How Did Intersex Become a Medical Problem - Essay Example

Introduction Our notions about human beings and their bodies are determined certain established standards of normalcy. These standards of normalcy are based on certain statistical averages and historical beliefs .It is this notion of normalcy that governs our beliefs on what is right or wrong. A person who we term normal fits into the so-called parameters that define normalcy. On the other hand an aberration or a difference is manifested as a disability and viewed as problematic or undesirable. (Taylor, Mykitiuk, 2001) Among the most important forms of human identity are sex and gender. We live in a two- sex world and it is considered normal to be either male or female. The tag of abnormality is also attached to those individuals whose sex or gender identity is ambiguous. This paper focuses on whether the ideas of normalcy along with the theory of Cartesian dualism shape the construction of intersex, intersex therapies and sex reassignment surger.y. The first section will focus on the variations in sexual and gender development and explain the terms, intersex, transsexuals, and transgender, which are relevant to this paper. The next section looks at intersex as a medical problem. The impact of Cartesian dualism on the attitudes of medical science towards intersex has been highlighted here. The third section describes the conventional practice of intersex management. The John/Joan case has been discussed in order to elaborate on the apparent inappropriateness of this method. The concluding section discusses how modern day intersex management is largely based on culturally perceived notions of normalcy. The need for an attitudinal shift with a view to accepting differences and historical understanding of intersex are discussed. Variations in Sexual/gender Development The alliance between bodies (male or female) and gender identity (man or woman) is taken for granted in our society. However Milton Diamond estimates at nearly 1.7% of the population is both with genitals that are not clearly male or female. (Hird, 2003). While this is an extreme condition, variations in sexual and gender development are not unusual. Some of the major types of variation have been elaborated in Fig 1. Fig 1. Source: Androgen Insensitivity Syndrome (AIS) Support Group website This paper focuses on people with intersex condition. Intersex is a biological condition. The Australian Medical Association states that a person born with intersex conditions has "sex chromosomes, external genitalia or an internal reproductive system that is not exclusively either male or female." (Androgen Insensitivity Syndrome (AIS) Support Group website) On the other hand there are transsexuals who are different from pople with intersex condition because they are biologically normal men and women. Transsexuals usually are people who feel they they are in the wrong body.The World Health Organisaton define transsexuals as people ," who have a desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomical sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex." (Androgen Insensitivity Syndrome (AIS) Support Group website) Many of the problems faced by people with intersex condition and transsexuals are rather similar. Often both are subject to sex reassignment surgeries. How did Intersex become a medical Problem In the 19th Century intersex was not regarded as a medical problem. Dr. Jorge J. Daaboul, Director, Pediatric Endocrinology Children's Hospital of Oakland in his paper presented at the American Association for the History of Medicine, May 19, 2000, refers to Hermaphrodites and the Medical Invention of Sex by Alice Dreger. He says that this book highlights how intersexed individuals led normal undistinguished lives until the late 19th century. Psychologically healthy and well adjusted, the genital peculiarities of these people were accepted as the variations caused by nature. Dr. Daaboul states that somewhere in the late 19th century medical science 'discovered' intersexed people and raised the need to repair their bodies. (Intersex Society of North America, website) It was in the late 19th Century, as Dr. Daaboul points out, that medicine became a hard science and all human functions were reduced to mechanistic processes that could be dissected and analysed. He goes on to state that this was the period when physical normals were established and anything that differed from the norm was deemed abnormal. (Intersex Society of North America, website) This change in the attitudes of medical science was largely attributed to the dualism theory put forth by Rene Descartes. Rene Descartes ((1596-1650) was philosopher, scientist, physiologist, and a mathematician. He believed in the existence of an independent nonmaterial soul, which inhabits and finds expression in a mechanically operated body. (Custance, 1980). It is this theory of a mechanically operated body not very different from a machine that forms the core of modern medical practice. Margrit Shildrick, Roxanne Mykitiuk refer to Leder who has said that this Cartesian Revelation forms the thrust of modern medical therapies that rely greatly on mechanical invasion. (Shildrick, Mykitiuk, 2005,p.31) This attitudinal shift resulted in intersex management