Category Archives: gender

Alice Dreger’s Blog: George Rekers, The Closet of Medicine, and David Reimer

Introduction

Alice Dreger is a professor of Clinical Medical Humanities and Bioethics at the Feinberg Medical School at Northwestern University. Her background and interests are in history, philosophy, and medical ethics. For a more extended biography, you can see the excerpt she has on Psychology Today (http://www.psychologytoday.com/node/43918) or on her page at Northwestern (http://bioethics.northwestern.edu/faculty/dreger.html).

What brings me to writing this article is some of Dreger’s recent articles about use of antibiotics for pregnant women to prevent CAH (congenital adrenal hyperplasia) and also, that I used many of Dreger’s books and articles for my thesis on intersexuality. Currently, Dreger blogs for Psychology today and is writing a book due to the Guggenheim grant that she received.

The article that I will talk about in this blog post is one about having “closets” in medicine. The person who Dreger talks about in her article “Cleaning the Closets of Medicine” published on July 21, 2010 in her blog entitled Fetishes I Don’t Get: Thoughts on Love, Life, and Lust mostly, is the psychologist George Rekers.

George Rekers and The Closet of Medicine

If you have not heard about George Rekers, here is an excerpt from the article:

“You may remember Rekers as the anti-gay-rights psychologist who hired a pretty young fellow via rentboy.com (a gay escort site) to lift his luggage and provide him massages during a ten-day vacation in Europe. Presumably the rub-downs did not coincide with the tender counsel Rekers claims he provided to the comely young gay “sinner” (Dreger 2010:1)

Reker was also one of the psychologists who worked on reparative therapies for homosexuality. When uncovering his many works done to say that homosexuality was basically a thing of the devil and turns out, he was a self-hating gay man, Dreger asks the question: Should we disregard all of his work? Should we count any of his work as reputable after what was revealed about his personal life and desires?

I feel like this question can be asked of anyone. For example, the last person I wrote about, John Money. After uncovering one of his most unethical cases on a nonintersexed boy (of a set of twins), David Reimer, Money’s reputation sunk, but yet, many of his theories about gender development are still part of a dominant paradigm.

David Reimer: The John/Joan Case

To backtrack, the David Reimer case started out with John Money trying to disprove one of his biggest critics, Milton Diamond, a biology professor. The case is most commonly referred to in medical literature as the John /Joan case and was made accessible to a larger audience through the book As Nature Made Him: The Boy Who was Raised As a Girl by John Colapinto.

The claim that Diamond made against John Money was that his scientific work was fundamentally flawed. The first point he made was that children are not fully psychosexually neutral at birth and gender malleable in terms of gender identity development because, as Money argued, enivornment is not the key contributor, but as Diamond argued, brain composition also played a part. Basically, what they were arguing about was the famed nature vs. nurture for gender argument.

The next few excerpts are from my thesis, which includes some points which I am beginning to rethink: mainly the sentence stating that none of Money’s previous empirical work should be disregarded. The one point that I think should be retained is that this case led to Money’s dominant treatment paradigm for intersex infants to being questioned first by Diamond and then over the next decade by the medical field and loudly by intersexuals themselves.

Thesis Section

Mostly what Diamond targets Money for is his gender identity theory, “… [Diamond] rejected Money’s theoretical conclusions that his findings provided insight into the psychosexual development in non-intersex persons” (Karkazis 2008: 66). In order to prove his theory, Money would need a biological male raised as female or vice versa. Soon, a case would be brought to Money that would change his reputation and would be key to Diamond’s attack of Money.

Diamond in no way denied that possibly Money’s interpretations may be correct, but stated that “their works shed no light on what [Money] called ‘normals’” (Fausto-Sterling 2001: 68). Money repeatedly used intersex and transgender people in order to say something about those who were born biologically male and female.

