A Genealogy of Puberty Science

Monsters, Abnormals, and Everyone Else

Pedro Pinto, Catriona Macleod, Catriona Ida Macleod

• Publisher: Routledge
• Year: 2019
• Print ISBN: 9781138295391
• eBook ISBN: 9781351392709
• Topic: Psychology
• Subtopic: Developmental Psychology
• Index: Psychology

A Genealogy of Puberty Science explores the modern invention of puberty as a scientific object. Drawing on Foucault's genealogical analytic, Pinto and Macleod trace the birth of puberty science in the early 1800s and follow its expansion and shifting discursive frameworks over the course of two centuries.

Offering a critical inquiry into the epistemological and political roots of our present pubertal complex, this book breaks the almost complete silence concerning puberty in critical theories and research about childhood and adolescence. Most strikingly, the book highlights the failure ?of ongoing medical debates on early puberty to address young people's sexual and reproductive embodiment and citizenships.

A Genealogy of Puberty Science will be of great interest to academics, researchers and postgraduate students in the fields of child and adolescent ?health research, critical psychology, developmental psychology, health psychology, ?feminist and gender studies, ?medical history, science and technology studies, and sexualities and reproduction studies.

Chapter 1
Introduction

Towards a history of the present

This book is about the modern invention of puberty as a scientific object and a health matter. Drawing on a Foucauldian genealogical analytic, or a ‘history of the present’, our research traces the birth of Western puberty science in the early 1800s, and follows its expansion and shifting discursive frameworks over the course of two centuries. We focus on the range of discourses and practices through which pubertal development was shaped and problematised in medical, psychiatric and paediatric literature, and historicise how, on the basis of those problematics, puberty has become a normalising technology of young people’s bodies and souls. Our main aim, thus, is to expound upon the conditions of possibility of the ensemble of norms, anxieties, and modalities of intervention within which pubescent subjects are medically figured and managed around the world.

In the introduction, we set the scene with a snapshot of today’s ‘puberty’. Starting with a brief review of explanations and advice offered in medical online sources, we home in on the ongoing medical debates about ‘precocious’ development. After framing the main issues and puzzles currently facing puberty science, we proceed to outline the overarching theoretical and methodological standpoints of our research. Finally, we present an overview of how the book’s central argument unfolds throughout the chapters.

Navigating ‘puberty’: from being a crisis to being in crisis

At present (April 2018), anyone searching for ‘puberty’ online will find several medical sites providing young people and adults with plenty of information. Similar definitions of puberty feature on the top pages:

Puberty is when a child’s body begins to develop and change as they become an adult. Girls develop breasts and start their periods, and boys develop a deeper voice and start to look like men.¹

Puberty is the time in life when a boy or girl becomes sexually mature. It is a process that usually happens between ages 10 and 14 for girls and ages 12 and 16 for boys.²

Puberty (say: PYOO-ber-tee) is the name for the time when your body begins to develop and change as you move from kid to adult. We’re talking about stuff like girls developing breasts and boys starting to look more like men.³

Alongside such physiological and chronological descriptions, several sites offer gentle reminders about the challenges that pubertal changes might pose and advice on how to handle them. While describing those issues, they reassure readers that it is natural to be concerned about this transitional time of life. Herewith some tips ‘for Kids’ provided by KidsHealth.org:

During puberty, you might feel confused or have strong emotions that you’ve never had before…. You also may feel anxious about how your changing body looks.⁴

Perhaps you’ve sprouted several inches above everyone else in class. Or maybe they all did the sprouting and you feel too short…. And now you’re looking in the mirror, thinking only one thing: Am I normal?… First of all, what’s normal? There’s no one type of normal. Otherwise, the world would be full of a lot of abnormal people!⁵

Your doctor knows all about puberty and can help determine if you are developing normally. But just about everyone catches up eventually, and most differences between you and your friends will even out. Until then, hang in there. Puberty can be quite a wild ride!⁶

The site simultaneously anticipates and appeases tweens’ anxieties. In doing so, it conveys the familiar figure of a pubescent subject naturally uneasy with new desires and bodily changes, and prone to doubt the normality of their own development. In the site’s encouraging words of advice, readers inescapably learn that going through puberty is not simply about growing up: it is about growing up either normally or abnormally. Incidentally, they learn that puberty can be a ‘wild’ transformation, a period marked by perplexing feelings, watchful expectations, and confusion about oneself – a time of ‘crisis’, as 19th-century doctors would say.

