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LIVING MY GAP YEAR

Intersexuality and Injustice:

Zuzu Tadeushuk

Examining Gender Identity and Reassignment via Butler and David Reimer

    In the third Chapter of her book Undoing Gender, Judith Butler sets out to examine the determinants of binary gender, and how one can define oneself as human—inhabit “personhood,” as she says—without conforming fully to any one of these determinants. To do this, she analyzes the case of David Reimer, a boy who was raised as a girl after undergoing a sex reassignment at nineteen months of age, and who eventually transformed himself back into a man during adolescence (Colapinto 51). David was the fulcrum of a prolonged and contentious debate within the medical and psychological establishments over whether one’s sense of gender identity is learned through socialization or ingrained in one’s anatomy at birth, and the rival specialists John Money and Milton Diamond used David’s situation to prove their opposing theories. Butler’s chapter, however, centers less on answering this “nature vs. nurture” question of gender, but rather on her claim that David neither proves nor disproves either of these doctors’ arguments: he stands outside every limitation of accepted gender norms, and he is no less human for doing so. 

 

    Judith Butler’s rhetoric is profound and thorough. Her investigation of David’s case and the medical furor that precedes, pervades, and proceeds from it, is astutely objective on the question of whether gender identity is a social construct or simple biology, although her tone does become more personal when she manifests disapproval of certain medical practices and the practitioners who endorsed them. The philosopher and gender theorist examines such weighty issues as the definition of justice, of intelligibility, and “the limits of the conceivably human” (Butler 64), while also relaying the sobering story of a case that made history and sparked both academic and popular discussion about the ethics of gender reassignment. 

 

    David Reimer was born a boy, along with an identical twin brother, but when he was eight months old his penis was accidentally obliterated in a surgery intended to remedy a minor condition called phimosis (Butler 59). The damage being found irreparable, David’s parents sought help from the renowned psychologist and sexologist John Money at Johns Hopkins University, who advised them that David be raised as a girl to spare him the psychological trials and tribulations of growing up male with no penis. The distraught parents agreed, and David was castrated, given a provisional vagina, and sent home again as a girl named Brenda (Colapinto 49-52). Each year, Brenda and her twin brother were returned to Money’s institute in Baltimore so that the renowned scientist could study and compare their psychosexual developments. These sessions also included “treatment” for Brenda: Money showed the child graphic photographs of vaginas and sexual intercourse, brought in adult transsexuals to tell her why it was good to be female, and forced her and her brother to perform “mock coital exercises” (Butler 60), believing that all these things would help Brenda assimilate to her new gender role, and that she would successfully grow up to be a “normal” and happy female, as his theory predicted she would. 

 

    While Money published papers and gave talks on the stunning success of his latest sex reassignment case, known popularly as the “Joan/John case,” Brenda’s reality was far from stunning: the child felt increasingly anguished in her state as female and insisted mysteriously on certain “boyish” activities, like peeing standing up and playing with trucks (Butler 60). Still unaware of the sex change she had undergone in infancy, she “started to make the realization she was not a girl” (Butler 60), and when eventually a team of local psychiatrists reviewed the case, Brenda was told the truth and decided to revert to the gender she had been born with. She had her breasts removed and a phallus constructed, and at age fourteen Brenda began living as David (Butler 60). 

 

    It was at this point that Milton Diamond entered onto the scene, and seized upon David as a means of refuting once and for all his long-time ideological rival John Money. At that time in scientific circles, Diamond was an anomaly in that he vocally advocated the “hormonal basis of gender identity” (Butler 60) rather than the social one. He and his colleague Sigmundson—and later the journalist Colapinto—made headlines with their publications revealing the ultimate outcome of Joan/John’s sex reassignment, shaking the scientific establishment and miring Money’s name in allegations of cruelty and egotism. 

 

    This all is relayed in Butler’s chapter concisely and judicially, and leads without rupture into her discussion of the ways in which the man David Reimer makes visible to us “those points where the human is encountered at the limits of intelligibility itself” (Butler 58). The author references the works of multiple gender scholars and scientists along the way, weaving key aspects of their views into her narrative without over-burdening the reader with extraneous information and theories. Ultimately, though, Butler uses the authors she cites both as first-hand informants from whom to sift the bare facts and events of David Reimer’s life, and as ideological trail markers to guide her, and her reader, through her venture into the thorny subject of gender identity and towards some incontestable kernel of truth.

