Critical Intersex

Morgan Holmes

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9780367603007
• eBook ISBN: 9781317157298
• Edition: 1
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

To date, intersex studies has not received the scholarly attention it deserves as research in this area has been centred around certain key questions, scholars and geographical regions. Exploring previously neglected territories, this book broadens the scope of intersex studies, whilst adopting perspectives that turn the gaze of the liberal, humanist, scientific outlook upon itself, in order to reconfigure debates about rights, autonomy and subjectivity, and challenges the accepted paradigms of intersex identity politics. Presenting the latest theoretical and empirical research from an international group of experts, this is a truly interdisciplinary volume containing critical approaches from both the humanities and social sciences. With its contributions to sociology, anthropology, medicine, law, history, cultural studies, psychology and psychoanalysis, Critical Intersex will appeal to scholars and clinical practitioners alike.

Part I Medical Practices/Colonial Practices

Chapter 1 Clinical Intervention and Embodied Subjectivity: Atypically Sexed Children and their Parents

Katrina Roen

DOI: 10.4324/9781315575018-2

Introduction: The Surgical Self

While surgery is now widely used not only for addressing health problems but also as a tool for ‘improving’ the body, this use opens up interesting questions about the relationship between surgery and psychology; the relationship between body and self. Those who advocate surgery as a way to address psychological concerns, and those who seek cosmetic surgery as a form of self-enhancement, may be altering the bodily form in the hope that this will have the desired effect on the sense of self or on the way one engages with others. In this respect, surgery comes to be like dieting, body-building, applying make-up, or choosing to wear particular kinds of clothing, for the sake of feeling good about oneself and for the sake of embodying a particular kind of self. Here, surgery is one of a number of technologies for moulding the embodied self (Davis 1995, Doyle and Roen 2008 ).

Surgical technologies, therefore, may be understood as tools for making interventions at both the psycho-social level (e.g., via the ‘husband stitch’ described by Braun and Kitzinger 2001 ), and at the socio-political level (e.g., via the historical use of surgery on selected, marginalized groups; Dally 1991 ).

The word ‘cosmetic’, coming from Greek, refers to adornment, beautification or ornamentation (Sceat 1993 ). In current English usage, ‘cosmetic’ refers not only to adornment and beautification, but also to the surgical possibilities of ‘imitating, restoring, or enhancing the normal appearance’, and suggests that the intervention is ‘intended to improve only appearances … [and to be] superficially improving or beneficial’ (The Oxford English Reference Dictionary 1996 : 323). Nevertheless, surgery does reach beyond the superficial and even beyond the material, enabling a different reality for the emerging self. For those who undergo surgery, the embodied self is necessarily remoulded: surgery is never simply a ‘cosmetic’ endeavour.

In the early twentieth-century development of plastic surgery, surgeons faced a hurdle in the belief that ‘medicine was meant to heal rather than beautify’ (Haiken 1997 : 93). During the twentieth century, however, came a rise in interest in psychology and a growing emphasis on self-improvement that helped plastic surgery to leap this hurdle. Haiken describes how the popularization of psychological concepts such as the inferiority complex paved the way for rationalizing and justifying cosmetic surgery as important for psychological well-being.

Haiken (1997) further explains how, during the 1920s and 1930s, in the U.S., people came increasingly ‘to believe that looks were crucial to social and economic success, as well as to mental health’ (95). Hence, they made demands for surgery that were all the more compelling because of their use of psychological concepts to bolster their claims about the value of cosmetic surgery for improving well-being. Both surgeons and their patients were affected by this. ‘In breaking down the barrier restricting them to reconstruction, surgeons laid claim to the whole body and mind of healthy individuals by linking physical abnormalities to psychological problems for which cosmetic surgical intervention was the prescribed cure’ (95). Surgery intended to ‘improve’ the appearance was repeatedly acknowledged as being of benefit psychologically, usually insofar as it might improve self-esteem.

Psychological problems could clearly have been seen as being resolvable by psychological means alone, so it is interesting that they became a route to cosmetic surgery. As Haiken writes, surgeons used psychological problems to justify surgical intervention by arguing that ‘a psychological problem that was the direct result of a correctable physical anomaly was on their turf’ (Haiken 1997 : 118). The 1930s saw the classification of a range of bodily features (such a wrinkled foreheads and double chins) as deformities or disfigurements, thus enabling surgeons to better justify cosmetic surgery.