In order to dispute Diamond’s claim, Money started research on a normal. The Joan/John case, which is how it is known as in the medical world, documents the life of David Reimer who was assigned as a girl as a child after having his penis cut off in a circumcision accident when he was seven months old. Reimer’s parents, not knowing what to do with a boy without genitals, in desperation contacted Money after seeing him on TV. Money told them to reassign David as a girl, which is how he remained until senior year of highschool when he transitioned back to boy and obtained sex-reconstruction surgery.

This failure was revealed to the general population in the UK in the 1980s and in 2001 (by form of media) in the United States.

In 1980 the BBC produced a TV documentary on the John/Joan case….But the BBC reporters had found that by 1976 Joan, then thirteen years old, was not well adjusted. She walked like a boy, felt boys had better lives, wanted to be a mechanic, and peed standing up….In an attempt to bring the facts to light in North America, Diamond, in 1982, published a secondhand account of the documentary in the hopes of discrediting Money’s sex/gender theory once and for all (Fausto-Sterling 2001: 69-70)

In publishing this article Diamond argued that there be a transition to a new treatment paradigm. Diamond’s interest in this was to postpone surgeries for intersex infants.

Although the story of Joan/John is incredibly unfortunate and horrible, what has to be remembered is that it in no way disregards Money’s previous empirical work. “It does not follow, however, that the case invalidates Money’s other empirical research in intersex cases (or that of other researchers supporting his theory), nor does it follow that this case provides unequivocal support for Diamond’s theory” (Karkazis 2008: 75). In this case, what is more important to focus on is how Diamond’s theory about biology influencing gender identity began to reign again. Also consequently, intersex medical management began to change.

Diamond repeatedly hounded Money for citing this case, which Money used as false proof to show that environment heavily weighs on gender socialization: “Throughout the 60s and 70s [Diamond] published at least five more papers contesting Money’s views. In a 1982 publication, he recounted how psychology and women’s studies texts had taken up John/Joan ‘to support the contention that sex roles and sexual identity are basically learned’” (Fausto-Sterling 2001: 69). Unfortunately for Money, his failed case was publicly announced and also targeted for its ethical violations.

After publishing Reimer’s case, Sigmundson and Diamond suggested a set of revised guidelines to medically treat the intersexed. The guidelines are as follows: 1) intersex conditions are not shameful; 2) doctors need to involve the patient in the decision making process; 3) surgeons need to consider more than just the size of the phallus in gender assignment; 4) there should be disclosure that the surgery could take away sexual function and pleasure (Karkazis 2008: 83). “These suggestions proved controversial and engendered debates in part because they went against forty years of medical knowledge and practice. They were also based on little empirical evidence” (Karkazis 2008: 84). As years passed, doctors started to cite Diamond and Sigmundson, lending credit to what they said. The change in intersex surgery protocol and the opening of space for the intersex to be heard came about because of the

Changing cultural understandings of sex, gender, and sexuality (and their relationships), concomitant movements for the acceptance of non-normative sexualities, gendered ways of being, and bodies, the decreased authority of the medical profession, and the rise of principles of medical ethics were changing the context in which intersexuality was understood and treated (Karkazis 2008: 64)

By the 1990s the protocol started to be challenged and by 2000, it was almost dismantled. This started to come about because of the rise of the intersex voice.

Work Cited

Fausto-Sterling, Anne. Sexing the Body: Gender Politics and the Construction of Sexuality. New York : Basic Books, 2001.

Karkazis, Katrina. Fixing Sex: Intersex, Medical Authority, and Lived Experience . Durham: Duke University Press, 2008.

Conclusion

Why I point out first, the article by Dreger, was to show how medicine is not fallible. It was also to introduce the famed Alice Dreger, who I will no doubt talk about later.

Second, why I point this specific section is not only to point to medicine, intersexuality, and changing in relying on scientific articles, but researching what gender theories are based on. One of the most discussed theories in the first gender studies classes I took was the claim: gender is influenced by environment. When that claim was said, I was immediately skeptical as I came from a chemistry background. This claim, the environment hypothesis, was made bigger by the debate between Milton Diamond and John Money.

So I guess, to finish. What do you think? Should data still be relied upon when a researcher is found to hypocritical or unethical? And also, how is gender influenced?

