There is no surprise that clinical psychologists hold conferences, nor that they write
up their conclusions of the meetings and debates they attend. Except that something
at a conference in 2000 held by the Tavistock/Portman clinic caught one of the
attendees askance: a conference on gender identity entitled “Atypical Gender
Identity Development: Therapeutic Models, Philosophical and Ethical Issues.”
Presentations were given by psychiatrists, psychologists and clinicians working with
transgendered and intersex people in Britain, Canada and the USA.
Myra Hird was there, reviewed most of the lectures and then went on to describe the
common agreement of most of those on gender identity disorder (GID) in
transgendered or intersex people: that “normal” girls wear skirts and dresses whereas
“normal” boys prefer trousers. Hird reported her astonishment about all of this if only
“all the female clinicians, including the presenters were wearing trousers. Moreover,
none of the female clinicians in the small group wore nail polish or high heels and
use of make-up was minimal.”
All of the criteria identified ~ nail polish, high heels, make-up ~ were given as
expression of “normal” femininity; if these criteria were absent in girls/women these
were considered as indicator for GID. Hird convincingly concluded that the female
clinicians “made assessments of GID based on behaviors, roles, clothing and so on
which, by their own assessment, would render themselves as suffering from GID.”
The conference attendees attitudes and anachronistic belief-sets were carried into a
‘knowledge production’ of intersex even by “professionals” who, if only they looked
in the mirror, would find themselves condemned by their own severely restricted,
even prejudiced, theories.
Intersex medical practice is predicated on highly questionable assumptions: almost
all of them described by males in the febrile environment of 1950’s McCarthyite
America: a culture bounded by racial segregation, overt misogyny and legally upheld
homophobia. It is possible to contend that a significant strand of those attitudes
applied to intersex infants and young children, and furthermore are eugenic in
purpose and principle.
Money’s 1955 paper refers to the theories of Konrad Lorenz , a psychologist who
studied instinctive behaviour of animals, namely those of wild geese. Lorenz was a
psychologist during the habitually cruel and violent years of Nazi rule, and a member
of the Office for Race Policy: a situation that has a bearing on his later work. It is
why his theories are deemed so controversial today. Lorenz worked on eugenics and
degeneration during those years, and although Salzburg later revoked his
Professorship after his death in the light of revelations about his previously
undeclared Nazi past, the Nobel Committee did not revoke his award, so Lorenz
remains credited as a Nobel Prize winner.
Money’s statement in his seminal 1955 paper references Lorenz’s ideas.
‘gender role might be likened to a native language. Once ingrained, a person’s native
language may fall into disuse and be supplanted by another, but it is never entirely
eradicated. So also a gender role may be changed or, resembling native bilingualism
may be ambiguous, but it may also become too deeply ingrained that not even
flagrant contradictions of body functioning and morphology may displace it’ (Money)
Lorenz had become interested in evolutionary psychology and devised a theory that
processes of degeneration he recognized in birds may be at work in humans. His
‘degeneracy theories’ owed much to his lifelong belief in Nazi ideology: he was
funded by a ruling party that looked favourably on his theories that the human race
faced extinction as a consequence of genetic decline; itself a primary concern that
focussed the attentions of eugenicists. In one instance, during 1942, he participated
in a study of 870+ offspring of German-Polish marriages to determine their potential
for assimilating into German society. Those deemed inferior genetic material were
sent to the concentration camps, others were ‘Germanised’.
The world of psychology in the 1950’s wasn’t so very large that Lorenz’s background
was unknown to everyone. Indeed it seems it is now known to have been fairly
widespread knowledge. But the 1950’s was the era of US dominance, and the
deep/profound fear of communism that followed in it’s wake, whether real or
imagined. (Viz. McCartyism, the persecution of many in the arts and politics:
sometimes themselves Jews who had fled the Nazi terror). Medicine, like every other
sphere of life in 1950’s, was not immune to the moral panic and prejudices of the day.
