"Through the various discourses, legal sanctions against minor perversions were multiplied; sexual irregularity was annexed to mental illness; from childhood to old age, a norm of sexual development was defined and all the possible deviations were carefully described; pedagogical controls and medical treatments were organized; around the least fantasies, moralists, but especially doctors, brandished the whole emphatic vocabulary of abomination."
— Michel Foucault, The History of Sexuality Vol. 1, p. 36
In her book Bodies in Doubt, Elizabeth Reis provides (as the subtitle aptly denotes) an American history of intersex. Reis' book contains a genealogical account of the treatment and understanding of bodies which are neither male nor female, from their being labeled as hermaphroditic monsters in early America, to their conflation with sexual perversion in the early 1900s, and finally to the origins of psychology as a "proper" science and that discipline's views on intersex people and sexual development more broadly. Reis ends her book with an epilogue entitled "Divergence or Disorder? The Politics of Naming Intersex." This section deviates from the book's historiographic theme and instead focuses on contemporary debate about what to call people who do not fit into the sexual binary. Reis states that, "Though the disagreement centers on what to call 'intersex,' its ramifications are much more than lexicological. Indeed, the debate underscores the central dilemma of this book: the evolving perception of atypical bodies, particularly bodies that raise our anxiety level because they seem to muddle clear gender divisions" (153).
The words that we use, especially when discussing human beings in society, are of vital importance. Every denotation carries with it a connotation, and the way that we talk about a concept affects our valuation and understanding of that concept in more than just a factual sense. Medicine, as a field of scientific knowledge, must conceive itself as objective and its objects of study as reducible to so many objective "facts." But the truth is that the medical industry exists within our society, is comprised of individual people who live within a pre-existing sociopolitical framework, and thus can never be divorced from the influence of politics and cultural presuppositions. As Michel Foucault says, "we should abandon a whole tradition that allows us to imagine that knowledge can exist only where the power relations are suspended and that knowledge can develop only outside its injunctions, its demands and its interests" (Discipline and Punish, 27). This understanding—that the scientific, the personal, and the political are incapable of being separated—seems to undergird Reis' discussion in the epilogue: "The choice of nomenclature influences not only how doctors interpret medical situations but, also and as important, how parents view their affected children, how intersex people understand themselves, and how others outside medical settings—such as gender and legal scholars, historians, and media commentators—think, talk, and write about gender, sex, and the body." (Reis 154)
The aforementioned debate surrounds a (relatively) new term, "disorders of sex development" or "DSDs." This category includes "conditions previously grouped under the broad categories of 'intersex' and 'hermaphroditism' (Reis 153). Reis takes issue with all three of these terms, each of which she states is "controversial and divisive."
Reis outright detests the word "hermaphrodite" (as should anyone who has read her book). She claims that it is an archaism "that can still be found in medical writings" and characterizes the term as "vague, demeaning, and sensationalistic" (154). Even though the term has supposedly gone out of vogue because of its negative connotation, Reis' research found that "Some physicians have used the hermaphrodite label in their medical records but avoided saying the word in front of children or parents, for fear it would cause alarm and harm. That awkward circumspection, while well meant, has contributed to a penumbra of secrecy and shame surrounding these conditions” (155). For doctors to use this word in their records that they know is hurtful to the people whom it describes creates a serious tension. Such a practice frames the physician's thinking of what is “correct” or “factual” as distinct from what is ethical or appropriate for interaction with patients. It promotes secrecy, an understanding that intersex people are “really” hermaphrodites but that “the truth” must be hidden from them or softened in its delivery, for their own good. If the medical field takes such a stance, it really is no wonder that many intersex people experience shame and crises of identity as a result of their treatment.
“Intersex,” which throughout Reis' book serves as the normative term, has a complex status. It is certainly more positive than “hermaphrodite,” and has been advocated for by activists such as the Intersex Society of North America; this advocacy has given the term an explicitly political connotation (Reis 154-5). Despite having been chosen by intersex activists as the preferred term, parents and doctors have not been keen to accept it. Because “there has never been agreement on what 'intersex' means or on what conditions constitute intersex,” doctors (who have little use for terminology unless it is either inherited from their predecessors or categorically delimited) have never incorporated the word into their vocabulary. Some parents were uncomfortable with the term because “they wanted to see their newborn babies as girls or boys, not as 'intersex. . . .' Others have associated the word 'intersex' with sexuality, eroticism, or sexual orientation and have preferred to discuss their child's anatomical condition without focusing on his/her future sexual activities” (Reis 155).
The heteronormative assumptions which underlie this disparaging of “intersex” cannot be overstated. “Intersex activists advocate raising children as girls or boys rather than as a third, in-between category” (Reis 155); nonetheless, parents of intersex children could not divorce their child's atypical genitals from their understanding of that child's gender. At the same time, there is a refusal to discuss the sex and eventual sexuality of children. If parents do not want to focus on their child's future sexual activities, then why should a status as intersex preclude a “typical” gender of girl or boy? There is a cultural taboo surrounding discussion of sex which serves to reify an understanding that there is a strict correspondence between sex, gender, and sexuality, and this understanding is further supported by the will to normativity and objectivity within the medical fields. Additionally there persists a conflation of abnormality with sexual perversion (which is why “intersex” provokes a parental response that “we don't want to talk about our child's sexuality”); because of this conflation, abnormality invokes the taboo around sexuality, ensuring that discussion of abnormal bodies and sexualities is circumscribed by an aura of suspicion and shame.
Reis sees this same drive for objectivity and normality as the impetus for the new terminology, disorders of sex development: “Supporters of the relatively new term. . . believe it deemphasizes the identity politics and sexual connotations associated with 'intersex' and the degradation associated with 'hermaphrodite' and instead draws attention to the underlying genetic and endocrine factors. . . . For their part, doctors want to provide the best care possible, and, ironically, in their world labeling something a 'disorder' normalizes it” (155-6, 158). She agrees with this reasoning, but adds that the word “disorder” should be switched out for the more neutral “divergence.” I agree with Reis' claim that “divergence” is less pathologizing, but it nonetheless carries a connotation of abnormality. If we want to dispel the stigma surrounding intersex, a minor change to the medical lexicon isn't going to be enough (though I agree that linguistic precision is of vital importance). For cultural perception to change, cultural perception has to change.
Works Cited:
Reis, Elizabeth. Bodies in Doubt: An American History of Intersex (http://www.amazon.com/Bodies-Doubt-American-History-Intersex/dp/1421405830)
Foucault, Michel. The History of Sexuality, Vol. 1 (https://dl.dropboxusercontent.com/u/99026633/foucault-the-history-of-sexuality-volume-1.pdf)
Foucault, Michel. Discipline and Punish (https://dl.dropboxusercontent.com/u/99026633/foucault-discipline-and-punish.pdf)
No comments:
Post a Comment