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John Money

Introduction

I have recently been thinking about doctors, sexuality, and the field of psychology. One doctor, or rather, psychologist, who I know the most about who has been involved with sexuality is the famed John Money. John Money is the first doctor (PhD) to have created a medical protocol that was adopted across the world to treat intersex infants, starting in the 1950s. Below, I give a background of his work on intersexuality, which is an excerpt from my undergraduate thesis. The works that I cite are Katrina Karkazis’ book Fixing Sex: Intersex, Medical Authority, and Lived Experience published in 2008 (if you haven’t read it, its a great addition to the field), Alice Dreger Intersex in the Age of Ethics, and Anne Fausto-Sterling’s Sexing the Body: Gender Politics and the Construction of Sexuality published in 2001.

John Money is an important figure because, not only did he develop a protocol to medically manage intersex infants, but many psychological theories about gender identity development are based on his medical publications. Money is one of the most influential people in both the medical world and as a dominant paradigm in the United States. Money’s theories about the way one is properly supposed to develop has seeped both into the influences of people who write about child-rearing and into dominant consciousness. He is not simply a man that influences the lives of people who are intersexed, but every single individual.

John Money: The Man and the Doctor

John Money was the first scientist to create a universal treatment paradigm for surgery on intersex infants. John Money immigrated to the United States from New Zealand in 1947 to obtain a PhD in psychology from Harvard. While at Harvard, Money discovered his interest in hermaphroditism when he came upon a case of a child who was raised as a boy despite having a sexual organ akin to a clitoris. As his interest evolved, Money came to publish his doctoral dissertation on hermaphroditism. His dissertation called “Hermaphroditism: An Inquiry into the Nature of a Human Paradox” observed past surgical interventions as faulty because of the focus on gonadal tissue (Karkazis 2008: 48). He challenged this management because of its lack of focus on psychological dispositions of the person and physical developments at puberty, both of which could change. In order to prove his point “… Money did a comparative analysis of 248 published and unpublished case histories (from 1895 to 1951) and patient files, as well as an in-depth assessment of ten living individuals classed as hermaphrodites” (Karkazis 2008: 49) . Although Money found this to be true, his development of a protocol did not reflect his insight.

In his research, Money found few cases of homosexuality and stated most fared well psychologically, which he argued meant having a girlfriend or being married to a person of the opposite sex (Karkazis 2008: 50). Although Money was concerned for the most part with making gonadal tissue correlate with that of assigned gender, he also imposed his ideas of healthy sexuality. Money found it natural that those who were assigned the gender of a girl would be attracted to men and vice versa. If this attraction failed, the gender assignment and thus gender identity was contradictory. This also meant that Money judged a person’s sexuality based on the “sex of rearing” and when a person was homosexual, the psychological technique of rearing had failed. Money found that those who had the most gender identity contradictions fared the worst, which led him to later conclude that those who raise the child need to be convinced of the infant’s gender/sexual identity. Money in his analysis did not question external value structures, but focused on pervading systems and the individual.

Where before hormones played a large part in determining the sex of the child, Money claimed environment played a large part.  “These findings supported his emergent theory, expressed more fully in 1955, that the sex of rearing was a primary determinant of an individual’s gender role and psychosexual orientation” (Karkazis 2008: 50). Also, more interesting is that his study was based not on how it would change medical treatment but what implications hermaphroditic management would have for contemporary psychological theories concerning sexual behavior/desire and psychosexual roles.