 

    In her notes on Chapter 3, Butler directs her reader to certain sections of a book by the biologist and gender theorist Anne Fausto-Sterling for “an excellent overview of this controversy” (Butler 253). She refers not solely to the debacle surrounding David Reimer’s life and body, but to the larger controversy surrounding intersexual individuals (those born with “either/or, neither/both” (Fausto-Sterling 45) sets of genitals) and the widespread medical practice of “fixing” them during infancy. Although David’s case is not that of an intersexed individual, they share many of the same characteristics—and many of the same complexities. Anne Fausto-Sterling explores these cases and complexities extensively in the renowned third chapter of her book Sexing the Body: Gender Politics and the Construction of Sexuality, which is one of the sources Butler credits within her actual text as an “important recent” (59) publication. In this selection, Fausto-Sterling lists common types of intersexuality, such as congenital adrenal hyperplasia (CAH) and androgen insensitivity syndrome (AIS), and critiques the incongruity between the attitudes doctors hold towards these conditions as defects to be remedied and the surprising frequency with which they occur. 1.7 percent of all births are intersexed, according to a study done by Fausto-Sterling herself, which makes intersexuality more common, in fact, than albinism (Fausto-Sterling 51-53). 

 

    Typically, Fausto-Sterling explains, during embryonic development the elongated and nerve-dense phallus, which grows on all fetuses, will at some point evolve into either a clitoris (on a homogametic child of XX chromosomes) or a penis (on a heterogametic child of XY). In the case of an intersex child the phallus will remain at an indeterminate length, or will formulate, to varying degrees of completion, the genitalia contrary to the chromosomal content of the child’s genes (Fausto-Sterling 48-50). In such cases, prenatal treatment via a steroid called dexamethasone can decrease the masculinization of an XX fetus, and if the condition is not detected in time or the drug is ineffective, surgical action is taken at birth to reconstruct the infant’s genitals as a recognizable penis or vagina (Fausto-Sterling 55), even though such contrived organs often perform only some of their “expected functions” (Butler 60).

 

    When considering infant genital surgery, Fausto-Sterling writes, doctors usually adhere to the advice of one renowned Dr. Patricia Donahoe that “[g]enetic females should always be raised as females, preserving reproductive potential, regardless how severely the patients are virilized. In the genetic male, however, the gender of assignment is based on the infant’s anatomy, predominantly the size of the phallus” (Fausto-Sterling 57). This logic effectively diminishes the definition of femininity to the capacity for reproduction, and that of masculinity to genital size. To so strip away the complexities of value and emotion from gender identity is, I believe, to base a momentous decision on a precarious and partial view. Risky at best, Dr. Donahoe’s strategy leaves much to its practitioner’s discretion, and many of the elements factored into the assignment of gender to a heterogametic intersex child are highly subjective.

 

    In determining whether to operate on a genetic male to make h/her outwardly resemble a physical male, the primary consideration is a technical one: is the phallus long enough to be acceptable as a penis? For it is much harder to build a fully functional penis from tissue nearer in size to a “normal” clitoris than it is to cut away excess phallus in the sculpting of a vagina (Fausto-Sterling 59). The question that follows, however, is far less pragmatic, and far more prone to debate: what constitutes an “acceptable” penis? “The worries in male gender choice are more social than medical,” Fausto-Sterling writes. “Most intersexual males are infertile, so what counts especially is how the penis functions in social interactions—whether it ‘looks right’ to other boys, whether it can ‘perform satisfactorily’ in intercourse. It is not what the sex organ does for the body to which it is attached that defines the body as male. It is what it does vis-à-vis other bodies” (Fausto-Sterling 58). Ultimately, then, it is society that determines what phallus length is “too small” for a penis and “too large” for a clitoris, indirectly influencing the surgeons whose job it is to choose which children to convert into which genders. 

 

