ABSTRACT

My discussion of intersexuality’s changing exemplificatory position with­in feminist studies of science explains how its medical management has emerged as an exemplary injustice of recognition.

Introduction

Twenty years after irrevocable genital surgery in childhood to reduce a body part named by medicine as an enlarged clitoris intersexed woman Morgan Holmes is adamant that ‘‘there was no reason to change my body” (1998, p. 224) An injustice has clearly been done In statements such as ‘‘I should have been left alone to mature in a body that quite feasibly could have penetrated another with its phalloclit” and ‘‘I should have been allowed to grow up to blur the physical markers of sexuality but I wasn’t given that freedom” Holmes (1998, p. 225) invites a normative commitment by the reader to her standpoint But it is not clear that agreement with her is enough; to what extent would a just response to her discourse of injury require the apparently impossible reinstatement of Holmes’ pre-surgical intersexed ‘‘freedom?’’ In seeking to answer this question my paper is about how the medical treatment of intersexuality of which Holmes’ experience is regrettably typical has become intelligible as an injustice

The feminist political philosopher Nancy Fraser has interrogated the character of contemporary justice in her essay ‘‘Social Justice in the Age of Identity Politics: Redistribution Recognition and Participation” Fraser (2003) identifies two principal kinds of justice that are currently claimed by, and on behalf of aggrieved individuals and groups ‘‘First and most famil­iar, are redistributive claims which seek a more just distribution of resources and wealth’’ (2003, p.

Within the academy during the last 25 years scholars working in feminist science studies have led the way in critiquing the traditional medical model of intersex management¹ In this paper I will explain how the development of their work during the 1980s and early 1990s has played a critical role in the emergence of the medical management of intersexuality as problematic and contestable in the manner described by Holmes Previously intersexed bodies had been considered a problem that required medical management Through a discussion of intersexuality’s changing exemplificatory position within feminist studies of science my paper will explain how the medical management of intersex has come to be figured by its critics as an exemplary injustice of recognition The failure by clinicians to recognize intersexuality - through the surgical protocol which makes intersexuality invisible rather than bringing it in to visibility - has been written as a wrong by feminist science studies This is neither to allege that clinicians are pernicious nor that the injustice of intersex is fictitious Rather than assign guilt to clini­cians I shall identify the discursive context that has made the medical management of intersex intelligible as unjust and specifically as an injustice that demands redress through recognition In the final part of the paper I return to Holmes and Fraser in order to outline the productive implications of my analysis for the ostensible impossibility of doing justice to intersexed individuals whose genital surgeries are irrevocable

A Genealogy of Feminist Science Studies

Contemporary feminist studies of science are heterogeneous but their roots can be located as one would expect, in the overlap between the projects of feminism and cultural studies of science The two projects although each diverse have a mutual interest in unmasking the values inherent to material practices and so in debunking the inevitably vested interests that motivate and shape such practices In this respect they share a commitment not merely to reveal the truth about a given practice but to the contribution of that revelation to new ways of living and interacting (see Yardley 1997 p.

Biologists [...] write texts about human development These documents which take the form of research papers texts review articles and popular books grow from interpre­tations of scientific data Often written in neutral, abstract language the texts have the ring of authority Because they represent scientific findings one might imagine that they contain no preconceptions no culturally instigated belief systems But this turns out not to be the case Although based on evidence scientific writing can be seen as a particular kind of cultural interpretation - the enculturated scientist interprets nature In the process he or she also uses that interpretation to reinforce old or build new sets of social beliefs Thus scientific work contributes to the construction of masculinity and mas­culine constructs are among the building blocks for particular kinds of scientific knowl­edge One of the jobs of the science critic is to illuminate this interaction Once such illumination has occurred it becomes possible to discuss change (1997, pp 223-224).

The conclusion here of Fausto-Sterling’s essay ‘‘How to Build a Man” super­bly shows how feminism and the cultural study of science dovetail· To reveal the ‘‘neutral, abstract language’’ of scientific texts as ‘‘a particular kind of cultural interpretation’’ is to expose science’s implicit ‘‘set of social beliefs’’ about masculinity The aim of the revelation is social justice In this way Fausto-Sterling’s role as a feminist is of a piece with her role as a critical scientist (Fausto-Sterling 2003) Moreover the social ‘‘construction of mas­culinity’’ is not merely a background factor that bears upon how medicine is practiced: on the contrary ‘‘masculine constructs are among the building blocks for particular kinds of knowledge’’ asserts Fausto-Sterling One such masculine building block is the conceptual separation of subject and object that installs a fictitious distance between scientists and their objects of study.

