The same word does two incompatible jobs in public discourse, and the confusion has consequences for whose claims get heard.
The word identity is everywhere. We have racial identity, gender identity, political identity, sexual identity, cultural identity, religious identity, national identity. Public arguments about who is what, who deserves what, and who counts as what now hinge on the term. Universities offer degrees built around it. Health systems organise care pathways around it. In some jurisdictions, legal and medical systems are being forced to respond to it.
For a word doing this much work, identity is remarkably underdetermined. Two people can use it in the same sentence and mean entirely different things, neither realising that the other has shifted register. The result is a kind of ambient confusion in which arguments that look like disagreements about identity are often disagreements about what identity is supposed to be a word for. This is not a pedantic complaint. The confusion has clinical consequences for people whose claims about themselves have nowhere to land.
A useful distinction from social theory
In a 2000 essay that has become a touchstone for anyone working seriously on the term, the sociologists Rogers Brubaker and Frederick Cooper proposed that identity in contemporary usage does two incompatible jobs at once. They called these the category of practice and the category of analysis[1].
A category of practice is what ordinary social actors use in everyday life, especially in political contexts. When someone says I am Black, I am a woman, I am Sardinian, I am Muslim, they are making a practical claim. The claim asserts that there is a fact of the matter about who they are, that this fact has consequences, and that others are obliged to recognise it. Categories of practice are organisational tools. They underwrite belonging, mobilisation, and demand. They are also experienced as natural rather than constructed: the speaker is not announcing the result of a sociological analysis but reporting something they take to be the case.
A category of analysis is what social scientists, philosophers, and historians use when they study what social actors are doing. In this register, identity is treated as a constructed object: contingent, negotiated, performative, and malleable across time and context. Gendered self-understanding, ethnic identification, even nationality are examined as the outcomes of long historical processes rather than as natural givens. The analytical move is to denaturalise what social actors take for granted.
The catch is that both registers use the same word.
Why the confusion is more than verbal
A word that does two jobs at once might still be useful, provided users keep the two jobs apart. Identity makes this hard because the two registers carry incompatible ontological commitments. The practice register assumes identity is given and worth defending; the analytical register assumes identity is constructed and worth examining. When the registers slide into one another mid-argument, both lose force.
Consider what happens when someone defending a practice claim is met with an analytical reply. I am a woman is answered by gender is a social construct. The reply is not, as a piece of social theory, wrong. But it is non-responsive, because the practice claim was not making a metaphysical assertion about the natural foundations of womanhood; it was asserting a fact of self that organises the speaker’s world. Conversely, when someone making an analytical observation is met with a practice rebuttal, the analytical claim is treated as a denial of the speaker’s reality rather than as a description of the conditions under which that reality came to feel real.
These are not exotic cases. They are much of the public conversation about identity in 2026.
The trap for newer claims
To see the problem more clearly, we can move into a particular grey zone: conditions that are felt deeply by those who live them, but have not yet found a secure place in medicine, law, or public language. The history of the past half-century in psychiatry and bioethics is full of cases in which contested self-descriptions were first refused, then analysed, then either depathologised, institutionalised, or translated into clinical categories. Homosexuality’s removal from psychiatric classification followed one version of this path. Trans-related diagnoses and care pathways followed another. More controversially, dissociative identity disorder, complex PTSD, and other categories also emerged through unstable exchanges between patient self-description, clinical interpretation, and institutional recognition.
The mechanism, simplified, is this: a group of people make a practice claim about who they are. The claim is initially refused as untrue, pathological, or unintelligible. Researchers begin examining it analytically, often without granting the practice claim itself. Over time, the analytical work generates a vocabulary, a literature, and sometimes a professional consensus that the practice claim describes something coherent. That consensus can then license the institutional recognition the practice claim originally demanded. The loop closes.
The catch is that the loop only closes if the analytical phase eventually produces something the practice phase can use. If the analytical work concludes that the underlying claim is constructed all the way down, that there is no there there, only contingent positioning, then the practice claim does not return. It dissolves. Recognition does not arrive.
The application
This is the situation, in 2026, of Body Integrity Dysphoria (BID). People with BID make a clean practice claim: my body, as it stands, is not completely mine; the leg I wish to remove was never part of who I am; my identity has a different physical configuration. The claim has all the features of a practice category. It is experienced as natural rather than constructed, organisational rather than merely expressive, demanding rather than descriptive.
The analytical apparatus that would adjudicate the claim has only just begun to assemble. BID is now recognised in the International Classification of Diseases under code 6C21. ICD-11 was adopted by the World Health Assembly in 2019 and came into effect on 1 January 2022. Yet BID remains without an agreed aetiology, an evidence-based treatment, or a professional consensus on appropriate clinical response. The analytical phase, in other words, is still in its early stages, and there is no broadly settled account of what the BID person’s claim should mean clinically, ethically, or institutionally.
This places people with BID in a particular bind. Their claim cannot easily be answered in the practice register, because medicine does not, as a matter of professional norm, treat practice claims about the body as sufficient grounds for irreversible intervention. When it does, as in some forms of cosmetic surgery, this is often treated as an ethical problem rather than as a model. Their claim also cannot easily be answered in the analytical register, because the analytical register cannot yet say with confidence what the claim is. The two registers do not meet at any point that would allow the loop to close.
What follows
None of this implies that the practice claim is wrong, nor that the analytical apparatus, once developed, will fail to produce a basis for recognition. The argument is narrower. It is that public debate about BID, like much public debate about identity more generally, proceeds as if there were a single thing called identity about which we are arguing, when in fact there are at least two. The confusion between them does much of the rhetorical work on both sides.
People who refuse the BID claim often do so by importing analytical-register reasoning into a practice question: identity is malleable, the BID person can be helped to feel differently about their body, surgery is therefore unnecessary. People who defend the claim often do so by treating analytical scepticism as a denial of the speaker’s reality rather than as a description of where the institutional work has not yet reached.
The way through is not to settle which register identity really belongs to. Both have their uses, and neither will dispense with the other. The way through is to be explicit about which register one is operating in at any given moment, and to notice that a great deal of what looks like disagreement about who has what identity is actually disagreement about what identity is for.
This is a small clarification, but it is the kind of small clarification that, once made, exposes how much of the surrounding argument was running on confusion.
[1] Brubaker, R., & Cooper, F. (2000). Beyond “identity”. Theory and Society, 29(1), 1–47. https://doi.org/10.1023/A:1007068714468
Essay adapted from my book Body Integrity Dysphoria and the Ethical Dilemma of On-Demand Amputation. Redefining Wholeness: Identity, Autonomy, and the Moral Boundaries of the Human Body
More writing: https://leandroloriga.com/