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?

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.

Caster Semenya

Introduction

Caster Semenya is an 18-year old runner from South Africa who was about to compete in a 4000 meter run after she had run a previous race and won the gold medal. There had been reports that she was suspected of not being a woman because of her musculature and her deep voice (and I highly suspect people were sort of jealous) . This speculation led her to get an examination by the IAAF (International Association of Athletic Federations). A doctor from Otago tested and examined her and found her to have an intersex condition, meaning that she possesses both female and male gonadal tissue (she did not have ovaries or a womb, but possessed inner testes).

There is a lot of controversy going around her right now because she may not be able to keep her medal due to the tests showing she had three times the amount of testosterone a normal female would have.

Since sports is so divided because of supposed biological advantages and body compositions of men and women, Semenya may be banned from participated anymore in the competition.

Since ideas of gender are so built into self-identity and also are very emotionally bound (for example if someone accused you of not being man enough or much of a woman, you would probably be taken a back or maybe offended), this is a very sensitive issue. Many people in forums, on blogs, and on the news are now not considering her a woman. She has been raised all her life as a woman and ran as a woman and probably identifies as a woman. Her family did not report knowing of her intersexuality, nor does it seem to matter much . Since this supposed “discovery” of who Semenya really is, apparently she is not a woman anymore.

In a wordpress article (http://identityrevealed.wordpress.com/2009/09/10/man-or-woman-revisited/) I found out that You magazine did a make-over of Caster. All I can say to that is, interesting.

Intersexuality

In this section I want to highlight some things I find highly problematic and troubling with some of the reports on Semenya.

First, In the news people are referring to Caster as a ‘hermaphrodite’. Hermaphrodite is a controversial term and considered offensive because of its connotations with the authoritative power medicine has had over the bodies of people who have been born with both female and male gonadal tissue (ovaries and testes). The correct term, that is still used in science, would be psuedohermaphrodite because she does not have ovaries.  Hermaphrodite is an old term and is used in old scientific journals. DSD (disorder of sexual development) has been determined by the ISNA (Intersex Society of North America) and Alice Dreger to be the term that is to be used in scientific texts from this point on. This term is also considered offensive by some because of the use of “disorder” and the term VSD is more commonly used or “Variation of Sexual Development”. This population has been too often referred to as freaks, monsters,  not human, not woman, not man, in between, etc. Refer to them as they prefer. If they have been raised a woman, call them a woman. If they have been raised a man, call them a man. Its about respect, call them what they wish to be called.

Two, do not make it about gender identity. Just because Semenya has been found to have typically male gonadal tissue does not make her less of a woman. Gender is complicated. It is not just about biology or raising a person or self-identity. It is about all of the above and more and it is a personal thing and should not be contested publicly.

Third, I think most of this is a Western thing to be concerned with, gender. We are all about categories and who fits where and how so that they can have a certain role. Races and sports are all about categories and natural selection at its own form of visible entertainment. Displaying physical agility and ability started out as a Grecian thing, a male thing. Sports usually have been a Western male white thing. Since Semenya performed so well especially at something that has been so predominantly and historically white and Western, she is bound to come under scrutiny and one of the first things to be on the list is that since she performed so well, she must be a man!

Finally, LANGUAGE. For the last time, language. It is not a shame, a horrible thing, or “at worst” that she may be intersex.

Conclusion

Caster Semenya’s controversy in sport may lead to categorization about what makes a man or a woman, which IS problematic. In the past there have been distinctions about how much of a hormone, how long your clitoris or how small your penis is, how long your labia is, or how deep your vagina is, either makes you or leaves you short of being a “man” or a “woman”. Categories in popular culture are oppressive to individuals. The Western world is obsessed with people fitting and being able to fit into designated categories and sports has made this issue clearer. Be aware of what these categories mean to the individual before making policy or law about it because that is dangerous.

Intersex Research

Hi all,

As I have noticed over the past few months, one of my most frequently visited pages is the one on Intersex Resources. To those who find the information interesting or identify as being intersex, I have news. I am going abroad next semester to study in Amsterdam, Netherlands and am doing research on the treatment of intersex individuals in the medical field.