Lorenz flourished, and was later awarded a Nobel Prize for his work in psychology.
It should give pause that Money felt comfortable citing Lorenz, and says more than
he or his acolytes was ever prepared to acknowledge, that Money’s theories were
situated in a much darker ideation that owed far too much to a longed for ‘purity’ of
humanity: something that eugenics has cravenly promised and took to it’s ultimate
end in the atrocities of the Shoah. Let it not be forgotten that the victims of that
genocide included members of the political opposition, union representatives, church
officials, gay men and women, transexuals, and anyone else who failed to fit the
atavistic savagery that dictated the so-called racial purity laws of that darkest stain of
human history: theories and laws upheld and promoted in his own work by one
Konrad Lorenz .
It is not difficult to extrapolate from these abhorrent practices the ideas that
underpinned intersex medicine, then and now. Abortion and genetic screening are
embedded, routine medical practices when addressing even the possibility of an
It’s a set of theories and practices that fit disturbingly well with the later adoption of
specifically designed medical practices toward intersex people.
When in 1952 John Money wrote his now legendary PhD thesis entitled
‘Hermaphroditism: An Inquiry in the Human Nature of a Paradox’ at Harvard
University: it was to prove the foundational beginnings of modern-day intersex
medical practice. The paper is still in publication ~ you can buy it from Harvard
University if you are prepared to pay top dollar. The paper has never been peer
reviewed and quite likely does not meet modern day standards of ethical practice.
All of this, yet the entire paper fails to produce the outcome that is most often touted
today: his dissertation makes the compelling case that anatomy does not influence a
person’s relationship to gender.
It flies in the face of what later came to pass, and it is worth asking, what exactly was
it that persuaded Money, the Hampsons and the rest of them at Johns Hopkins to
pursue their research into intersex that made sense at all if their sample of people did
not show any evidence that psychological unhealthiness was at all notably higher in
intersex people. What made them continue with their research if there was no
significant evidence of mental ill health in relation to what they call “sexual
incongruities”? What on earth was the relevance of their research if they had to state
“the most noteworthy finding of this study of psychologic healthiness in
hermaphrodites is the conspicuous absence of severe psychologic disorder”
The awkward fact that Money et al learned of those he studied is openly related:-
“In 95 per cent of our 94 cases, gender role and orientation corresponded
unequivocally with the sex of assignment and rearing, irrespective of incongruities
between this pair of variables, on the one hand, and one or more of the other five
variables of sex, on the other hand.”
In plain language, it mattered not a jot what the person’s anatomy consisted, they
were comfortable in the gender they grew up in.
It’s a remarkable situation that many know an intersex person, yet are unlikely to
know that person is intersex. Far from being ‘marked out’ intersex has become an
abstract, a circumstance that is discussed in a vacuum by people who fail to
understand that those who are intersex live in this world despite what they endure in
childhood, not because of what was inflicted.
Prejudice and ignorance of a lived experience is confirmed by the majority’s failure
to address the privilege that assumes what is done, is enacted, in the name of “care” ,
experimental practices are affirmed as legitimate simply by the confirmation of the
stigmatising that the majority fail to question in themselves. Procedures that would
not be countenanced on others ~ FGM is illegal in many jurisdictions, are routinely
enacted on intersex infants declared female (by often arbitrary means in the cloistered
realms of medical authority).
Surgical assignment doesn’t guarantee later adult declaration of gender, and doctors
know it, even if they don’t tell the parents. There are many examples of adults
living/presenting as someone other than the gender they were assumed to be in
infancy. Doctors estimate different variations in different ways, depending on the
expectations they place on the outcomes: in some at least 50% of the childhood sex
assignments as female are later found to be adults living as male or in other
The diagnosticism that saturates almost all discussions about intersex and the medical
practices enacted, by clinicians, parents and sadly too often by activists, only serves
to reify intersex as one of medical need.