What are the implications of embarking on cosmetic surgery with the specific understanding that it will have far-reaching psychological effects? How is the relationship between the surgical and the psychological conceptualized by those undertaking such treatment with intersex¹ children? Surgery seems to figure as a discrete intervention that operates on the material body (Roen 2008 ), with the understanding that the related work needs to be done through the parents’ engagement with the child in their ‘new’ gender and this is supported by clinicians’ insistence that the child is ‘really’ that sex (Hird 2003 ) but just needs ‘correction’ (see, for example, American Academy of Pediatrics 2000 ).

The work that is done, therefore, is on the level of belief: if the parents believe that the ambiguity can be erased, and if they can therefore raise the child unambiguously into their new gender identity, then the work of producing a typically-sexed child from an atypically sexed child will have been done. As Fausto-Sterling writes, ‘our beliefs about gender affect what kinds of knowledge scientists produce about sex’ (Fausto-Sterling 2000 : 3). But there is a black-box effect here: it is not made clear exactly what the surgery needs to signify to the child in order for the magic of producing a typically sexed child to take effect. The child is assumed to be the subject pictured by mainstream Anglo-American psychology, where identity is formed in a fairly straight-forward way through socialization. Complexities of embodiment are not tackled in this understanding of how early surgery might ‘work’ for intersex children.

Cosmetic Genital Surgery: Medicine and Consumerism

Our bodies have become the ultimate cultural metaphor for controlling what is within our grasp. (Davis 1997 : 2)

Before people will spend money on something as expensive and uncomfortable as cosmetic surgery, they need to be motivated not only by desire but by concern or self-doubt. Bringing the authoritative language of medical science to the aestheticization of the vagina is one key way to trigger such anxiety. (Davis 2002 : 10)

While some of the work that is done, to make sense of cosmetic genital surgery for infants, involves beliefs about gender and socialization, some of the work is done through understandings that are part of consumer culture.

Simone Weil Davis (2002) refers to the way that advertising has been used to produce the kind of anxiety needed to sell medical products and interventions. The authoritative voice of science has long told women that their genitalia should be a site of anxiety, whether because of vaginal odours and fluids, or because of their appearance. Medicalized products and procedures are marketed to remedy each ‘problem’ as it is produced. Davis documents how, at least since the sixteenth century, ‘large labia have often been associated with deviance’ (15), being connected at various times with hypersexuality and lesbianism. In the nineteenth century, clitoridectomies were carried out both as a response to larger than average vulvas and long labia minora, and in an attempt to ‘reduce “hysteria” and other nervous ailments, but particularly to combat “excessive” masturbation’ (Davis 2002 : 16).

Currently, with regard to atypically sexed children, the stated concern driving surgery relates to the gender identity development of the child and the relationships that the child has with others (such as family members who need to accept and love the child, peers who need to be able to get on with the child rather than bullying him/her). The unstated concern relates to issues of aesthetics. There is currently a growing industry in the surgical production of beautiful genitalia, working in tandem with the long-standing belief that large, visibly protruding female genitalia signal deviance. Running alongside the industry popularly known for the production of the ‘designer vagina’ (Braun 2005 ) is the production of images of (female) genitalia in the context of pornographic work, where particular representations of sexual anatomy are made, and ‘enhanced’ via photographic technique, and according to particular norms of female sexual appearance (Davis 1995 ). Here, some bodily presentations are sold as attractive and others are edited out (Davis 2002, Kapsalis 1997 ). The surgical ‘correction’ of the appearance of intersex genitalia cannot pretend to be innocent of this industry, or unrelated to this cultural drive to erase the imperfection of (female) genitalia.

According to Braun’s (2005) analysis of designer vagina surgery, benefits of the surgery are framed as being both psychological and physical. Here, once again, surgical changes are understood to address psychological or emotional issues. One surgeon in Braun’s study reportedly stated: ‘I’m a psychiatrist with a knife’, in the attempt to indicate that psychological benefits, such as increased confidence and increased enjoyment of sex, could result from cosmetic genital surgery. While benefits are described in ways that maximize them, the actual surgical changes are described in ways that minimize them, using terms such as ‘trim’ to refer to cutting away parts of the genitalia.