After his dissertation, John Money came to Johns Hopkins in 1951 when he was offered a position as a professor. While there, he joined Lawson Wilkins, the only other medical practitioner who treated intersexuals. Lawson Wilkins started a pediatric endocrine clinic in 1935 called the Harriet Lane Home in Baltimore and organized a team of researchers to treat hermaphroditic conditions.  “Wilkins, seeing the merit of an interdisciplinary approach to intersexuality, assembled the first cross-specialty team to deal with infants with intersex conditions (Redick 2004)” (Karkazis 2008: 51). This team included Howard Jones, William Scott, Joan and John Hampson, and later in 1951, John Money. When John Money joined the team in 1951 he was the first pediatric psychoendocrinologist and “founded the Psychohormonal Research Unit to study ‘all the different types of hermaphroditism in order to discover all the principles of psychosexual differentiation and development that they would illuminate’ (Money 1986:10)” (Karkazis 2008: 51). Until the 1960s Wilkins was the director of the program and made treatment decisions that were carried out by Scott and James. Money and the Hampsons provided their psychological expertise and conducted outcome studies (Karkazis 2008: 51). Through this opportunity Money and the Hampsons started to develop their own theories and protocols for the medical management of intersexuality.

“Money and the Hampsons first introduced principles and protocols for the medical management of intersexuality in a series of articles published in the 1950s (Hampson 1955; Hampson, Hampson, and Money 1955; Money, Hampson, Hampson 1955a, 1955b, 1956, 1957, Money 1956)” (Karkazis 2008: 52). In these articles, Money used gender role/identity as a governing principle in influencing the way in which he recommended surgery be done. “Based on a study of sixty-five ‘ambiguously sexed people,’ the authors declared it inappropriate, even unwise, to rely solely on gonadal, hormonal, or chromosomal criteria for gender assignment” (Karkazis 2008: 52). Money and the Hampsons did further studies among 105 intersex individuals in which most of them (all except 5) had gender identities congruous with their gender assignment and rearing (Karkazis 2008: 53). From these studies, the researchers made a revolutionary proposition: “…they considered gender-role development a multistage process that relied on multiple attributes of biological sex and social variables but that could not be said to derive from these exclusively” (Karkazis 2008: 53). Through this reasoning, parents could rear a child towards a specific gender. Money and the Hampson’s proposal was to fill a gap, the gap that Money found in his dissertation.

Money’s budding theory of gender development, which suggested that sex of rearing was critically important for gender acquisition and development, filled this gap and, when coupled with surgical and hormonal treatment, could ensure that the child avoided physical developments incongruous with the assigned gender (Karkazis 2008: 54).

Critiqued by some for being culturally and environmentally deterministic, Money’s approach was applauded and applied by others. “Contrary to recent characterizations of Money’s theory as exclusively social, he actually suggested a complex system of psychological and physiological interaction and development” (Karkazis 2008: 54).

Given their belief in some flexibility and malleability in gender development and formation, Money and his colleagues proposed moving away from identifying an indvidual’s supposedly true sex and toward a new model of gender assignment that would take into account multiple biological variables of sex and its future development at puberty to select the optimal gender for the individual (Karkazis 2008: 55).

Now instead of sex, intersexuality became predominantly about gender, psychological health, and belonging.

This publication led to Money and the Hampsons establishing a treatment protocol for treating the intersexed. Instead of treating adults, they decided to manage infants in order to shape gender identity because according to Money gender identity developed around eighteen months of age. Therefore, the first suggestion they had addressed was when to assign gender to the infant. “They suggested a small window of flexibility and opportunity- until roughly eighteen months of age- during which gender assignment could be most successfully accomplished” (Karkazis 2008: 55) . In relation to this, they said that sex assignment should be made within the first few weeks of life. These recommendations were based on a “belief that successful gender assignment required complete certainty on the part of the child’s parents as to whether the child was male or female” (Karkazis 2008: 55). After age two, changing gender could cause psychological disturbance so assigning gender as early as possible was increasingly important. Also,  “According to Money’s theory, once sex assignment was made, surgery should be done as soon as possible so that the genitals could be made to match the assigned sex (Money, Hampson, and Hampson 1955b: 291; Money 1974: 216)” (Karkazis 2008: 57). In determining the need to do this they would weigh the functioning of the gonads and if treating an older child or adults, they would make sure genitals conform to gender of rearing (Karkazis 2008: 56). Money firmly believed in surgery because in making a person aesthetically look like a female or male, they became part of what was assumed to be the natural gender binary.  “Money and his colleagues believed that current techniques enabled surgeons to ‘make’ females, but not males; even though the surgical removal of the penis (or clitoris) left no clitoral equivalent, they argued that erotic feeling and sexual climax were still possible (see e.g. Money, Hampson, and Hampson 1955b: 288, 295)” (Karkazis 2008: 57). In providing reason for favoring surgery, Money said it would help with gender identification and rearing. “The reason for this was twofold: first, Money felt that the child was more likely to develop a proper gender role with genitals matching those of the assigned sex; second, parents troubled by gender ambiguity might waver in their commitment to raising the child in the assigned gender” (Karkazis 2008: 57-58). Of utmost importance to Money, was to highlight psychological health, one which was based on fitting social norms.