As for grown-ups, they also learn that a similar sense of confusion and some worrying uncertainties can reasonably be provoked by their children’s pubescence:

Puberty can be a confusing time for a tween, and for parents. As a child changes, so does his [sic] mood, body, interests, and even family dynamics can change. While you may prefer that your child remain little forever, puberty is coming, and that means you have to prepare.⁷

While puberty is a normal condition and not an illness, many medical conditions and illnesses may first appear during puberty.⁸

In other words, puberty is said to be a critical period for parents in that they are confronted with their children becoming sexual, meaning that parents might find themselves grappling with a sense of loss, that is to say, their own children’s loss of innocence. Just as children will have to adjust to their new bodies and selves, so parents have to adjust to these changes. Similar to the instructions given to young readers, parents are enjoined to keep in mind that pubescence is but ‘a normal condition’ while, at the same time, remaining vigilant about the health dangers inherent in this period.

As these quotes illustrate, today’s medicalised discourses on puberty, either targeted at youngsters or their guardians, rest on a set of premises with peculiar internal tensions. First, puberty is a natural phenomenon which paradoxically leaves the limits between childhood and adulthood in doubt. Second, it is a ‘normal condition’ susceptible to the onset of abnormal and pathological states. These forces entangling around maturing young subjects – naturalness and dangerousness, normalness and abnormality/pathology – compose the overarching plot of our genealogy.

Our book is mainly about this ‘normal condition’, so naturally at risk of abnormalities, and about ‘normal’ and ‘abnormal’ pubescent people, who are neither children nor adults. We trace the confusion between maturity and immaturity within the pubescent body, as construed and continually reworked over the last two centuries in medical discourse. Through the following chapters, we show how this dilemma emerged in modern clinical practice to become one of the most important and disputed objects of today’s sexual health sciences. But, for now, we shall continue exploring our present.

Pubertal timing: ‘too late’, ‘too early’

As quoted above, MedlinePlus.gov, the site of the US National Library of Medicine, indicates that ‘[puberty] is a process that usually happens between ages 10 and 14 for girls and ages 12 and 16 for boys’. These are, roughly put, the age norms established at the end of the 1960s by the famous 20th-century growth scientist, J. M. Tanner, in collaboration with human biologist W. A. Marshall (Marshall and Tanner 1969, 1970). Their work laid the foundations of today’s clinical standards of pubertal development, the Tanner Scale used to assess breast, pubic hair, and testicular and penile growth: from Stage 1 (prepubertal) to Stage 5 (mature).

Although these norms are currently adopted in international medical practice, their validity has been increasingly debated over the last two decades in paediatric circles worldwide. As we show a bit later, several experts have called for the lowering of the earliest age limits at which the onset of puberty is considered ‘normal’. Unsurprisingly, thus, wider age ranges of pubertal development are more cautiously proposed in other medical sites, as found in the pages ‘for Teens’ by KidHealth.org: ‘Puberty takes place over a number of years, and the age at which it starts and ends varies widely. It generally begins somewhere between the ages of 7 and 13 for girls, and somewhere between the ages of 9 and 15 for guys’.⁹

Regardless of the version adopted concerning the age ranges of ‘normal’ pubertal development, the physiological processes involved in the onset of puberty are agreed upon. KidsHealth.org explains as follows:

When your body is ready to begin puberty, your pituitary (say: pih-TOO-uh-ter-ee) gland (a pea-shaped gland located at the bottom of your brain) releases special hormones. Depending on whether you’re a boy or a girl, these hormones go to work on different parts of the body.¹⁰

More detailed physiological descriptions can be found in other health web resources, such as the site of the UK Society for Endocrinology, ‘You and Your Hormones’:

In normal puberty, hormones from an area of the brain called the hypothalamus signal to the pituitary gland (a small gland situated underneath the brain) via a hormone called gonadotrophin-releasing hormone to produce hormones known as gonadotrophins (luteinising hormone and follicle stimulating hormone). These gonadotrophins in turn stimulate the sex glands (gonads: testicles in boys and ovaries in girls) to produce steroid hormones. These hormones are mainly testosterone in boys and oestrogen in girls and it is these steroid hormones that stimulate the development of the physical signs of puberty.¹¹

As these sites indicate, a range of clinical issues may occur which will disturb the endocrinal mechanisms described above. Consequently, they can either hasten or delay the appearance of pubertal manifestations, namely breast development and testicular growth. ‘In a few cases’, as KidsHealth.org tells young readers, ‘kids who are developing very early or who are very late in starting have a problem that may need to be checked or treated. If you are concerned about that possibility, talk with your parents and schedule a visit with your doctor’.¹²

Of course, parents might also reasonably wonder: when is the young body clinically deemed ‘very early’ and ‘very late’?

