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.
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.
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.
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?