    But is this really their job? Fausto-Sterling makes the argument that it is only out of a need to uphold the traditional understanding of gender as starkly binary that the medical establishment so fervidly takes action to saddle the intersex infant with a recognizable sex (48). She calls for doctors to instead make a provisional gender assignment at birth but hold off all surgery until the child is old enough to make such decisions for him/herself. She even goes so far as to equate infant gender surgery with genital mutilation, and alleges that “early genital surgery doesn’t work: it causes extensive scarring, requires multiple surgeries, and often obliterates the possibility of orgasm” (79-80). Worse yet, in most cases the parents of the patient, and even the patient themselves once they are older, are not given complete and honest information about their own circumstances: surgeons belie the truly ambiguous and open nature of intersex genitalia, preferring to convince uncertain parents that there is a “true” gender present in their child that’s been temporarily covered by a developmental deformity, and that their decisions are not arbitrary but aligned with this “truth” (Fausto-Sterling 64-65). Medical procedures are often not fully disclosed, alternatives not enumerated, and medical records not released to patients even years after the fact (Fausto-Sterling 84). “In their suggestions for withholding information about patients’ bodies and their own decisions in shaping them,” Fausto-Sterling argues, “medical practitioners unintentionally reveal their anxieties that a full disclosure of the facts about intersex bodies would threaten individuals’—and by extension society’s—adherence to a strict male-female model” (65). This anxiety can be compared to John Money’s desire that his social-construct theory be proven correct. Just as Money drove Brenda into girlhood for the sake of his ideology, so do surgeons impose genders on infants who have none—infants who by their very existence outside of the binary gender system pose threats to the ideologies of the surgeons. 

 

    Butler uses Sterling’s work to illustrate the greater gender debate that simultaneously exceeds and includes David’s case, and to show why Money’s assertions about David were so important at the time they were published. It also helps Butler show why, when Money’s claims were eventually disproven, the covert manipulations David claimed to have undergone “galvanized” (Butler 64) the intersexual movement by exposing such practices to the public. Butler recapitulates Fausto-Sterling’s opposition to the practice of operating on intersex babies, pointing out, as Fausto-Sterling did before her, the paradoxes that riddle doctors’ justifications for performing such surgeries: they operate because they claim gender at birth is malleable, but then tell the parents they’re simply uncovering the “true” gender their child was destined to be (Fausto-Sterling 76). They operate in the name of making the child appear “normal,” but the extensive scarring they leave behind achieves all but that (Fausto-Sterling 85-86). It becomes increasingly clear through her relaying of these facts that Butler aligns herself with the opinion of her source (Butler 64).

 

    Another book that Butler uses in her chapter about David Reimer’s case is As Nature Made Him, by John Colapinto. While Anne Fausto-Sterling provides the medical background to the case, Colapinto offers the emotional and personal background. And contrary to Anne Fausto-Sterling’s opus, this is not so scientific a work as it is narrative, with Colapinto delivering in detailed but straightforward prose a comprehensive account of David’s childhood and relationship to John Money—his undisclosed resistance to the psychologist, unacknowledged frustrations with the gender imposed on him, and his family’s unwitting compliance with the prolonged torment of their daughter via the “pressure tactics, cajoling, pornography and unorthodox inspections and posings” (Colapinto 96) that Money subjected the young Brenda to during their private interviews. 

 

    In addition to shedding light on the personal interactions of this case, Colapinto illuminates the cultural context that influenced the scientific community during the 1950’s, setting the scene for the debut of Money’s social-constructionist theory. “Explanations for sex differences had been moving towards a nurturist view for decades,” Colapinto says. “Against this background, the Johns Hopkins team’s conclusions that sexual identity and orientation were solely shaped by parents and society fit perfectly into an intellectual zeitgeist in thrall to behaviorist theories” (34-35). He proceeds to show the scientific and cultural implications of Money’s claims. David’s anonymous case, in its role as Money’s victorious proof of gender malleability, was soon “enshrined in myriad textbooks” (Colapinto 70), echoed in articles in the New York Times and Time magazine, and celebrated in books by the likes of feminist Kate Millet. The women’s movement hailed it as validation of their driving principle: John’s successful transition into Joan proved, as Time put it, that “conventional patterns of masculine and feminine behavior can be altered” (Colapinto 69). “Such findings,” one Baltimore newspaper raved, “could have an effect on future attitudes about sex roles that could prove comparable to that of Darwin’s Theory of Evolution” (Colapinto 78). As we have seen, though, this was not to be the case.

 

    In her own text, Butler appears to have drawn on both the emotional and cultural insights of As Nature Made Him. She summarizes the traumatic interactions between David and Money described by Colapinto, and directly quotes Colapinto when discussing the deadly ramifications that misrepresented results (like those of Money and his team) can have for all of science and society at large. She specifically includes the quotes he used from Time magazine and Kate Millet to support this claim (Butler 62).