Keller’s argument which like Fausto-Sterling’s analysis is situated at the productive overlap of the cultural study of science in particular and the feminist study of culture in general exemplifies the agenda of feminist sci­ence studies that emerged during the 1980s Broadly early scholarship in feminist science studies combined the key insight developed by cultural studies of science - that scientific practices are open to cultural analysis exactly because they cannot occur outside or beyond culture (Kuhn, 1962; Latour & Woolgar, 1979; Shapin & Schaffer 1985; Traweek, 1988) con­trary to what scientists have tended to believe (Haraway 1997, pp 136-137) - with a central observation of feminism that women in Western culture have been erroneously constructed as irrational passive beings in opposition to their enterprising and reliable male counterparts (Beauvoir 1972; Cixous & Clement 1996; Gilbert & Gubar 1979) Specifically ‘‘Feminists [in science studies] have pointed out that culturally entrenched stories about science rely on a series of dichotomies that exclude ‘woman’ from the class of knowers” as the philosopher Alessandra Tanesini (1999, p. 32) puts it in her account of feminist approaches to science

Consequently feminist studies of science in the 1980s explored ways of uncovering assessing and revalorizing the position of women in science. This was a politics of recognition The work ranged from biographies of individual female scientists such as Nobel Prize-winning geneticist Barbara McClintock (Keller 1983) to interrogations of epistemology in general (e.g. Harding 1986; Rosy 1983) Texts of both kinds were corrective in the manner described above by Fausto-Sterling: they documented and disman­tled gender biases in scientific practices and theories Generally in the early 1980s work by feminist critics of science gravitated around the scientific construction of women’s ‘‘nature’’ (eg Bleier, 1984; Jaggar, 1983) and in the mid- to late 1980s such scholarship moved into a tighter orbit around issues of reproductive technology (eg Corea 1985; Stanworth 1987) At the end of the 1980s and during the 1990s while debates over epistemology continued (eg Alcoff & Potter 1993; Harding 1991) the figures of the cyborg ape and gene became feminist science studies’ principal points of enquiry (eg Haraway 1989 1991; Spanier 1995) The 1990s also marked a turn in feminist studies of science towards the interlocking roles of ethnicity and globalization in addition to the role of gender in the configuration of science and power (eg Clarke & Olesen.

In the sections that follow I will describe and analyze the first two important texts on intersex by Anne Fausto-Sterling (1985) a developmental biologist and Suzanne Kessler (1990) a social psychologist I shall show how their texts chart and enact a shift in the way intersex management is framed by its critics My argument is that intersex management in the work by Kessler and Fausto-Sterling over a 5 year period changes from an example of androcentrism to an exemplar of sexual/political injustice and contestation. Their critiques have shifted from a principally anti-androcentric standpoint towards a standpoint that views intersexed bodies and identities as worthy in themselves of preservation and protection That is to say whereas the early work in feminist science studies about intersexuality sought to problematize medical protocols because they were incompatible with feminism the later work starts to ground its criticisms of medicine in a belief that intersexuality qua intersexuality is worthy of recognition Moreover as we will see the recognition of an individual’s intersexuality is an act of social justice for it is a discursive correction of a discursive wrong.

Anne Fausto-Sterling

Fausto-Sterling’s monograph Myths of Gender: Biological Theories about Women and Men was published in 1985, and is indicative of the evolving intellectual climate within feminist science studies On the one hand the book sets out to debunk deterministic views of women’s biology that posit natural, essential links between one’s body - especially the brain hormones and genes - and one’s gender (Fausto-Sterling 1992 in particular pp. 13­155).² Put the other way around in the accounts that Fausto-Sterling crit­icizes it is because body parts such as the brain are gendered that gender is believed inescapably to exist In this aspect Myths takes its place among feminist critiques of how the ‘‘natural’’ female body is constructed by sci­entific practices that naturalize perceived gender differences Fausto-Sterling (1992, p 190) argues that such deterministic viewpoints are often secured through straightforwardly bad science - for instance by defining in human terms (such as rape) animal behaviors observed within artificial settings (such as the sex lives of scorpionflies in a laboratory) and then re-framing human behaviors as biologically determined According to Fausto-Sterling (1992, p 222; see also pp 160-161) it is ‘‘logically flawed’’ to posit rape among humans as natural on this basis She therefore calls for badly struc­tured and irrelevant research of this kind to be halted (1992 pp 221-222)

On the other hand Myths also engages with the questions of epistemol­ogy raised by early 1980s feminist science studies albeit less explicitly than the book's subversion of the notion of women's ‘‘nature '' Fausto-Sterling (1992 p 222) argues that mistaken reasoning about gender - such as those theories of human sexual aggression based on contrived observations of scorpionflies - is ‘‘politically dangerous '' Its danger lies in the casting of acts like rape as biologically inevitable while failing to acknowledge the coexistent and irreducible moral legal and cultural dimensions of such behaviors (eg 1992, pp 126 and 204) Moreover in keeping with the fun­damental precept of cultural studies of science that science is cultural prac­tice Fausto-Sterling (1992 pp 203-204) refutes the protestations by sociobiologists that their research is essentially free from values and has simply been unfortunately imported into other non-scientific value-laden domains ‘‘In the study of gender (like sexuality and race) it is inherently impossible to do unbiased research’’ she advises (1992, p 10) It is at this point that a tension in Fausto-Sterling’s project becomes apparent She wants to say that procedurally and logically unsound sex science exists; she also wants to say that no sex science is purely procedural and logical, because it is always already biased The tension is symptomatic of her work’s situation in mid-1980s feminist science studies where the emerging discipline sought to identify as secretly ‘‘cultural’’ erroneous accounts of women’s ‘‘nature’’ while simultaneously acceding that no account of nature could escape its own cultural constitution

It is from inside the constitutive intellectual context of this tension that Myths will offer the first critique within feminist science studies of the med­ical management of intersex The book does not deal directly with the treat­ment received by intersexed patients in hospital; rather its discussion is embedded within an analysis of the supposed relations between hormones and gender differences In her chapter ‘‘Hormones and Aggression: An Explanation of Power?’’ Fausto-Sterling (1992, pp.