It is no such thing.
For my part, I am wary to the point of refusal, of indulging in a diagnosticism that
pervades intersex medicine, a practice which medicalises and pathologises bodies
that are not in medical need of surgery. Almost all of the surgeries that continue to be
performed all too clearly serve to consolidate heteronormative ideals of embodiment
and gender identity.
Suzanne Kessler long ago coined the term “Cultural Genitals”. It describes how a
child is perceived as either a girl child or a boy child by the colour of the clothing
they are wrapped in. From that the unspoken assumption follows that the child
possesses the appropriate genitals according to the sex their clothing signifies.
Clothing becomes a signifier that sets the scene for the projected trajectory of that
child’s life. From there it is only a small step to associating that child with a given set
of culturally bound expectations of behaviour ~ our gendered selves, set to fulfil the
social role marked out by those neonate assumptions first delivered by the colour of
the clothing the child is wrapped.
In fact, as Money discovered all those years ago, the biological sex and embodiment
of a child is far less likely to indicate a person’s later gendered selves. Even more so
in intersex children, subject as they are to intrusive and overwhelming attention that
is determined to define and create them as medicine says they ought to be.
Witness too a trans movement populated by a significant if small number of intersex
adults who self declare as trans in open defiance of the social expectation that the
huge weight of medical effort placed on them, but who speak of profoundly traumatic
experiences at the hands of medics who refuse to accept that the intersex person at the
centre of all this unwanted attention has very clear ideas of their own about their
personhood. And it doesn’t include coercive surgeries that impair/deny sensate
experience and declare them to be someone alien to themselves.
Recently updated generalised medical procedural practices still declare that cosmetic
outcome is a goal of genital surgery. Outside the abusive and misogynist world of
pornography genitals are not in themselves there to be looked at: in their unmarked
state genitals are the most innervated part of the body, even if that part accounts for
just a few percent of the body’s surface. Taking a scalpel to such a small area of the
body, often repeatedly in intersex surgery, cannot fail to inflict damage.
And it does, often appallingly so. Whatever form of clitorectomy a surgeon willingly
enacts, it is ruled in law, that such a procedure is harmful. Yet not so for an intersex
child. No thought is given to the adult that child will become.
Tales told by intersex men and women are written off by clinicians as “anecdotal”.
Mere stories. Only doctors, it is insinuated, carry sufficient authority to talk about
these issues. Yet most adults remain “lost to follow up” and there is no longitudinal
evidence anywhere at all that details the lived experience of intersex people and the
lifelong outcomes of the procedures inflicted in childhood. It is as if the very
practices and procedures are sufficient in themselves.
Yet here we are, well into the 21st century, and children are still forced to undergo
genital surgeries that have no medical application, are routinely sterilised, endure
hormone procedures that irrevocably alter their bodies for ever and leave lifelong
consequences for the recipient that include osteoporosis, mental health issues, bodily
mutilation and stigmatisation ~ a circumstance that continues irrespective of the
degree of medical intervention or that person’s outward appearance and presentation
to the world.
Peter A. Lee, now immortalised in medical circles as the “father of the Consensus
Statement” is on record as saying:-
“feedback from former patients generally suggests that considerable variation is
preferred to surgery that will compromise sexual sensation. Hence, much greater
variation should be more acceptable than previously thought”.
Not willing to renounce the grip medicine, and surgeons in particular, hold over
intersex medical practice Lee insisted that
“if genital ambiguity is severe enough to demand a decision concerning sex of rearing, surgical reconstruction must be considered”.
Lee all too clearly illustrates the gate-keeping that doctors exercise over the
knowledge of intersex, and how it is presented to colleagues and parents alike. It
speaks of desperately wanting to maintain surgery’s relevance as a means of
What does it say that medicine has positioned itself as the regulator and manager of
intersex as a ‘type of person?’ It has done so by a producing a cascade of clinical
papers and initiating conferences, positioning intersex as an undesirable, an anathema
to acceptance that can only be ameliorated by medical intervention. Medicine has
been here before, in it’s classification of homosexuality as a mental illness. That was
officially ended in 1973, when homosexuality was removed from DSM ~ the US
published ‘official handbook’ of pathology.