 

    And yet one sentence after quoting Colapinto, she challenges him; drawing attention to his assumption of “the inarguable value of normalcy itself” (Butler 62)—an assumption Butler and Anne Fausto-Sterling (76) alike do not approve of. Fausto-Sterling, in fact, may be the only scholar Butler mentions whom she does not challenge or dismiss with some comment or observation over the course of her chapter. The philosopher makes no secret of her disagreements with her peers: in her text Butler challenges the journalist Natalie Angier on the latter’s characterization of David’s case as having “the force of allegory” (Butler 62), and Money on his obvious omission and misrepresentation of facts (Butler 61). She protests Diamond for his appropriation of David’s case to argue that intersex infants possessed of a Y chromosome should be categorically constructed into males because, as he claimed, biological makeup determines all (Butler 63), and challenges David himself about the grounds on which he claims to have known all along that he was male. Responding to an interview in which David explains that he knew because he never liked traditional girl’s toys, Butler wonders: “But in what world, precisely, do such dislikes count as clear or unequivocal evidence for or against being a given gender? Do parents regularly rush off to gender identity clinics when their boys play with yarn, or their girls play with trucks?” (70). She even takes a jab at the scientific establishment as a whole when she caricatures industry posturing, quipping, “And surely we must have knowledge here. We must be able to say that we know, and to communicate that in the professional journals, and justify our decision, our act” (67). 

 

    Indeed, I do not believe Butler raises aloft any of these sources of hers as absolute authorities on this morally-fraught topic, or paragons of virtuous objectivity either. She uses them, rather, to demonstrate the breadth of variation in human reasoning and the ways in which ego can infiltrate scientific examination. By exposing the blind spots of many of the scholars she mentions in her chapter, who each had a voice to add to the cacophony surrounding David’s existence, Butler drives home her ultimate point: that in David’s case, as in all gender identity cases, there is a story apart from—“supervenient to”—the normative “discourses on sexed and gendered intelligibility that constrain” (Butler 73) and instruct our understanding of gender. That is to say: David was able to exist as a human being even though his prosthetic genitalia, through which he could not urinate, ultimately entered him into neither male nor female gender categories (Butler 60). Instead, he existed outside of such bounds and definitions, and by doing so showed that those bounds—the “norm”—must not include all possibilities, but must be limited (Butler 74). 

 

    David Reimer committed suicide at age thirty-eight (Butler 74). An article by John Colapinto reported it may have been a result of marital and financial difficulties, not to mention the “cyclical depressions” (Colapinto slate.com) David had suffered since childhood. Whatever the case, I believe David left behind an indelible memory, and a message, that will be heeded by doctors and scholars more than the girl Brenda ever was. For David’s life and death were occasions of awakening to the issues of infant genital surgery and imposed gender identity for hundreds of Americans; and now for me, too.

 

    This chapter of Butler’s, and the research I’ve done on her research, has opened my eyes to the entire world that exists in between genders—a world of which I was previously ignorant. Delving into Anne Fausto-Sterling’s book as one of Butler’s sources educated me for the first time not only in what intersexuality is, but also in how gender can be considered a sliding scale rather than a duality, and how vital it is that we promote and protect this insight. My foray into John Colapinto’s book, on the other hand, showed me how vital it is that research—scientific reporting especially—be honest and uncoercive. Inaccurate evidence leads to inaccurate thought, which leads to inaccurate action, and just like that a whole life, or a whole movement, can be founded on a fib. 

 

    The three texts of Butler, Fausto-Sterling, and Colapinto, when surveyed together, ultimately compose one resounding testament to the importance of honoring the rights of the individual, of respecting their privacy and observing their will. For although David’s case can be taken as grim evidence of how individual freedom may be quashed, I believe somehow it simultaneously proves the inverse: it shows us just how much freedom we actually each have to mold, modify, and metamorphose our identities in whatever image we desire—and now with modern technology, our bodies too. Those very situations that for David were the source of such suffering, for others hold out the promise of each our own version of human limitlessness. Maybe Natalie Angier was right after all: for despite the sorrow knitted into David’s tale, despite the fallacies and the partialities, this is essentially an allegory of hope.

Pen on paper, 2016

 

Works Cited:

Butler, Judith. Undoing Gender. Routledge, 2004.

Colapinto, John. As Nature Made Him. Harper Collins, 2000.

— — —. “Gender Gap: What Were the Real Reasons David Reimer Committed Suicide?” Slate,     www.slate.com/articles/health_and_science/medical_examiner/2004/06/                gender_gap.html. Accessed 9 Oct. 2016 

Fausto-Sterling, Anne. Sexing the Body: Gender Politics and the Construction of Sexuality.         Basic Books, 2000, pp. 45-88.