Fausto-Sterling’s Intersex Critique

The example of intersexuality enters Fausto-Sterling’s chapter about hor­mones in a subsection that opens with the question ‘‘What happens in the Womb?’’ and closes with the comment that ‘‘The claim that clear-cut evi­dence exists to show that fetal hormones make boys more active aggressive or athletic than girls is little more than fancy although harmless it is not’’ (1992, pp 133 and 141) It is intersexuality deployed as an example of feminist science criticism which enables Fausto-Sterling to maneuver from her question to her answer Intersexed people specifically those with adrenogenital syndrome (hereafter AGS) have been studied by influential gender psychologists John Money Anke Ehrhardt and Susan Baker as a means of discovering the impact of fetal hormone exposure upon childhood aggression (Money & Ehrhardt, 1972; Ehrhardt & Baker 1978).³ Individuals with AGS have XX chromosomes and female gonads (ovaries) and are customarily raised as girls but unlike most XX individuals their bodies produce high levels of androgens The effect of these androgens is to cause non-standard external genital development that clinicians describe as ‘‘masculinized” (Fausto-Sterling 1992, p. 296) For example the clitorises of AGS individuals typically are larger than most; their clitorises are surgically reduced In sum AGS individuals are exposed in the womb to ‘‘masculine” hormones that are apparently contradictory to their ‘‘feminine” rearing and surgical assignment The thesis put forward by Money Ehrhardt and Baker is that although girls with AGS do not question their female gender identity they do engage in ‘‘tomboy behavior” prefer ‘‘toy cars and guns to dolls” and are more interested in career plans than in marriage - all phenomena coded by Money Ehrhardt and Baker as masculine (Fausto-Sterling 1992 p. 134) Money Ehrhardt and Baker read such phenomena as evidence that prenatal hormone exposure effects - not just affects - gendered behavior.

If intersex operates as a good and clear example of the effects of hormones on fetuses for Money Ehrhardt and Baker then the exemplificatory status of intersex in the three researchers’ scientific discourse and practice is itself for Fausto-Sterling an example of bad and obtuse science ‘‘Not to put too fine a point on it the controls are insufficient and inappropriate the method of data collection is inadequate and the authors do not properly explore alternative explanations of their results’’ she contends (1992, p. 136). Fausto-Sterling (1992, pp. 136-41) details her objections on all three fronts. Of special importance to my project of charting the influence of feminist science studies on the contemporary dispute over intersex treatment is the fact that Fausto-Sterling’s criticisms of Money Ehrhardt and Baker’s studies centre repeatedly upon the way the three researchers represent (or fail to represent) clitoral surgery For example when she introduces their research Fausto-Sterling complains that: ‘‘Money and Ehrhardt never made clear, except through one photograph that such [surgical] ‘correction’ to what they term a ‘normal female appearance’ involved clitoridectomy’’ (1992, p. 134). Further even though it is ‘‘unlikely that most of the patients underwent total clitoridectomy’’ Fausto-Sterling observes Ehrhardt and Baker ‘‘never men­tion the extent of the surgery other than to say that the correction made the girls ‘normal-looking’’’ (1992, p. 135) Ostensibly Fausto-Sterling is arguing simply that Money Ehrhardt and Baker’s studies are poorly written: they do not adequately describe the surgeries which were performed on their subjects. But by insisting that ‘‘normal’’ and ‘‘normal-looking’’ remain in quotation marks Fausto-Sterling is also putting in question the very possibility of describing the outcomes of intersex surgery.

Uncertainty over what a ‘‘normal’’ or a ‘‘normal-looking’’ clinical out­come might be is not limited to the post-surgical appearance of the genitalia, Fausto-Sterling shows The assessment of AGS individuals’ behavior is also problematic When discussing the inadequate controls used by the research­ers she notes comparatively that:

At least one group of psychologists offers strong circumstantial evidence that supposed sex differences in newborns (male/female differences in activity wakefulness and irri­tability) may result from the simple culturally inflicted procedure of circumcision The children in the Money Ehrhardt and Baker studies underwent surgery more drastic than circumcision an event that could contribute to reported behavior differences (1992, p. 136).

In this excerpt, Fausto-Sterling is clearly implementing the strategy of mid- 1980s feminist science studies: she uncovers how the irreducibly cultural dimension of science embeds into research biased beliefs about sex differ­entiated behavior To record ‘‘tomboy behavior’’ in the subjects of one’s study is to make a judgment steeped in arguably anti-feminist cultural values about what counts as gendered It is not a neutral observation (see Fausto-Sterling 1992, p. 138 fn). Consequently in my opinion Money, Ehrhardt and Baker conflate their methodology with their object of study. This means that they mistake the means by which they measure their object (the observation of tomboy behavior) for the object itself (the influence of testosterone) Certain behaviors are intelligible as tomboyish only within a cultural milieu that marks such behaviors as notable because of their deviation from traditionally ‘‘feminine’’ behavior Put a different way tom­boy behavior is constituted as observable because it disrupts gender ster­eotypes Therefore although testosterone might indeed stimulate behaviors which are describable as tomboyish it is a conflation not a deduction that equates the observation of tomboy behavior to testosterone influence For Fausto-Sterling the question raised by this conflation is the extent to which Money Ehrhardt and Baker are straightforwardly mistaking as gendered something that is not actually gendered but rather is a side-effect of intersex genital surgery