According to Money’s theory, all children are born essentially psychosexually neutral at birth, and thus surgeons can make any child any gender as long as the sexual anatomy can be made reasonably believable. For this reason, it did not matter how the genitalia looked originally, according to Money, because you could always teach gender or sex roles.  “…if children are to develop stable gender identities (and by consequence be happy and mentally healthy), they must have “correct” looking genitalia” (Dreger 1999: 11). Intersex surgery was more cosmetic because of the desired result to have a normal-appearing body. This normal appearing body would insure proper psychosexual development to what Money considered the proper gender and, in turn, assume the appropriate (hetero)sexuality. In choosing a gender, the child could be integrated into society if everything is done “to assure that the child and h/her parents believed in the sex assignment” (Fausto-Sterling 2001: 46).

Money also advocated being frank and truthful with the parents to minimize psychological disturbance. Yet in practice, Money said that parents should be told immediately if the child was a girl or boy because of the stigmatization of the intersex being labeled as “half-boy”, “half-girl”. He insisted that the parents be told genitals would be finished through surgery (Karkazis 2008: 59). Thus, the parents were not always told the full truth about the child’s condition and surgery was usually performed if discovered at birth.

Surgeries were performed if their were noticeable differences according to definitions of typical genitalia. Surgeries were done if boys were born with a phallus that was less than 2.5 centimeters; doctors would reduce it and proclaim the baby a girl. If a girl was born without a Y chromosome and had a clitoris longer than 1 cm the doctors would seek to reduce it because they  thought that “it will bother the child’s parents and interfere with bonding and gender identity formation” (Dreger 1999: 12). Hormone treatments were used later if needed, under the conditions that the individual had different ratios of testosterone or estrogen then was determined as normal by the medical field. Out of a commitment to do no harm doctors did not usually tell the parents or the children all that they knew because it will “confuse or complicate the family’s understanding of gender. All of the professional energy is aimed at producing a physically ‘right’ girl or boy who, presumably, the parents will then be able to raise in an unambiguous way” (Dreger 1999: 12). Surgery was intended to produce a heterosexual happy person who could have relationships with their family, without ever knowing they were born intersexed until later.

Before puberty, Money advocated giving the child information about their condition (Karkazis 2008: 59).  “Somewhat confusingly, then, Money and his colleagues advocated both honesty and concealment- a fact that may have led many clinicians to assume that given the option, concealment might prevent more harm and engender less confusion” (Karkazis 2008: 60). His form of concealment led parents to hide countless surgeries from children. Although his protocol was not full-proof, Money’s methods became the dominant model for over forty years.

Money is revolutionary because his methodology for treating the intersex took hold and persisted for an extended period of time. Money was the first person to suggest a multistage model to treat intersex infants and the first to provide a complicated view of intersexuality that recognized phenotypes of diagnoses and prepared for later physical developments (Karkazis 2008: 60). Also, his work and implementation of the protocol was met with widespread approval and integration.   “Following publication, the treatment protocols were quickly incorporated into medical practice and texts, and they achieved a remarkable dominance for the following forty years” (Karkazis 2008: 60).

Conclusion

This section epitomizes most of my thesis, especially the last sentence. My intention in my thesis or my argument, which is the last thirty pages or so, analyzes the current change in medical protocol. What I found most interesting in my readings is that medicine does not usually follow umbrella protocols, but addresses individual cases, unlike say, political public policy. I found this interesting and a rare occurrence in medicine which allowed for unethical decisions to be made such as concealment which as referred to by Money, was a vague concept.