In the case of the intersex child, the benefits of surgery are framed in both psychological and social terms concerning the child’s ability to live comfortably within their gender of rearing. This is described as helping the child to develop a gender identity consistent with their gender of rearing. By presenting intersex surgery as being primarily about a developmental—or identity—project, and not about aesthetics, those engaged in this project have their work and their decisions validated. To understand such surgery primarily in relation to aesthetics would be to trivialize it and show it up as highly problematic or even indefensible (Davis 1995 ).

Such surgical alterations are not only intended to ‘improve’ appearance and bring psychological benefits to the person who undergoes the surgery; these alterations are also understood to bring benefits to those around the child: parents may feel less upset, babysitters less confused, and other family members less worried (Warne 1998, 2004 ). Clearly, the surgery is not intended to have simple outcomes at all, but to bring a wide range of effects to the child and those around the child.

As with other types of cosmetic surgery, the problems with early cosmetic genital surgery are largely conceptualized as ‘risks’ that can be known, evaluated, and reported on clinically.² Conceptualizing the problems with early genital surgery as risks means focussing on the kinds of problems that may be addressed through further surgery (Roen 2008 ), that may be put down as being due to surgical error,³ or that may be understood as being due to an unpredictable change (for instance, when a child with Congenital Adrenal Hyperplasia [CAH] has been surgically assigned as female but grows up to identify as male). The kinds of problems that are therefore left out, or not fully evaluated, concern those issues pertaining to the future desires of the intersex person, or the future political perspective and social opportunities of the intersex person, and issues to do with the complex involvement of the body in the process of becoming. These issues that are largely ignored within clinical texts make sense in a socio-political realm, speak to philosophical issues, and are not easily conceptualized within the terms of surgical follow-up studies or psycho-medical assessments (Roen 2008 ). The willingness to engage with these issues, and not try to reduce them to psychometric categories such as ‘coping’, is a necessary ingredient to productive interdisciplinary dialogue on this topic.

A combination of consumerist contexts and psychological rationales makes it possible to argue for the cosmetic surgical alteration of atypically sexed infants’ genitalia. Yet considerations of the materiality of intersex infants’ bodies and the work of surgeons crafting genital tissue, bring us inevitably back to the question: whom do the intersex people undergoing such surgery become? What is intended for the infants for whom this surgical intervention is chosen?

What is needed here is an approach that considers bodies as ‘embedded in the immediacies of everyday, lived experience’ (Davis 1997 : 15). Such an understanding demands of us an embodied theory that ‘tackle[s] the relationship between the symbolic and the material, between representations of the body and embodiment as experience or social practice in concrete social, cultural and historical contexts’ (Davis 1997 : 15).

Postmodern Bodies

Debates about the use of ‘cosmetic’ surgery to normalize the appearance of young children can be seen to traverse the theoretical terrain described by Kathy Davis whereby in ‘modernist discourse, the body represents the hard “facts” of empirical reality’ (1997 : 3) while ‘postmodern scholars … take the body as the site par excellence for exploring the construction of different subjectivities’ (4). Thus, clinicians promoting ‘corrective’ surgery (tending to take a modernist approach) and critics of such surgery (sometimes drawing on postmodernist understandings) ‘propose the body as secure ground for claims’ (4), including knowledge claims and identity claims. Thus, early genital surgery works in tandem with claims that a child is, for instance, a girl with genitalia that need to be corrected; while being born with atypical genitalia might allow one to make a claim to being ‘intersexed’. Each claim makes sense in terms of the materiality of the body, but the two claims are in tension with one another when considered in relation to the notion of ‘imaginary bodies’. As Gatens (1996 : viii) writes:

I am not concerned with physiological, anatomical, or biological understandings of the human body but rather with what will be called i...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Contents
• List of Contributors
• Series Editors’ Preface
• Acknowledgements
• Dedication
• Introduction: Straddling Past, Present and Future
• Part I Medical Practices/Colonial Practices
• Part II Challenges to Identity Claims
• Part III Refiguring the Human
• Index