It may be that intersex surgery makes AGS girls agitated and that their irritability is misconstrued by observers as an active ‘‘masculine’’ way of engaging with the world When discussing the researchers’ apparent unwillingness to countenance alternative explanations such as this Fausto­Sterling remarks that ‘‘Baker and Ehrhardt consider only briefly the pos­sible effects of clitoridectomy on the behavior and feelings of both AGS children and their parents” (1992, p. 137) and further that:

The subtle effects of genital surgery on behavior and even the likelihood of mutilation fears, cannot be lightly dismissed Yet nowhere are these possible effects adequately discussed as contributors to the observed differences in the behavior of AGS girls (1992. p. 138).

In this extract even if it is sensible not to ‘‘lightly dismiss” the behavioral impact of genital surgery as Fausto-Sterling warns it is unclear how one would ever take surgery’s influence fully into account Certainly Fausto- Sterling’s reiterated point about intersex surgery is that Money Ehrhardt and Baker have failed to account in their analysis for the likely impact of genital surgery on behavior Significantly this shortcoming lays their work open to criticism from a feminist science studies perspective: Fausto-Sterling shows that when the adverse effects of surgery are considered even if only spec­ulatively the assertions by Money Ehrhardt and Baker about the ‘‘nature’’ of gender as well as their method of knowing what counts as gendered are exposed as unstable To phrase this another way the discussion of intersex­uality in Myths makes salient the two issues which defined feminist science studies in the mid-1980s It is specifically when surgery for intersex is con­sidered a potentially aversive intervention that concerns over the ‘‘nature’’ of gender and the possibility of unbiased epistemology are activated

In one sense then the effects of genital surgery are factors that need to be considered by Money Ehrhardt and Baker in order to produce a sound balanced account of the influence of prenatal hormone exposure on child­hood behavior But in another sense childhood genital modification marks a radical limit to any claim ‘‘correct’’ or ‘‘incorrect ’’ about gender It is not at all certain whether even the most rigorously designed study could state that the behavior of a post-surgical intersexed child is meaningfully ‘‘gendered’’ whether it just resembles the genuinely gendered behavior of non-intersexed children or whether it is nothing to do with gender and furthermore how one would firmly distinguish these three possibilities Fausto-Sterling quietly acknowledges this difficulty of recognition by referring to ‘‘normal’’ female­ness only within quotation marks but the implications are great It is in this way that intersex surgery is first construed by feminist science studies as a site where the ‘‘nature’’ and epistemology of gender are contentious and insecure.

In employing intersexuality to prompt an interrogation of gender’s nature and epistemology Fausto-Sterling does two things of crucial importance First she figures intersex surgery as potentially detrimental Second she uses it to exhibit the usefulness of a feminist approach to scientific practice. To recapitulate: it is because the studies by Money Ehrhardt and Baker try to ground in biology gendered behaviors that the use of postsurgical inter­sexed individuals in studies of sex hormones can be criticized by Myths as an example of bad science However there is a difficulty The fact that intersex surgery renders uncertain these researchers’ claims about the biological basis of gender also unhinges the implicit opposite possibility that good science would be characterized by a correct definition of what constitutes and causes gender This means that intersex specifically in its role as an exam­ple neither wholly supports the agenda of feminist science studies nor entirely destabilizes it - just like the tension in feminist science studies that I have shown to constitute Myths’ intellectual context Myths countenances the harmful side-effects of intersex surgery in order to reveal the holes in Money Ehrhardt and Baker’s claims; concomitantly the book’s spec­ulation that surgery for intersex might precipitate irritability and agitation in AGS girls suggests that an accurate study of the gender of intersexed individuals would be unattainable Overall, using intersex as an example does not make Fausto-Sterling’s work redundant or incorrect, but it does thematize difficulties inherent in feminist science studies during the 1980s. Therefore intersex emerges in Myths as a figure for both the possibility and the impossibility of a feminist critique of scientific practice.

Suzanne Kessler

In the spring of the year that Myths was published Suzanne Kessler (1998, p. 13) was interviewing clinicians working at four New York medical centers for her own research into the medical management of intersex In prepa­ration for what would be the second feminist critique of clinical attitudes towards intersex Kessler spoke with a psychoendocrinologist a urologist a clinical geneticist and three endocrinologists Two of the latter were spe­cialists in pediatrics (1998, p. 13) The multidisciplinary spread of inter­viewees has made Kessler’s insights of enduring relevance for the critical study of intersex management; further interviews conducted by her in the mid- to late 1990s which found little change in clinicians’ attitudes con­firmed that her initial 1985 sample represented the weight and obduracy of medical authority (1998, p. 135 n5). Kessler published a pilot analysis of her interviewees’ practices and opinions as well as a critique of relevant liter­ature such as work by Money and Ehrhardt in the leading feminist journal Signs in 1990 ⁴ Unlike Fausto-Sterling her emphasis was on the protocols for treating intersexed infants in hospitals and health centers rather than their role in research into sex-differentiated behaviors Eight years later the Signs paper was reprinted as a chapter in Kessler’s monograph Lessons from the Intersexed. It was the first book to systematically critique the contem­porary medical management of intersex