Here is my proposal:

Question I want to answer

Upon reading Sexing the Body by Anne Fausto-Sterling I became interested in how society and political beliefs, among many other factors, influence the experimental findings and ideologies of science. One of the main groups of people Fausto-Sterling focuses on, are people who identify as intersexed, to prove a point about how sex identification is a prominent part of human culture. I have been prompted, by Fausto-Sterling, to investigate the treatment of intersexed people further and to propose ideas in which to categorize less and to self-identify more. In conclusion, I want to answer the question of how people who identify as intersexed, both as individuals and as a collective, are medically considered and socially regarded by endocrinologists, neonatalists, and medical students in the surrounding area of Amsterdam.

What method do you want to use?

To go about answering this question I want to interview medical students, neonatalists, endocrinologists, and those who identify as interceded. In addition, I would do historical research about the treatment administered to people who had “ambiguous genitalia” in the past few hundred years.

What I am asking for

I was wondering, if any of you who had any research backgrounds, knew of places I could grants? or…if there are any intersexed individuals out there, that they would be willing to share their stories?

Third Gender,Third Sex, and the Two-Spirit

Introduction

The Third Gender/Third Sex and the Two-Spirit are notions I just happened to cross by. I have never heard of them before, but the terms make sense when referring to someone who considers themselves gender different, but not exactly sexually different. I have usually associated gender difference with sexual difference, which is not always the case. I think if we, as a society, understand the differences between sex and gender, that they are not just one and the same, that my prejudice about gender correlating with sex can be erased, understood, and that sexual difference will not automatically be connected to gender inversion or difference, etc.

Below is some information, that is now considered to relate to the transgender community (referred to as “thirdness”), about the Third gender in society, biology, extensive resources, and a personal account into what “thirdness” is.

Third Gender

“The terms third gender and third sex describe individuals who are considered to be neither women nor men, as well as the social category present in those societies who recognize three or more genders.

The state of being neither male nor female may be understood in relation to the individual’s biological sex, gender role, gender identity, or sexual orientation. To different cultures or individuals, a third sex or gender may represent an intermediate state between men and women, a state of being both (such as “the spirit of a man in the body of a woman”), the state of being neither (neuter), the ability to cross or swap genders, or another category altogether independent of male and female. This last definition is favored by those who argue for a strict interpretation of the “third gender” concept.

The term has been used to describe Hijras of India and Pakistan,^[1] Fa’afafine of Polynesia, and Sworn virgins of the Balkans,^[2] among others, and is also used by many of such groups and individuals to describe themselves. In the Western world, lesbian, gay, transgender and intersex people have been described as belonging to a third sex or gender, although some object to this characterization.

The term “third” is usually understood to mean “other”; some anthropologists and sociologists have described fourth,^[3] fifth,^[4] and many^[5] genders.” (http://en.wikipedia.org/wiki/Third_gender)

Third Sex in Biology

“In animals that exhibit sexual dimorphism, a number of individuals within a population will not differentiate sexually into bodies that are typically male or female. In non-human animals, this is called hermaphroditism, and in humans, it is called intersexuality. The incidence varies from population to population, and also varies depending on how femaleness and maleness are understood. Biologist and gender theorist Anne Fausto-Sterling proposed in a 1993 article that five sexes may be more adequate than just two, for describing human bodies.^[6]

The white-striped form of the white-throated sparrow, which has two distinct female and two male morphs.

In addition to male and female sexes (defined as the production of small or large gametes), evolutionary biologist Joan Roughgarden argues that more than two genders exist in hundreds of animal species.^[7] Species with one female and two male genders include red deer who have two male morphs, one with antlers and one without, known as hummels or notts, as well as several species of fish such as plainfin midshipman fish and coho salmon.^[8] Species with one female and three male genders include bluegill sunfish, where four distinct size and color classes exhibit different social and reproductive behaviours, as well as the spotted European wrasse (Symphodus ocellatus), a cichlid (Oreochromis mossambicus) and a kind of tree lizard, Urosaurus ornatus.^[9] Species with two male and two female genders include the white-throated sparrow, in which male and female morphs are either white-striped or tan-striped. White-striped individuals are more aggressive and defend territory, while tan-striped individuals provide more parental care. Ninety percent of breeding pairs are between a tan striped and a white striped sparrow.^[10] Finally, the highest number of distinct male and female morphs or “genders” within a species is found in the side-blotched lizard, which has five altogether: orange-throated males, who are “ultra-dominant, high testosterone” controllers of multiple females; blue-throated males, who are less aggressive and guard only one female; yellow-throated males, who don’t defend territories at all but cluster around the territories of orange males; orange-throated females, who lay many small eggs and are very territorial; and yellow-throated females, who lay fewer larger eggs and are more tolerant of each other.^{[11]” (http://en.wikipedia.org/wiki/Third_gender)}