I recognize in Money that what he did was revolutionary. In the end I still ask myself, as an aspiring medical practitioner, what I would do? If I was a parent, what I would do? As an intersex adolescent, what might I do? How would I feel? I have no idea. What is the right thing to do? And I still puzzle over that and always will.

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Autostraddle

The other day I discovered a blog about “girl-on-girl culture” which made me laugh and also incredibly excited. This blog is definitely one of the most comprehensive lesbian blogs that covers pop culture, politics, contemporary news, and also has video.

Definitely check it out if you haven’t heard of it before: http://www.autostraddle.com/

The writers also include round-tables where they took about up-to-date feminist topics and also about self-identity (current round table is on intersectionality)

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Encyclopedia of Androgyny

Introduction

I found this while searching around either on wikipedia or somewhere else and found it fascinating. It has a bunch of pictures and stories about people who are famous, through history, mythical people, and gods, who are androgynous. Its very interesting and here I will include a basic background about it.

The Encyclopedia of Androgyny

This is on the introduction page:

“The idea of androgyny has hounded humanity from its very beginning, whether you consider “the beginning” as a creationist, an evolutionist or through some other hybrid of standard mythology and spirituality. While the “creator” of the world, either God, Zeus or some other figure has been consistently portrayed as male, the immediate progeny of these creators have experienced some of the closest encounters with androgyny of all figures throughout history. God’s Adam, an archetypal man, was originally something more than, or daresay, other than a man. He was originally both man and woman, a creature from whom woman, Eve, was created. Adam became the first man only after Eve was taken from his rib. As a man, he was the remainder of a more complete organic and sexual being whose sexuality was not distinctly male or female” (http://www.androgynylist.com/intro/intro.htm).

Conclusion

This is a very interesting site to explore due to the variety that you encounter of the site. It has many categories, including the third sex fetish and andryogyny in body and soul. I highly reccomend visiting it and checking it out.

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This woman is my new hero: Claire Winter!

Introduction

After having Claire Winter speak in my Introduction to Gender Studies class I started to become interested in Trans issues and how they affected me and many others. I had read a book The Testosterone Files: My Hormonal and Social Transformation from Female to Male by Max Valerio, which I wasn’t too interested in. That winter I had also read Middlesex by Jeffrey Eugenides, which was about someone who was intersex. Both of these books along with Claire Winter made me wonder about why I should care about trans issues.

Trans issues are important because they address gender ambiguity even though at times trans people are pushed into a perception of a gender binary in order to gain access to hormones or GRS (genital reassignment surgery). Also, trans existence dismantles the idea that gender is purely a physical phenomena. There is both a brain gender and a body gender.

Since I am probably not the best person to come to to explain trans issues or educate the general public, I will give this amazing resource, TransPortal, Claire’s website, for you to explore and learn more.

TransPortal

This site is purely educational and is not the single site to come to for resources. There are many others, which she provides on her website

.Mission Statement

Transgender Portal exists to provide a starting point and ongoing guide that will assist anyone in the process of educating themselves about the psychology, issues, and various organizations of the transgender community. The main focus of this site is on those persons who know little or nothing about the transgender perspective and want to find out more as clearly and efficiently as possible.

I     It is the specific goal of Transgender Portal to:

p     1) Provide a cross-section of introductory educational materials on-site, and

2     2)to serve as a single inclusive “hub” of links to educational and organizational transgender resources, making all of these more accessible to   anyone who is searching on the internet. ”

<http://transgenderportal.com/TransgenderPortal/About.html&gt;

What it Provides

  • Transgender sites
  • LGBTQ sites
  • videos on trans topics and about trans people’s lives
  • religion that is inclusive of LGBTQ and trans people
  • education materials such as a glossary, why people can be trans, a manuscript for her new book, etc

Conclusion

I’m hoping that this will provide people with information that is useful : )

http://transgenderportal.com/TransgenderPortal/Home.html

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