Like Fausto-Sterling Kessler was known for a feminist science studies approach to so-called sex differences In 1978, she had published with Wendy McKenna Gender: An Ethnomethodological Approach, which sought to destabilize the presumed biological ground of sex-differentiated behaviors by carefully referring to only ‘‘gender chromosomes’’ ‘‘gender hormones’’ and suchlike (Kessler & McKenna 1978 p. 7; see also Kessler 1998 ₽· 134 n2) Even though this seemed ‘‘awkward’’ the authors’ brave refusal to conflate sex and the body - to ‘‘sex the body’’ as Fausto-Sterling (2000) has put it - laid substantial conceptual ground for the rise during the next 15 years of gender as an analytic category in social constructivist work (see Haig 2004 in particular p 91) Further Kessler and McKenna’s emphasis upon ‘‘gender as a practical accomplishment’’ pre-empted 1990s gender studies texts such as Judith Butler’s (1993) Bodies That Matter, Gilbert Herdt’s (1996) anthol­ogy Third Sex, Third Gender, and Thomas Laqueur’s (1990) Making Sex. Indicative of 1978’s nascent feminist science studies movement Kessler and McKenna’s (1978 p. 3) purpose was to reveal that the science of ‘‘sex’’ is in fact a cultural construct and should be identified as such by the term ‘‘gen­der ’’ Whereas sex might be thought of as natural gender connotes the cultural (Adams 1989, p. 247) The switch of terms and the ensuing dif­ficulty of referring to ‘‘sex’’ without quotation marks to indicate its cultural status as something to which individuals collectively make reference with­out knowing its foundation (rather like an unattributed maxim or turn of phrase) prefigures Butler’s subtitle for Bodies That Matter: On the Discursive Limits of “Sex” (Kessler & McKenna 1978 pp· 5-6) It anticipates the performative model of sex/gender for which Butler (1997 1999) is well- known⁵ In their refutation of biological determinism Kessler and McKenna promoted an implicitly but strongly feminist agenda ‘‘Biological psycho­logical and social differences do not lead to our seeing two genders ’’ they alleged; ‘‘Our seeing of two genders leads to the ‘discovery’ of biological, psychological and social differences’’ (1978 p 163) Hence by changing the way genders are seen ‘‘we can begin to discover new scientific knowledge and to construct new realities in everyday life’’ (1978 p 167) The authors’ feminist agenda emphasized the mutability of cultural constructions and thus also the negotiability of inequalities perceived erroneously as inevitable because of their purported basis in the sexed body

Kessler's Intersex Critique

It is with this background in mind that I turn to the first evaluative state­ment - the second sentence - in Kessler’s Signs paper: ‘‘In the late twentieth century medical technology has become sufficiently advanced to allow sci­entists to determine chromosomal and hormonal gender which is typically taken to be the real, natural, biological gender usually referred to as ‘sex’’’ (1998, p. 12) Immediately the insights of feminist science studies are deployed and foregrounded by Kessler to denaturalize ‘‘sex’’ by describing its constitutive context, as well as by placing it in quotation marks The sentence is also notably general - ‘‘in the late twentieth century medical technology has become sufficiently advanced’’ - but this is not a flaw; rather it is an important facet of Kessler’s argument about intersex management In her paper she reads the management of intersex as a symptom of general cultural practices and beliefs (including but not limited to those of clini­cians) about gender differences Put differently for Kessler medical attitudes are an index of how individuals in Western culture commonly construct gender With McKenna (1978, p. 4) she has written that ‘‘Even scientists must ultimately rely on their own common sense knowledge’’ about what counts as female or male In that respect, the ‘‘Case Management of Intersexed Infants’’ named in the paper’s title is itself a case of how gender is constructed by culture at large ‘‘The process and guidelines by which decisions about gender (re)construction are made reveal the model for the social construction of gender generally’’ she contends (1998, p. 12) Kessler differs from Fausto-Sterling insofar as she employs intersex principally as an instance of how gender works; its function as an example of how feminist science studies works is important but secondary The change of priorities is subtle but fundamental

Kessler therefore argues that the ‘‘members of medical teams have stand­ard practices for managing intersexuality which rely ultimately on cultural understandings of gender’’ (1998, p. 12) This point builds on Fausto- Sterling’s critique of the assumptions about gendered behavior smuggled into the ostensibly scientific studies by Money Ehrhardt and Baker Just as Fausto-Sterling demonstrated that the conceptual building blocks of Mon­ey Ehrhardt and Baker’s experiments (for instancy the idea of tomboy behavior) were in fact culturally constructed so too does Kessler argue that the case management of intersexed infants is actually an instance of gender’s cultural construction Her strategy is written into the provocative equation that constitutes her paper’s full title ‘‘The Medical Construction of Gender: Case Management of Intersexed Infants’’ For Kessler the two halves of her title are equivalent ‘‘[B]iological factors are often pre-empted in physicians’ deliberations by such cultural factors as the ‘correct’ length of the penis and capacity of the vagina” she advises (1998, p. 12) Moreover, when these ‘‘cultural factors’’ inform surgical decisions for example by making a vagina to suit the dimensions of an ‘‘average’’ penis the seemingly immutable ‘‘sex’’ of the body becomes the effect, rather than the cause of gender (1998, p. 16; see also pp. 108-109) Therefore what is misleading about clinical practice according to Kessler (1998, p. 17) is its perpetuation of ‘‘the notion that good medical decisions are based on interpretations of the infant’s real ‘sex’ rather than on cultural understandings of gender ’’ even while medical decisions really work the other way around She and McKenna (1978, p. 8) had previously noted the incongruity that sex ‘‘Reassignment could imply that the child had been one gender and is now the other when actually the child is seen by everyone as having been the ‘new’ gender all along’’ with the notion of cultural construction going unmentioned among clinicians and parents