becoming what Suzanne Kessler calls 'surgical and hormonal management'. Instead of embracing the differences caused by nature and allowing intersexed people to lead normal lives, medical science now recommends surgery to convert people with intersex condition to a particular gender. Reassigning gender is legitimsed by the standard medical theory which assumes that is a social construct.. The theory maintains that gender identity or the sense of belonging to one sex or the other develops postnatally and is not established definitively until the child reaches is about two years of age. With firm faith in this theory, John Money and colleagues in the 1950s at Johns Hopkins Hospital initiated the practice of subjecting male children born with ill-formed penis to surgical and hormonal treatments to make them female. The doctors believed that a male without a penis is not acceptable socially or psychologically. Also it is easier to create a vagina than to create a penis. Thus a majority of intersex children were reared as girls. The continuous surgical and hormonal treatments were done to ensure that as they grew older their physical form would conform to the specifications of the female body. In the 60's and 70's this system became the standard practice for the management of intersex. (Hausman, 2000) The appropriateness of surgery for the management of intersex remains a debatable issue. One of the most prominent cases that brought this question to light is the John/Joan case. A male baby John who lost his penis when he was just a few months old was had his gender reassigned by surgery by Money and his team. John then went on to grow up as a girl, Joan. However by the teenage years Joan developed a distinct preference for living as a male and at the age of 14 opted for another surgery to be assigned as a male once again. This case brought to light the hormonal aspect of the gender identity theory propagated by Milton Diamond. Diamond believed that the Y-chromosome present in intersex babies was reason enough to establish that they were male. John's experience revealed that he had a deep-seated sense of gender, which surgery and socialization could not reverse. (Butler, 622-625) Besides these the whole process of management of intersex therapy is flawed. To begin with the surgery happens without the consent of the person on whom it is performed. An intersex infant has no control over his/her gender assignment and is forced to live a role he or she may never feel comfortable with. The Joan/John case is a typical example even though John was not of intersex condition. The process of sex reassignment complicates familial relationships as parents are advised against telling their children about their condition. (Hird, 2003) Intersex patients also suffer mental trauma as they are subject to repeated surgeries and routine examination often in the presence of a large audience. In the John/Joan case for instance, Joan during childhood and adolescence was constantly monitored and even asked to disrobe in front of doctors who would then monitor her genital development. Joan was even asked to engage in mock-coital exercises with her brother. (Butler, 629) Irrespective of gender, such practices are likely to traumatize a young mind. Besides the trauma of repetitive surgery and public examination, people who undergo sex reassignment surgery are under constant stress to conform to the standards of their new gender. John in one of his interviews states, "There were little things from early on. I began to see how different I felt and was, from what I was supposed to be." The words 'supposed to be' reveals the mindset of the society. Post surgery John/Joan was expected to behave like a girl, right from his clothes to his toys, his choices were supposed to reflect the feminine. In some way the right choices are thrust on these people The current practice of gender reassignment is based on the idea that intersex children need a clear male or female gender identity and that their genitals must conform to the same. Driven by the ideas of normalcy medical practitioners repeatedly focus on assigning a stable gender. Even when psychoanalysis of intersex persons is taken up, the focus is on identifying the true gender of the person rather than dealing with significant psychological issues like trauma, shame, anger and frustration. (Hird, 2003, pg 1081). Hird goes on to discuss the common belief that the purpose of psychoanalysis is to help inter sex children with gender reassignment. While a small minority of medical practitioners like Dr. Daaboul feel the need for change in the management of intersex therapy, most others like Ian Aaronson, director of pediatric urology at the Medical University of South Carolina, believe that to advocate non-intervention in intersex infants until they are old enough to decide what gender they would like to adopt is a return to the dark ages.