The connection is compelling: intersex medicine openly shroud waves it’s distaste of
homosexuality, and posits that medical interventions clarify a clear outcome that
speaks to ‘normalising’ relations between what are now declared as men and women.
That orientation has no relation to intrinsic embodiment is not discussed, instead the
spectre of fearful potential inherent in an adult with a generous phallo-clit actually
achieving pleasurable experience is utilised as legitimising surgery without merit.
Nowhere is it declared that a phallus and a clit are homologues ~ made from the same
tissue. That to name the organ is to declare an interest in how that child/adult will
traverse the exploration of their own embodiment and abruptly curtail that possibility
before it begins.
In all of this intersex itself remains a nebulous, inchoate ‘phantasm’ repeatedly
conjured by medical authority and it’s apologists, only achieving solidity as a ‘type of
person’ by the very differences that cannot be seen, only darkly hinted at and
Nobody wears their genetic architecture on their sleeve, genitals remain safely out of
sight, concealed by clothing in all but the most intimate of circumstances.
Reproductive capacity is variable even amongst those with seemingly ‘regularly’
equipped reproductive capacity. The increasing frequency of reports that
environmental influences are reducing fertility points to reproductive challenges that
declare themselves in unforeseen ways to societies that continue to consider the
production of children as a birthright.
An insight into why these practices toward intersex children continue can be found in
an explanation of how intersex surgical body modifications – genital surgery on
infants who cannot give their consent: all form a basis for a constantly reproduced,
and enforced model of a heteronormative, misogynistic practice of ‘containment’ . A
model that serves to reinforce the phallocentric bias of the male/female dichotomy
that medicine continues to uphold and enforce by the application of those procedures
on intersex children.
That thinking dictates a female must not possess a phallus capable of erect, sensate
experience. Nothing must challenge the male’s dominance as the sole possessor of a
erectile phallus . Reducing the size of a phallus, now named clitoris to reflect the
declaration that the child is, in fact, a girl child is a direct means of reducing/containing any potential for sexual expression that does not conform to rigid heteronormativity, and receptivity to a male phallus.
The circularity of these practices is hard to avoid. The argument runs thus: these
practices exist because men and woman can only function fully in society if they are
fully complementary. It speaks to intersex embodiment as impairment, a disability.
It is predicated on the belief that a man must have an adequately sized penis capable
of penetrating a female, and that female has a ‘vaginal’ capacity sufficient to accept an
averagely sized erect male phallus. No talk of sensate experience must intrude, if
only because a scalpel cannot deliver such a thing.
Yet these same theoreticians fall at the first hurdle in their failure to acknowledge the
contradictions of a legacy of scarring, iatrogenic trauma (trauma caused by the very
practices that supposedly “cure” the individual of their assumedly impaired
personhood). And the mistakes made by assignment in the first place.
Intersex exists entirely as a product of medical discourse. By classifying what a man
and a woman should be in behaviour and embodiment, medics ‘created’ intersex as a
category. Intersex became the outlier simply because it failed to conform to the
ideals medicine adopted in the era of profound theological influence in society. Yet
medicine has no place in this at all.
Intersex is a circumstance of social and cultural expectations.
Who others expect to find before them when encountering another person, and the
assumptions that flow from there is governed by cultural expectations taught from
almost the first day of existence. It’s Kessler’s ‘cultural genitals’ from day one. Of the
concern about genitals, the moral panic instilled by the possibility that someone may
possess a body that doesn’t conform to expectation: it’s fair to say that it’s no business
of anyone else at all. It’s nothing to do with parents, that’s for sure. Yet it is parents
who are paraded as the sanctifiers of these vile medical practices, borne of cranky
philosophising long ago, in eras long before many of us today were born.