Because Kessler uses feminist science studies differently from Fausto­Sterling - to illuminate how intersexuality itself disrupts the cultural con­struction of gender for which the medical management of intersexed infants serves as synecdoche - her project diverges from the agenda of 1980s fem­inist critics to formulate a correct account of women’s biology by means of accurate sex science Fausto-Sterling (1992, ₽· 11) sets out with ‘‘the eyes of a scientist who is also a feminist’’ to demystify the pejorative ‘‘myths’’ invo­ked by her title and delineated in chapter headings (1992, pp 13 and 156) such as ‘‘A Question of Genius: Are Men Really Smarter Than Women?’’ (the feminist scientist’s answer will be ‘‘no’’) and ‘‘Putting Woman in her (Evolutionary) Place’’ (Fausto-Sterling’s feminist science will lever ‘‘Woman’’ out of that subordinate place) Contrastingly in Kessler’s work the existence of intersexuality renders opaque the biological ground and scientific goal of a ‘‘feminist’’ critical program She observes that ‘‘in the face of apparently incontrovertible evidence - infants born with some com­bination of ‘female’ and ‘male’ reproductive and sexual features - physicians hold an incorrigible belief that female and male are the only ‘natural’ options’’ (1998, pp 12-13) Where Fausto-Sterling at the time of Myths deploys intersexuality to exemplify how feminist science studies can reveal instances of bad or biased research Kessler is very careful to note that doctors who treat intersexeds infants are not ‘‘hypocritical ’’ ‘‘medically incompetent or deficient’’ (1998, p 30) They are not guilty Instead the seemingly intractable belief of these doctors in the naturalness of a male/ female dichotomy in the face of evidence to the contrary ‘‘highlights and calls into question the idea that female and male are biological givens com­pelling a culture of two genders” (1998, p. 13) The effect of this admission by Kessler is to problematize the feminist science studies agenda because femaleness and maleness in her view cannot be deduced even by good sci­ence conducted to the meticulous standards that Fausto-Sterling demands (1992 P· 11)·

Exemplification and Exemplarity

I am contending that in Kessler’s discourse her object of study (intersex­uality) interferes significantly with her politico-scientific methodology (fem­inist science studies) She had argued together with McKenna that ‘‘the question of what it means to be a male or a female is merely another way of asking how one decides whether another is male or female’’ (1978, p. 3) So when a decision about whether an infant is male or female cannot be made but must instead be replaced by the ‘‘medical construction of gender’’ named in Kessler’s paper title the question of ‘‘what it means to be a male or a female’’ becomes redundant, and by implication the project of feminist science studies becomes problematic Now this is not to say that intersex­uality destroys the possibility of feminism (see Morland 2001) Rather I want to make clear that the relationship between intersexuality and feminist science studies which in Fausto-Sterling’s discourse is relatively straight­forward and exemplificatory, is queried by Kessler’s discourse precisely at the discursive level In other words the key to understanding the troubled relation for Kessler between intersex and feminist science object and meth­od, is in how her discourse deploys intersexuality to advance its argument; the key is not in any extra-discursive shift of relations between feminists and intersexuals that might have taken place in the years between Fausto- Sterling’s Myths in 1985 and Kessler’s ‘‘The Medical Construction of Gen­der’’ in 1990. In fact, I will propose that the discursive change between the two texts is of substantial importance to the emergence of the medical management of intersex as a controversial ‘‘problem’’ demanding debate in the 1990s and the 21st century (Creighton & Liao 2004) Stated simply, this controversy is characterized by its positing of intersexuality as an exemplar that explodes the very idea of gender as distinct from employing intersexuality to exemplify a particular theory Intersexuality for Fausto­Sterling is exemplificatory but for Kessler in 1990 it is starting to become exemplary

