biology and society in identifying it as a mental disorder — which the APA did do before 1973 — that can and should be corrected.

So there’s the rub. Most positions depend on trying to explain, justify, or excuse a characteristic that should be value-neutral. Sexual orientation, along with race, gender, (dis)ability, and countless other identity categories, is a difference that ought to be celebrated not explained. I have faith that we can do it. Historically speaking, we’ve come quite a long way, but we still have a long way to go.