Parents accede for many often complicated reasons, some of which are related to the
stigma they feel on learning they have produced an intersex child, albeit with none of
the consequences which bear on the lives of the children at all. Parents are not the
people who have to live with the outcomes, are extraordinarily ill-equipped to deal
with the barrage of technical information they are subject to, yet it is parents who are
championed by doctors into consenting to what actually becomes a life long
circumstance for the intersex person. (Obtaining parental consent is a highly variable
situation in which doctors convey just exactly what they need, the better to secure
parental consent: in short, they are economical with the truth).
Yet it is clear that parents, overwhelmed by technical information they are not
supposed to understand are deeply invested in these procedures, if only to confirm to
themselves that they made the right decision in the first place. There isn’t any offer of
advice if the outcomes fail to meet the expectations of parent or (more importantly, in
their eyes at least) the medics who have held sway over the child’s development to
adulthood. Instead the affected adult is blamed: numerous are accounts of failing to
adhere to pharmaceutical interventions, little or no references are made to the
complexity of variables that alter how a particular person metabolises those
medicines or even how they might actually be counter productive to a child’s
Medical intervention is held to absolutists standards that will always be impossible to
attain, based as they are on subjective, often highly personal ideas. It is easier by far
to blame the individual at the centre of all the attention.
Intersex medicine is a vile abuse of otherwise heathy infants and young children.
Children find their own hormone balances irrevocably interrupted by sterilisation and
the advent of artificial HRT interventions: all of which have profound health
consequences throughout life. The occasions that an intersex child is born with an
endocrine imbalance are not managed by taking a scalpel to that child’s genitals. A
consideration that still passes doctors by without comment, in fact surgery is the first
consideration. Doctors and researchers are still convinced that dealing with
differently shaped genitals remains the crux of clinical management:-
“surgery in infancy should be aimed principally at creating the appearances of
normal external female genitalia, to alleviate parental distress”
The leviathan that is intersex medicine is predicated on salving parental distress, and
has been since Money et all did that 180 degree swerve from their first conclusions in
order to introduce medical management of intersex difference as an imperative.
Everything that has been written since, by clinicians and researchers alike, reinforces
the determination that intersex embodiment is an impairment that doctors seek to
‘cure’: a conclusion nowhere to be found in the foundation work Money was lionised
for throughout his long career.
To-date none of these stentorian voices of authority have provided evidence to
support their claims, nor is there any to be found. These procedures are done,
because that’s what has been done, and will be done until it is stopped by outside
agencies. Left to themselves doctors will continue ad infinitum.
In all of this intersex voices remain marginalised. Whether or not an intersex person
has been subject to any coercive procedure at all, and it is more likely than not, any
intersex person who dares to articulate questions about the legitimacy of processes
they have been subjected to, that have been repeatedly condemned as ‘torture’, are
themselves censured as having ‘no immediate relevance’ because ‘techniques have
changed in the intervening years.’
Yet here we are,all of us living with the procedures now disavowed as irrelevant. Doctors say
these things of everyone who is intersex yet deny it when faced with the reality of
their circumstance. Intersex medicine’s foundation and continuance is a tissue of lies.
It isn’t only the techniques that are the subject of articulate condemnation, although
they are vile enough, it is the theoretical underpinnings that continue to uphold these
practices that articulate intersex advocates interrogate. That they do so goes a long
way to explaining exactly why intersex voices so often remain marginalised in the
Once someone is marked by the weight of medical expectation of an unwanted and
unasked for induction into a medicalised intervention which pre-emptively decides
how that child will be as an adult, then their life narrative is systematically ‘owned’
by medical authority. It is medics who pronounce and decide; in those circumstances
it becomes all too easy to understand why intersex voices remain sidelined.