This tricky but analytically useful difference between exemplification and exemplarity requires clarification I have identified a shift from the construal of intersex as exemplificatory to its construal as exemplary This shift is akin to the difference between saying for instancy that Shakespeare’s work is valuable because it exemplifies or demonstrates the characteristics of Early Modern English drama and saying in contradistinction that the value of his work abides in its incomparability to other literature In the latter view Shakespeare exemplifies nobody - rather, his work is exemplary According to literary theorist Steven Connor (1993, p. 39) exemplification and exem­plarity are distinctive ways of composing and employing an example and importantly for my argument they are indivisible from their discursive context Connor observes that ‘‘Exemplification usually operates in an indexical or synecdochic mode by substituting the part for the whole’’ (1993, p. 35) It is in this indexical capacity I have argued that intersexuality works in Myths to illustrate both the usefulness of feminist science studies and the paucity of Money Ehrhardt and Baker’s research Like a nest of Russian dolly intersexuality’s indexical work positions Myths as represent­ative of mid-1980s feminist science studies Therefore as Connor notes, ‘‘Exemplification is an endlessly renewed promise of the reciprocal conform­ity of theory and its object: a guarantee of the possibility and effectiveness of the procedures of argument and evidencing” (1993, p. 37) It is a way of instating a discipline To an extent intersexuality performs exempli- ficatory work in Kessler’s article too for instance in her proposal (1998, p. 12) that decision-making about genital (re)construction reveals gender’s social construction at large Exemplification occurs when an example is proffered in this way to discursively maneuver ‘‘from the singular to the genera) [...] the case to the law” according to Connor (1993, p. 39)

But for Kessler intersexuality is at the same time not at all exemplifica- tory Recall her complaint that ‘‘Case management [of intersex] involves perpetuating the notion that good medical decisions are based on interpre­tations of the infant’s real ‘sex’ rather than on cultural understandings of gender’’ (1998, p. 17) So the law is not revealed by the case; when an intersexed infant is born the truth of gender’s cultural constitution remains concealed Absolutely central to Kessler’s article is this observation (1998 p. 32) that for clinicians parents and in fact for Western culture generally, the medical management of intersexuality does not exemplify gender’s con­struction This is concurrent to but apparently incompatible with Kessler’s assertion that intersex management is indeed an example of how gender is constructed. Yet Kessler is not wrong Actually her argument that clinicians do not see their medical work for what it really is - namely an instance of gender’s construction - forms the incisive conclusion of her Signs paper She writes:

the medical management of intersexuality instead of illustrating nature’s failure to ordain gender in these isolated ‘‘unfortunate’’ instances illustrates physicians’ and Western society’s failure of imagination - the failure to imagine that each of their management decisions is a moment when a specific instance of biological ‘‘sex’’ is transformed into a culturally constructed gender (1998, p. 32).

In making this path-breaking claim that intersex is not an ‘‘unfortunate’’ occurrence in need of medical management but that medical management itself is indicative of a regrettable ‘‘failure of imagination” by physicians and Western society Kessler posits intersexuality not as exemplificatory but as exemplary Now an exemplar in the words of Steven Connor (1993, p. 39) ‘‘retard[s] or even resist[s]’’ the maneuver from the singular to the general that exemplification enables In its reticence to demonstrate a general rule an exemplar signals ‘‘its own unprecedented and inimitable exemplarity'' (1993 p 39) In Connor's terms Kessler is claiming that because intersex­uality does not work as exemplificatory it is exemplary This formulation seems paradoxical but therein lies its force: it describes the strange state of affairs whereby the most obvious literal example of gender’s construction is not treated as an example of gender's construction The singular (intersex) is not extrapolated to the general (gender) and this striking failure is therefore exemplary

To explain this point consider that one of Kessler's central observations in her Signs article is the existence of a discrepancy between how gender is construed at non-intersexed and at intersexed births During the medical management of non-intersexed births gender is treated by clinicians as a matter of biology; conversely when an intersexed child is born clinicians regard gender as a process of socialization:

In the case of intersexed infants the physicians merely provide the right genitals to go along with the socialization Of course at so-called normal births when the infant’s genitals are unambiguous the parents are not told that the child's gender is ultimately up to socialization In those cases doctors do treat gender as a biological given (1998, p. 24).

The analysis turns on the construal of intersexuality within Kessler's dis­course as simultaneously exemplificatory and as exemplary because of its failure to exemplify This is what makes it so remarkable to Kessler that the theory of gender malleability upon which the surgical management of intersexuality was founded logically entails that ‘‘gender identity (of all children not just those born with ambiguous genitals) is determined pri­marily by social factors that the parents and community always construct the child’s gender” at the same time that surgeries performed on the basis of the theory conspicuously fail to exemplify and thereby to “reveal,” as Kessler would have it, ‘‘the model for the social construction of gender generally’’ (1998, p. 24) Surgery for intersex marks a failure of recognition, both of intersexed bodies and of intersexuality’s social significance In short, Kessler writes intersex management as a wrong by writing it, in its exem­plarity as a problem of recognition

Conclusion: Towards Rewriting?