Third Sex in Contemporary Societies

“Since at least the 1970s, anthropologists have described gender categories in some cultures which they could not adequately explain using a two-gender framework.^[5] At the same time, feminists began to draw a distinction between (biological) sex and (social/psychological) gender. Contemporary gender theorists usually argue that a two-gender system is neither innate nor universal. A sex/gender system which only recognizes the following two social norms has been labeled “heteronormativity“:

• female genitalia = female identity = feminine behavior = desire male partner
• male genitalia = male identity = masculine behavior = desire female partner” (http://en.wikipedia.org/wiki/Third_gender)

This section, as introduced above, covers Thailand, India, the Western World, Indigenous cutlures, and many others.

In the Western World

“Some writers suggest that a third gender emerged around 1700 AD in England: the male sodomite.^[22] According to these writers, this was marked by the emergence of a subculture of effeminate males and their meeting places (molly houses), as well as a marked increase in hostility towards effeminate and/or homosexual males. People described themselves as members of a third sex in Europe from at least the 1860s with the writings of Karl Heinrich Ulrichs^[23] and continuing in the late nineteenth century with Magnus Hirschfeld,^[24] John Addington Symonds,^[25] Edward Carpenter,^[26] Aimée Duc^[27] and others. These writers described themselves and those like them as being of an “inverted” or “intermediate” sex and experiencing homosexual desire, and their writing argued for social acceptance of such sexual intermediates.^[28] Many cited precedents from classical Greek and Sanskrit literature (see below).

In Wilhelmine Germany, the terms drittes Geschlecht (“third sex”) and Mannweib (“man-woman”) were also used to describe feminists — both by their opponents^[29] and sometimes by feminists themselves. In the 1899 novel Das dritte Geschlecht (The Third Sex) by Ernst Ludwig von Wolzogen, feminists are portrayed as “neuters” with external female characteristics accompanied by a crippled male psyche.

Throughout much of the twentieth century, the term “third sex” was a popular descriptor for homosexuals and gender nonconformists, but after Gay Liberation of the 1970s and a growing separation of the concepts of sexual orientation and gender identity, the term fell out of favor among LGBT communities and the wider public. With the renewed exploration of gender that feminism, the modern transgender movement and queer theory has fostered, some in the contemporary West have begun to describe themselves as a third sex again.^[30] One well known social movement of male-bodied people that identify as neither men nor women are the Radical Faeries. Other modern identities that cover similar ground include pangender, bigender, genderqueer, androgyne, intergender,”other gender” and “differently gendered”.

The term transgender, which often refers to those who change their gender, is increasingly being used to signify a gendered subjectivity that is neither male nor female — one recent example is on a form for the Harvard Business School, which has three gender options — male, female, and transgender.^[31]”

(http://en.wikipedia.org/wiki/Third_gender)

Third Sex in History

This covers a range of countries from Mesopotamia, Egypt, Indic culture, and Mediterranean among others .

If you are interested in this subject you can go to this link: http://en.wikipedia.org/wiki/Third_gender

Two-Spirit

”

Two-Spirit (also two spirit or twospirit) people are American Indians who fulfill one of many mixed gender roles found traditionally among many American Indian and Canadian First Nations indigenous groups. Traditionally the roles included wearing the clothing and performing the work of both male and female genders. The term usually implies a masculine spirit and a feminine spirit living in the same body and was coined by contemporary gay, lesbian, bisexual, and transgender Native Americans to describe themselves and the traditional roles they are reclaiming. There are many indigenous terms for these individuals in the various Native American languages as “what scholars generically refer to as ‘Native American gender diversity’ was a fundamental institution among most tribal peoples”^[1].

As of 1991, male and female bodied Two-Spirit people have been “documented in over 130 North American tribes, in every region of the continent, among every type of native culture”^[2].”

(http://en.wikipedia.org/wiki/Two-Spirit)

To see the historical and modern examples of a Two-Spirit, go to the link above.