(Hird, 2003, p.1081) Conclusion The popular perceptions of heterosexuality and dualism in gender manifest themselves in the medical management of issues like intersex. Society allows the discrimination of gender minorities, which includes people with intersex condition. Legal systems across the world also endorse this form of discrimination. In most countries where there are laws on anti-description, the aspect of discrimination against transsexuals or intersex people is ignored. (Bird, 1998) This attitude towards intersexed people and other gender minorities has resulted in the belief that people with ambiguous sexuality cannot lead normal lives. Alongside, progress in medical technology enabled medical practioners to perform surgeries that can alter the anatomy of an individual and reassign his/her gender. As a surgery and hormonal treatment became the standard practice for intersex management However both experts and people with intersex condition now question this assumption that the human species is dimorphic. Intersexed people who have gone through this method of treatment believe that it has not helped them much. Their views are expressed by this statement published in the website of Intersex Society of North America, "Our intersexuality, our status as individuals who are neither typical males nor typical females---is not beneficially altered by such treatment. Instead, it is pushed out of the view of parents and care providers." History records evidence of the prevalence of a third gender and its acceptance in society. The foundation of Hindu Law, the Manu Smriti (c. 200 BC - 200 AD) even explains the biological origin of the thrd gender. It states, "A male child is produced by a greater quantity of male seed, a female child by the prevalence of the female; if both are equal, a third-sex child or boy and girl twins are produced; if either are weak or deficient in quantity, a failure of conception results."(Wikipedia) Mesopotamian mythology too has references to people who were neighter male nor female.The sumerian goddess Ninmah is assigned the role of standing before the king. People of the third gender were also assigned special religious duties in Babylonia, Sumer and Assyria,Similarly in Incan mythology, third gendered ritual attendents played significant roles in Andean ceremonies. In Thailnd people of the third gender are referred to as kathoeys (or "ladyboys"). As recent as 2004, kathoeys at the Chiang Mai Technology School in Northern Thailand were alloted their own separate restroom. (Wikipedia) In the western civilization, the concept of a third gender seems to be a more recent one.In the 19th century several writers like Karl Heinrich Ulrichs, John Addington Symonds and Magnus Hirschfeld who described themselves as belonging to the intermediate sex argued for social acceptance of sexual intermediates. (Wikipedia)Society inability to accept them was perhaps the reason for the popularity of surgery to assign gender. Ancient cultures on the other hand show an acceptance of the third gender as a natural occurrence. The differences in anatomy are recognized but not considered abnormal. Hence these cultures managed to assign specific roles to the third gender. Social acceptance and psychological counseling form an essential part of intersex management. Modern medicine like, Dr. Daaboul points out must learn from history and treat sexual ambiguity as a psychosocial issue not a medical problem. A paradigm shift in intersex treatment is essential. The focus should no be on finding out what people with sexual ambiguities like the intersex condition require rather than force them to accept a gender that means nothing to them. References Androgen Insensitivity Syndrome (AIS) Support Group website. Accessed on 27th October 2006 at http://home.vicnet.net.au/aissg/transgender_and_intersex.htm Bird, J, 1998, When Sex Means 'Condition' or 'Impairment': Evaluating the Human Rights of Transgender and Intersex Peoples. Accessed on 27th October 2006 at http://www.scu.edu.au/schools/lawj/law_review/jo_bird_article.pdf Butler, J., 2001, 'Doing Justice to Someone: Sex Reassignment and allegories of transsexuality' GLQ 7:4 Custance, A, 1980, The Mysterious Matter of Mind, accessed on 26th October 2006 at http://www.custance.org/old/mind/ch2m.html Daaboul, J.J, 2000, 'Does the Study of History Affect Clinical Practice Intersex as a Case Study: The Physician's View'. Paper presented as part of panel at the annual meeting of the American Association for the History of Medicine, Bethesda, May 19. Accessed on 27th October 2006 at http://www.isna.org/articles/daaboul_history. Hausman,B.L,2000, 'Do Boys Have to Be Boys Gender, Narrativity, and the Jon/Joan Case' NWSA Journal, Vol.12 No3 (Fall). Hird,M.J,2003, 'Considerations for a Psychoanalytic Theory of Gender Identity and Sexual Desire: The Case of Intersex' Signs: Journal of Women in Culture and Society 2003, vol. 28, no. 4, University of Chicago. Accessed on 27th October 2006 at www.queensu.ca/sociology/files/hird publications.pdf Intersex Society of North America Website. Accessed on 27th October 2006 at http://www.isna.org. Shildrick, M (EDT) Mykitiuk.R (EDT) 2005, Ethics Of The Body: Postconventional Challenges. Accessed on 27th October 2006 at http://books.google.com/booksid=dsE19xurRjAC&dq=+sex+reassignment+surgery+and+Intersex+therapy+Cartesian+Dualism&psp=9 Taylor,K., Mykitiuk.R, 2001, 'Gender Normalcy and Disability', ISUMA, Autumn 2001. Accessed on 27th October 2006 at www.osgoode.yorku.ca/faculty/documents/mykitiuk.pdf Wikipedia, Third gender. Accessed on 30th October 2006 at http://en.wikipedia.org/wiki/Third_gender Read More