ABSTRACT ON KESSLER'S 'THE MEDICAL CONSTRUCTION OF GENDER'

ABSTRACT ON KESSLER'S 'THE MEDICAL CONSTRUCTION OF GENDER'

• Her article analyses interviews with several physicians involved on the 'treatment' of intersexes to reveal how they intervene on the attribution (annountiation) of a particular heterosexual sex on bases which are rather cultural than the supposedly uncontested biology
  • She reveals how the biological criteria show up so blurred that the 'ideal' references become useless and the decision is usually cultural

• Fewer than 5% of intersexes are 'true intersexes' (have both ovary and testicles)
• The current attitude towards intersexes are primarily influenced by three factors:
  1) The possibility of surgically constructing a sex
  2) As feminists in the USA have called into question the valuation of women according to strictly reproductive functions, the presence or absence of functional gonads is no longer the only or the definitive criteria for gender assignment
  3) Psychological theories of 'gender identity', instead of 'gender role', claim for eraly assignments of sex so that one can develop such identity successfully.
• Management of intersexed cases is baded upon the theory of gender proposed first by John Money, J. G. Hampson, and J. L. Hampson in 1955 and developed in 1972 by Money and Anke A. Erhardt
  • She criticizes the Erhardt's references for being restricted to few cases, and she suggests that the widespread acceptance of their work is because it fits the contemporary ideas about gender, etc...
    • Many of her respondents claimed to use Erhardt's references just for those are the only medical publications on the issue, and in cases the doctors even questioned the effectiveness of the technique.
  • Doctors argue that gender is changeable until approximately eighteen months of age
    • Ideally the parents must be left no doubt of rather their child is male or female for the success of the assimilation, thus none of the respondents was positive about the idea of waiting the eighteen months, prefering to do it as quick as possible
    • Doctors claim that time is crucial to avoid confusing development of the body which could pose doubts on the way parents refer to the sexuality of the children
      • Endocrinologists pointed that this pushes to premeditate diagnosis which miss hormonal evidences which demand time to be produced
      • Doctors usually inform parents about intersexuality as being a malfunctioning of either heterosexual sex, but not as a condition in itself which they want to alter to conform bodies to cultural patterns.
        • Doctors pointed to her that keeping the first sex claim is important, even in cases when the doctor is convinced of having claimed the 'wrong' sex it's better not to retroactive for the sake of the confidence they must transmit
          • For this reason they condemn precoce anounciations of sex at the moment of birth for they may demand changes and inspire doubts
            • When, after 'being confused' parents come to the 'specialists on gender' those physicians usually try to deny the confusion even by criticizing previous doctors if necessary
        • On the urge of assimilating a sex early for avoiding doubts the respondents main concern was with avoiding a 'wrong' castration rather than avoiding a wrong 'devaginization' (construct of a penis), what reveals how masculinity is perceived in a cultural folder of substance while feminity is merely seen as the absence.
          • When chromossome tests reveals any possibility of Y there's an effort through hormones to assimilate masculinity, a preference which is rather cultural as chromossome tests revealing no Y keep the doubt opened to other variables instead of pointing to hormonal femininization.
            • In such cases, though, physicians usually retroced on masculinity assimilations whenever the penis doesn't develop as culturaly expected (which means that femininity is attributed even in cases where all the other masculine functions are avaiable but still the penis is considered aestheticaly small)
              • A penis must be good enough (not be a micropenis), otherwise a vagina is assimilated as there's no such thing as a good enough vagina
            • Another evidence of how physicians relate masculinity to substance and femininity with asbence is the reference to small penis instead of overdeveloped clitoris before assimilating a definitive sexuality
              • One respondent, endocrinologist, deliberated loud about the useless effort of performing so many tests as the appearance of the genital is usually the last word on the decision
              • Also, when teams of physicians disagree on the sex assimilation the practice usually points to assimilating as female
                • Urologists usually point to the possibility of making 'men' if the girl ever decides so due to hormonal or other developments, while the reverse way is always foreclosed under the spectre of castration traumas.
    • In cases where assimilation has to wait, usually when the assimilation depends on hormonal treatment which requires time, physicians also play a role shaping the parents reaction as they foster some sort of secrecy and denial (sidestep) of the intersex condition by delaying to give name or to give neuter names (e.g Claude or Jean)
      • Physicians normalize intersexed conditions in those cases through 4 steps:
        1) They teach parents about fetal development and explain that all fetuses have the potential to be male or female, thus implying that what is happening is a delayed definition rather than a condition 'as natural as the hetrosexual ones'
        2) Physicians stress the normalcy of the infant in other aspects and instead of refering to the abjected sexual identity they portray it as particular malfunctionings of an otherwise intelligible overall condition
        3) They reduce even more the intersex identity through saying that its just a genital malfunctioning.
        • In essence, the physicians teach the parents Money and Erhardt's theory of gender development
  • She emphacizes that physicians don't even refer to themselves as constructing genitals or sexes in general, but as fixers or repairers.
    • Certain physicians admited that they are the ones who decide the sex rather than simply announcing a naturaly given thing, but even than, they claim that they assign on biological bases of what sexual identity can be developed and kept stable, rather than on cultural preferences per se
      • Kessler criticizes this denial of culture on their part on what the mere fact that they are looking for sexual stable identities and the bases through which they frame what is or not sable are culturaly defined, and the objectivation with which they approach it is just an outcome of their very deep immersion into one such system
        • This is made evident as a medical success in those cases is usually judged on what their pacients have 'common' sexual genitals and develop capable of engaging on genital [heterosexual] sex.
        • Many doctors talk about hapiness as a criteria steaming from this sexual normality
  • In post-inphancy Kessler notes that physicians stimulate social convincements of the assigned sex by exhibition of the successfully created genital and spreading of medical reports which they recognize to have an authotity legitimacy within society
    • On dealing with the patients own questionments, physicians also reproduce the same kind of practice given to the parents, fostering some sort of essential naturality on the atributed sex and reducing the hiden intersexuality to malfunctions which they had to fix.
    • Even though access to biological knowledge and the horizons of litigious claims may prevent doctors from stating truths (lies), they still pretty much induce so by not mentioning certain aspects (e.g: the chromossome XY of assigned 'girls') or introducing partial explanations.
• She concludes that the peculiar balance of discovery and determination throughout treatment permits physicians to handle very problematic cases of gender in the mst unproblematic of ways.
  • This balance relies on a particular conception of the natural as waht it ough to have been
  • Naturality is made culturaly indisputable in a process of which main base is the actualy construct of a distinction between culture and nature
• In order for intersexuality to be managed differently than it currently is, physicians would have to take seriously Money's assertion that it is a misrepresentation of epistemology to consider any cell in the body authentically male or female.
• Neither the psychology nor the technology is doubted, since both shield physicians from responsibility on the reproduction of [hetero]sexual schemes of body.