Terminology (Two-Spirit)

”

The older term “berdache” is a generic term used primarily by anthropologists, and is frequently rejected as inappropriate and offensive by Native Americans. This may be largely due to its pejorative etymology as it is a loan from French bardache via Spanish bardaxa or bardaje/bardaja via Italian bardasso or berdasia via Arabic bardaj meaning “kept boy; male prostitute, catamite” from Persian bardaj < Middle Persian vartak < Old Iranian *varta-, cognate to Avestan varəta- “seized, prisoner,” formed from an Indo-European root *welə- meaning “to strike, wound” (which is the same in English as vulnerable). It has widely been replaced with two-spirit.^[3][4][5]

“Two-spirit” originated in Winnipeg, Canada in 1990 during the third annual intertribal Native American/First Nations gay and lesbian conference. It is a calque of the Ojibwa phrase niizh manidoowag (two spirits). It was chosen to distance Native/First Nations people from non-natives as well as from the words “berdache” and “gay.”^[6]“

(http://en.wikipedia.org/wiki/Two-Spirit)

Other Examples of Third Sex/Two-Spirit

“The following gender categories have also been described as a third gender:

North America

• Two-spirits, a category found in some Native American tribes and applicable to men and women

Middle East:

• Oman: Xanith or khanith.^[35]

Asia-Pacific:

• Polynesia: Fa’afafine (Samoa),^[36] fakaleiti (Tonga), mahu wahine (Hawaii), mahu vahine (Tahiti), whakawahine (Māori) and akava’ine (Cook Islands).^[37]

• Indonesia: Waria.^[38] Additionally, the Bugis culture of Sulawesi has been described as having three sexes (male, female and intersex) as well as five genders with distinct social roles.^[4]
• In the Philippines, a number of local sex/gender identities are commonly referred to as a third sex in popular discourse, as well as by some academic studies. Local terms for these identities (which are considered derogatory by some) include bakla (Tagalog), bayot (Cebuano), agi (Ilonggo), bantut (Tausug), binabae, bading — all of which refer to effeminate ‘gay’ men/transwomen. Gender variant females may be called lakin-on or tomboy.^[39]

Europe:

• The Balkans: Sworn virgins,^[2] females who work and dress as men and inhabit some men-only spaces, but do not marry.
• 18th century England: Mollies^[22]

Africa:

• Southern Ethiopia: Ashtime of Maale culture^[40]
• Kenya: Mashoga of Swahili-speaking areas of the Kenyan coast, particularly Mombasa
• Democratic Republic of the Congo: Mangaiko among the Mbo people.^[41]

Latin America and the Caribbean:

• Travestis of Latin America have been described as a third gender, although not all see themselves this way. Don Kulick described the gendered world of travestis in urban Brazil as having has two categories: “men” and “not men”, with women, homosexuals and travestis belonging to the latter category.^[42]
• Dominican republic: Guevedoche, intersex girls who become boys at puberty, due to “5-alpha-reductase deficiency disorder”.^[43] The same phenomenon is known as kwolu-aatmwol in the “Sambia” community in the eastern highlands of Papua New Guinea.^[44]”

(http://en.wikipedia.org/wiki/Third_gender)

Outside Links about Two-Spirits

External links

• NativeOUT A Two-Spirit group in Phoenix, Arizona. Website has Native American LGBT/Two-Spirit News & Information.
• Two-Spirit Society of Denver Traditional Two-Spirit group in Denver, Colorado.
• Bay Area American Indian Two-Spirits includes links to other two-spirits groups, based in San Francisco, CA
• NorthEast Two-Spirit Society Based in New York City
• Nations of the 4 Directions San Diego TS organisation
• Directions in Gender Research in American Indian Societies: Two Spirits and Other Categories by Beatrice Medicine
• Berdache on glbtq.com
• Indigenous Literature with a Queer/LGBT/Two-Spirit Sensibility
• International Two Spirit Gathering
• [1] Two Spirit Author, J. Spencer Rowe MA
• Northwest Two-Spirit Society
• The Spirit and the Flesh: Sexual Diversity in American Indian Culture by Walter L. Williams
• Two Spirits: A Story of Life With the Navajo by Walter L. Williams & Toby Johnson
• The Two-Spirit Tradition collection of articles at the Androgyne Online site
• The Two-Spirit Tradition article in the Androphile Project site
• In Search of “Berdache”: Multiple Genders and Other Myths

Here is a link to a JSTOR article about the Third Gender, if you have access to JSTOR: http://www.jstor.org/pss/483350

An Extra: A Blog on Thirdness

Though I do not know this person, or their name (though I could easily find out by liking on the website), I feel as if the information on this website is very useful to consider for personal reflection.