My analysis of intersexuality’s changing position within feminist science studies shows that clinicians are not necessarily maleficent or negligent (Creighton & Liao 2004, p. 662); rather the surgeries they have performed on intersexed patients have become intelligible as injustices of recognition within the constitutive discursive context of feminist science studies Kessler’s critique in particular has set the tone not only for her own 1998 monograph Lessons from the Intersexed, but also for Fausto-Sterling’s (2000) next book Sexing the Body: Gender Politics and the Construction of Sexuality and Alice Dreger’s (1998) Hermaphrodites and the Medical Inven­tion of Sex: common to the three works is the idea that intersex manage­ment not intersexuality itself is contentious and problematic In chorus with these texts none of my analysis is meant to imply that intersex surgery is purely ‘‘rhetorical’’ or that its injurious consequences are ‘‘allegorical:’’ the medical management of intersex has been tangibly unjust because it has not recognized the intersexuality of its patients But more than this the corollary of medical failure has been the elision of the omnipresent cultural politics of gender which must be acknowledged in order for a feminist formulation of social justice Although that parallel issue of cultural politics initially moved Fausto-Sterling and Kessler as feminists to critique intersex treatment their work has made possible an understanding of the treatment as an injustice of recognition that cannot be remedied simply by correctively pointing out ‘‘with the eyes of a scientist who is also a feminist’’ the ‘‘truth’’ about gender This is because the entire substance of the injustice is the surreptitious scientific creation of the ‘‘truth’’ of gender Indeed later com­mentators such as historian and chair of the Intersex Society of North America Alice Dreger (2004, p. 150) will explicitly frame the intersex con­troversy as a matter of civil rights - ‘‘Like the movements on behalf of women people of color gay men and lesbians’’ - that has no intrinsic relation or relevance to gender That is one way of engaging with the exemplary suppression of gender’s cultural construction from the very med­ical discourse wherein it is so paradoxically exemplified.

Another way is by returning to Nancy Fraser and Morgan Holmes Fraser explains that ‘‘The term ‘recognition’ [···] comes from Hegelian philosophy, specifically the phenomenology of consciousness In this tradition recogni­tion designates an ideal reciprocal relation between subjects in which each sees the other as its equal and also as separate from it’’ (2003, p. 10) More­over as Fraser continues ‘‘This relation is deemed constitutive for subjec­tivity; one becomes an individual subject only in virtue of recognizing and being recognized by another subject’’ (2003, ₽· 10) For Holmes - and I agree with her - it is in the disruption of such intersubjective recognition that the injustice of intersex surgery is most immediately experienced ‘‘[T]he reassurance I used to seek and the one that is still often given (‘I can’t tell the difference’) fails to acknowledge two things: first, I can literally feel the difference on both physical and experiential levels and second just because an external viewer can’t recognize the difference that doesn’t mean there isn’t one’’ (1998, p. 225) The issue here is not merely an inattention to how Holmes’ body looks but more importantly a radical breakage of the subject­constituting scene of recognition valorized by the Hegelian tradition How is one to be recognized as a gendered subject when one’s post-surgical genitalia are a reminder of the somatic persistence of loss when one’s ‘‘sex’’ is a surgical effect when one is merely ‘‘normal-looking’’ (see Morland 2005)? Despite the assurances of non-intersexed others reciprocity - the simulta­neous intersubjective recognition of separation and equality - is often experi­enced by intersexed people as impossible

And yet because intersexuality is irreducibly discursive as well as irreducibly material justice is not unattainable; ‘‘I refuse to allow my mutilation to rob me any longer of my difference’’ writes Holmes (1998, p. 225) She is referring not to the material undoing of surgery but to the discursive disclosure of the intersexuality that surgery sought to conceal or remove In her opinion (1998 p. 225) surgery may make people less recognizable as intersexed but it does not stop them being intersexed This is because the post-surgical inter­sexed body is only ever questionably ‘‘normal-looking ’’ as Fausto-Sterling acknowledged and because the elision of its surgical and cultural construction does not make it any less constructed as Kessler proposed So, in the face of medical protocols that disguise their investment in the social construction of gender the recognition of an individual’s intersexuality is a gesture toward social justice for it is a recognition that the sexual is political

Holmes therefore insists ‘‘that people think about my marriage as that between a man and an intersexual’’ (1998, p. 225) Just as intersex management emerged in feminist science studies as a wrong through its inscription as unjust, it is by means of an insistence within discourse upon her obdurate embodied difference that Holmes takes back ‘‘by force” the freedom ‘‘to blur the physical markers of sexuality” (1998, p. 225) Put another way it is certainly by recourse to recognition that Holmes seeks redress for the unjust medical treatment of her intersexuality But it is by recourse to a recognition that is also necessarily discursive concerned with naming as much as it is with looking: ‘‘It is my hope that in a future perfect world queers will not question the validity of calling oneself ‘queer’ even if no one can see their difference” she explains (1998, p. 225) In such a future the reinstatement of freedom will be coextensive with the restatement of freedom At stake is not the detection and punishment of individual clinicians who may be guilty of injustices of recognition much less the magical reversal of genital surgeries but the eminently possible rewriting and righting of a social and discursive wrong

NOTES

1. Other significant critiques have come from scientists such as Milton Diamond, and increasingly in the 1990s and 21st century from intersexed patients themselves, but these are beyond the scope of my paper For a fine representative selection see Dreger (1999)

2. Further references are also to this revised edition which differs from the orig­inal only in its new preface and addendum neither of which are pertinent to my paper’s project.

3. Adrenogenital syndrome is more commonly known as congenital adrenal hyperplasia or CAH.

4 Kessler (1990); further references are to the reprint of the article in Kessler (1998).

5Butler (1999, p. 194 n8) does cite Kessler and McKenna in Gender Trouble, but not in direct connection to the theory of gender performance and/or performativity.

ACKNOWLEDGEMENTS

I wish to thank Robert Eaglestone Suzanne Kessler, and Mandy Merck for helpful comments on this paper and Matthew Anderson for editorial advice My research is supported by the Arts and Humanities Research Board

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