Precocious puberty is the abnormally early development of any secondary sexual characteristics: before the age of nine years in a boy and eight years of age in a girl.¹³

Delayed puberty is defined as no secondary sexual maturation or any sign of puberty by the age of 13 years in girls and 14 years in boys.¹⁴

Delayed puberty is known, as indicated in these sites, to be caused by malnutrition or anorexia, excessive bodily exercise or stress, chronic illnesses (e.g. diabetes or cystic fibrosis), hormonal deficiency caused by disorders of the hypothalamus and the pituitary or thyroid glands, ovarian disease and testicular problems (e.g. cryptorchidism), and chromosomic disorders, namely Turner and Klinefelter syndromes.

But, in a vast majority of the cases, it turns out that teenagers are simply ‘late bloomers’, meaning there is no underlying condition causing the delay:

Most often, it’s simply a pattern of growth and development in a family…. This is called constitutional delay (or being a late bloomer), and it usually doesn’t require any kind of treatment. These teens will eventually develop normally, just later than most of their peers.¹⁵

In over 90% of cases, delayed puberty is due to what is known as a constitutional delay in growth and puberty…. Typically these children will have a short stature compared with other children of the same age and they are often thin and have a family history of delayed puberty.¹⁶

As to precocious puberty, it can also result from several clinical issues. Pituitary tumours and brain injuries or infections might trigger excessive levels of gonadotrophin production, in which case secondary sexual characters take form earlier, although assuming their ‘normal’ sequential pattern. This is nowadays called ‘central’ or ‘true’ precocious puberty. Also, gonadal and adrenal disorders causing alterations in steroid production can lead to breast budding with no other signs of sexual maturation (premature thelarche) or the appearance of pubic or axillary hair alone (premature pubarche or adrenarche). In such instances, the precocity is understood as ‘peripheral’. Precocious pubescence is also one of the symptoms of the McCune-Albright syndrome, a very rare genetic disorder which, besides endocrine abnormalities, causes severe bone disease and a particular pattern of skin pigmentation.

However, the largest number of early developers are healthy girls with what is frequently called idiopathic true precocious puberty: their hypothalamus’ nerve cells are activated so that gonadotrophin-releasing hormones are produced, just as occurs in any ‘normal’ pubescent body, only prematurely in their case. Until today, nobody has found the cause of this phenomenon – just as no scientist knows what exactly triggers puberty tout court.

For the majority of girls, there’s no medical problem at fault – they simply start puberty too early for no known reason. In boys, the condition is less common and more likely to be related to another medical problem.¹⁷

The cause of precocious puberty related to early increases in activity of the hypothalamus is usually unknown although underlying causes are occasionally found in girls and in up to 50% of boys.¹⁸

In short, similar to what is said about delayed puberty, most cases of pubertal precocity are ‘constitutional’. Unlike the average late bloomer, however, early pubescent children have rarely inherited their condition: ‘Less than 1% of girls’ and ‘about 5% of boys’.¹⁹

Furthermore, the two conditions are said to follow quite distinctive epidemiologic patterns, as evidenced in the extracts below. First, there is a striking sex-differentiation as to their incidence: late bloomers are mostly male adolescents, and early developers, as seen above, mostly female children. Second, not only is precocious puberty suggested as more prevalent than ‘late blooming’, it is often framed in racial terms. Third, it seems that the age of puberty onset has continually declined over the decades among several world populations:

Delayed puberty is roughly estimated to occur in about 3% of children, with 90% of these cases being caused by a constitutional delay. Constitutional delay is 10 times more common in boys than girls.²⁰

According to 1997 data, an estimated 4–5% of girls from all racial groups had precocious puberty. Although figures for boys are unknown, they are likely to be much lower.²¹

Adolescent girls reach puberty today at earlier ages than were ever recorded previously…. For example, the average age of the onset of menstrual periods in girls was 15 in 1900. By the 1990s, this average had dropped to 12 and a half years of age.²²

Around the world, the age of puberty has reduced over recent generations and it is recognised that puberty is earlier in...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• Preface and acknowledgements
• 1 Introduction: towards a history of the present
• PART 1 Precocious little monsters
• PART 2 From biological to cultural monstrosities
• PART 3 The surveillance of all
• References
• Index