The various theorems and strategies and procedures procured as ‘the answer’ to the
moral panic instilled into parents by doctors simply in order that those same medics
can then ‘manage’ the outcomes were embedded in the first decades that these
practices were being adopted. By the time those first wave intersex activists were
motivated to speak out medicine had already confirmed to itself the rightness of it’s
own self-reverential practices.
The disruption caused by that early intersex activism has produced it’s own
unforeseen, and unwanted consequences. The broadcasting of the lived experiences
of with-holding medical information, of the lies told to access and procure surgeries,
of the consequences to the mental health of people who have been arbitrarily
assigned by coercive means a sex and the ejected into the world without any
reference points were all laid out in plain sight for all to see.
Today we can see the results of that initial, failed enterprise. Doctors have retreated
behind a blizzard of genetic information, dehumanised nomenclature, the welter of
which is designed to overwhelm the non-specialist (most importantly, parents) and
confirm, as if there had been any real doubt, that medics, and only medics are the sole
arbiters of authority in the obviously complicated situation of being intersex.
Intersex medicine has evolved and developed entirely to placate and assuage the
fearful phantasmagoria that moral panic engenders; a terror of an unknown that
clinicians themselves have produced in order to legitimise what are recognised as
abusive, mutilating practices. Instead intersex is an abstract that stands as the
nebulous representation of all that parents and the society they inhabit believe is
unspoken and unwanted.
Intersex has been routinely appropriated, instrumentalised and more prosaically,
thrown under the bus, as other vested interests co-opt whatever facet of intersex most
appeals to them. All the while the people at the centre of these abstractions continue
to live with the consequences of practices that have changed hardly at all since their
We are long into the 21st century, and young people are increasingly questioning the
apparently immutable notions surrounding what it means to be male or female. Why
intersex continues to be segregated from that discussion, regarded as a ‘special case’
by many reflects the persistence of medical influence over the lifetime trajectories of
intersex lived experiences. It is long overdue those influences were sidelined instead
giving preferential, even privileged bias to the expectations of the affected individual
and their life choices. None of which threatens anyone, and, as Money learned in
those far off years of mid 20th century.
Speak to us by our name as you would others, not continue to construct some
contrived nomenclature that segregates and ghettoises us as monstrous, made real
from some mythological phantasm that never existed.
We know who we are and how we want our bodies to be. It is our life, it is ours to
decide how to live it.
Carpenter M 2016: The human rights of intersex people: addressing harmful practices
and rhetoric of change: Reproductive Health Matters
Carpenter M August 2014: Diversity & power in mental health services: Addressing
structural violence Structural violence, intersectionality and intersex Presentation for symposium at The MHS
Crissman et al 2011: Children with disorders of sex development: A qualitative study
of early parental experience: International Journal of Pediatric Endocrinology
Hird, M (2003b): ‘Considerations for a Psychoanalytic Theory of Gender Identity and
Sexual Desire: The Case of Intersex.’ In: Signs: Journal of Women in Culture and
Society 28 (4): 1067-1092.
Holmes M 2008: Intersex A Perilous Difference: Susquehanna University Press
Kessler S 1990: The Medical Construction of Gender: Case Management of
Intersexed Infants: The University of Chicago Press
Lee et al 2006: Consensus Statement on Management of Intersex Disorders Pediatrics
Vol. 118 No. 2 August 1, 2006 pp.
Money, J. (1952): ‘Hermaphroditism: An Inquiry into the Nature of a Human
Paradox’, doctoral dissertation, Harvard University
Report of the Special Rapporteur on torture and other cruel, inhuman or degrading
treatment or punishment, Juan E. Méndez: February 2013
Schutzmann et al 2006 Psychological Distress, Self-Harming Behavior, and Suicidal
Tendencies in Adults with Disorders of Sex Development:Arch Sex Behav (2009)
Also, my personal thanks to (Name with held) for
Gedanken einer Mutter
A personal correspondence with the mother of an intersex child