Somewhere in one of the articles, there is a very interesting quote:

“I think that Kate Bornstein’s [1995] words are very important, here. She says:

I know I’m not a man — about that much I’m very clear, and I’ve come to the conclusion that I’m probably not a woman either, at least not according to a lot of people’s rules on this sort of thing. The trouble is, we’re living in a world that insists we be one or the other — a world that doesn’t bother to tell us exactly what one or the other is.” (http://www.bcholmes.org/tg/tgthird.html)

http://www.bcholmes.org/tg/tgthird.html

Conclusion

After discovering all of this information and reading a book at the beginning of this summer on being genderqueer, I have a new concept of gender and its relation to biological sex. I think its going to take me awhile to split the two and digest them and I am sure being a Gender Studies major will aid in that. Hopefully this will be of some use to understanding the sentiments and feelings of someone who is of the third sex, third gender, etc, who does not consider themselves one or the other, bu in between.

Being Intersexed: Resources

Introduction

Many people do not know what intersex means because it was commonly referred to in the past as being a hermaphrodite. Being intersexed is very in the closet because of the general belief in American society that gender fits into a binary. Being intersexed proves that gender is complicated, sex is complicated, and identity is complicated (as are many more things that influence being intersexed and anything in general).

I am not intersexed, I am not an expert, but I wish to distribute information. This is what I have found, encountered, believe, etc. I can not be expert advice, but I can be a start.

I highly recommend visited the ISNA website, whose acronym I explain below. It is an excellent resource and has been advocating for intersex rights ever since Cheryl Chase helped create it.

What is Intersex?

““Intersex” is a general term used for a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn’t seem to fit the typical definitions of female or male. For example, a person might be born appearing to be female on the outside, but having mostly male-typical anatomy on the inside. Or a person may be born with genitals that seem to be in-between the usual male and female types—for example, a girl may be born with a noticeably large clitoris, or lacking a vaginal opening, or a boy may be born with a notably small penis, or with a scrotum that is divided so that it has formed more like labia. Or a person may be born with mosaic genetics, so that some of her cells have XX chromosomes and some of them have XY.

Though we speak of intersex as an inborn condition, intersex anatomy doesn’t always show up at birth. Sometimes a person isn’t found to have intersex anatomy until she or he reaches the age of puberty, or finds himself an infertile adult, or dies of old age and is autopsied. Some people live and die with intersex anatomy without anyone (including themselves) ever knowing.” (http://www.isna.org/faq/what_is_intersex)

To find out more about this, go to the ISNA’s website (which I will cover later in this post). They have a bunch of information, links, and recommendations.

What Intersex Condition do you have?

To find out what conditionmay fit to your genitalia, explore this website, but be sure to confirm with a clinician.

Intersex Conditions: http://www.isna.org/faq/conditions

How common is intersex?

“To answer this question in an uncontroversial way, you’d have to first get everyone to agree on what counts as intersex —and also to agree on what should count as strictly male or strictly female. That’s hard to do. How small does a penis have to be before it counts as intersex? Do you count “sex chromosome” anomalies as intersex if there’s no apparent external sexual ambiguity?¹ (Alice Dreger explores this question in greater depth in her book Hermaphrodites and the Medical Invention of Sex.)

Here’s what we do know: If you ask experts at medical centers how often a child is born so noticeably atypical in terms of genitalia that a specialist in sex differentiation is called in, the number comes out to about 1 in 1500 to 1 in 2000 births. But a lot more people than that are born with subtler forms of sex anatomy variations, some of which won’t show up until later in life.

Below we provide a summary of statistics drawn from an article by Brown University researcher Anne Fausto-Sterling.² The basis for that article was an extensive review of the medical literature from 1955 to 1998 aimed at producing numeric estimates for the frequency of sex variations. Note that the frequency of some of these conditions, such as congenital adrenal hyperplasia, differs for different populations. These statistics are approximations.

Not XX and not XY	one in 1,666 births
Klinefelter (XXY)	one in 1,000 births
Androgen insensitivity syndrome	one in 13,000 births
Partial androgen insensitivity syndrome	one in 130,000 births
Classical congenital adrenal hyperplasia	one in 13,000 births
Late onset adrenal hyperplasia	one in 66 individuals
Vaginal agenesis	one in 6,000 births
Ovotestes	one in 83,000 births
Idiopathic (no discernable medical cause)	one in 110,000 births
Iatrogenic (caused by medical treatment, for instance progestin administered to pregnant mother)	no estimate
5 alpha reductase deficiency	no estimate
Mixed gonadal dysgenesis	no estimate
Complete gonadal dysgenesis	one in 150,000 births
Hypospadias (urethral opening in perineum or along penile shaft)	one in 2,000 births
Hypospadias (urethral opening between corona and tip of glans penis)	one in 770 births
Total number of people whose bodies differ from standard male or female	one in 100 births
Total number of people receiving surgery to “normalize” genital appearance	one or two in 1,000 births

¹ Dreger, Alice Domurat. 1998. Ambiguous Sex—or Ambivalent Medicine? Ethical Issues in the Treatment of Intersexuality. Hastings Center Report, 28, 3: 24-35.

² Blackless, Melanie, Anthony Charuvastra, Amanda Derryck, Anne Fausto-Sterling, Karl Lauzanne, and Ellen Lee. 2000. How sexually dimorphic are we? Review and synthesis. American Journal of Human Biology 12:151-166.

We were recently asked to update these frequency figures, and a lively discussion arose between two staff members.” (http://www.isna.org/faq/frequency)

The ISNA: Intersex Society of North America

The ISNA, as found on their website (by their mission statement) stand for:

“systemic change to end shame, secrecy, and unwanted genital surgeries for people born with an anatomy that someone decided is not standard for male or female.

We have learned from listening to individuals and families dealing with intersex that:

• Intersexuality is primarily a problem of stigma and trauma, not gender.
• Parents’ distress must not be treated by surgery on the child.
• Professional mental health care is essential.
• Honest, complete disclosure is good medicine.
• All children should be assigned as boy or girl, without early surgery.

Click here to learn more about our agenda. With your help, we can make the world a safer place for families dealing with intersex conditions.” (http://www.isna.org/)

Doctors for the Intersexed

You can find this at this website: http://www.aissg.org/52_CLINICIANS.HTM

NOTE: This is only a start and from limited sources I found online and thus can be outdated. I would recommend getting in contact with someone from ISNA to talk about this or finding a support network in your area where you can feel safe in asking about a doctor who will provide you with safe service and make you feel comfortable.

What to do once you found out you are intersexed

Support groups:

http://www.isna.org/support

Find a doctor who can confirm hormonal/genetic difference: http://www.aissg.org/52_CLINICIANS.HTM

You may have a lot of questions, just discovered it yourself, and may feel overwhelmed. I do not recommend this website right away, but it is incredibly helpful and from what I have seen, considerate:

http://www.isna.org/faq

Excellent Resource: Sexing the Body by Anne-Fausto Sterling

Sexing the Body: Gender Politics and the Construction of Sexuality. By Anne Fausto-Sterling. New York: Basic Books, 2000, 473 pages.

Spanish Translation: Cuerpos sexuados. Editorial Melusina: Barcelona, Spain, 2006.

“Professor Fausto-Sterling’s most recent work, entitled Sexing the Body: Gender Politics and the Construction of Sexuality, was published by Basic Books in February 2000. It examines the social nature of biological knowledge about animal and human sexuality.

Sexing the Body received the Distinguished Publication Award in 2001 by the Association for Women in Psychology. In 2000 it was chosen as one of the Outstanding Academic Books of 2000 by CHOICE Magazine, Published by the American Library Association. It was also co-winner of the Robert K Merton Award of the American Sociological Association Section on Science, Knowledge and Technology.

From the back cover:

“Why do some people prefer heterosexual love while others fancy the same sex? Do women and men have different brains? Is sexual identity biologically determined or a product of social convention? In this brilliant and provocative book, the acclaimed author of Myths of Gender argues that the answers to these thorny questions lie as much in the realm of politics as they do in the world of science. Without pandering to the press or politics, Fausto-Sterling builds an entirely new framework for sexing the body-one that focuses solely on the individual.” (http://bms.brown.edu/faculty/f/afs/afs_publications_books.htm)

More books:

http://www.isna.org/books

Conclusion

I do not know much about the experience of being intersexed because I am not. I wish to increase the visibility of intersex while keeping people who identify as intersex safe. I hope that the gender binary begins to blur or that everyone can accept others differences. I hope this is a valuable resource and if you wish to hear more about this particular subject, feel free to contact me.