Book Review: Contesting Intersex: The Dubious Diagnosis

20 Jul

book review

The question of intersex is one that challenges not only the medical community, but our entire society, encouraging us to see gender and sex (and even sexuality) as more complicated and nuanced than we might regularly imagine. The very existence of intersex bodies demands a decoupling of gender from bodies, and a dismantling of essentialist, binary views. Georgiann Davis’s new book, Contesting Intersex: The Dubious Diagnosis (2015, NYU Press), explores the role of language, medicine, and gender structures in shaping the experiences of intersex people (alternatively, people diagnosed with disorders—or differences—of sex development, DSD).

In particular, she studies the linguistic shift from ‘intersex’ (or hermaphrodite, and variations of these terms) to the new diagnosis common within medical circles, ‘DSD.’ Her key argument, amply demonstrated by interviews with members of the intersex community, doctors, activists, scholars, and parents, is that the language used to describe intersex bodies has important ramifications for the lived experiences of intersex people.

There are several important findings to support this argument. She shows historically that the medical community was primed to accept this terminological shift, at least in part to reassert their power over intersex bodies. John Money, a doctor famous for his claims that ‘nurture’ would always win over ‘nature’ in gender identity, sullied the medical community’s relationship to ‘intersex.’ Money lost credibility after encouraging parents of a male child to raise him as a girl after a botched circumcision left him mutilated. “She” eventually committed suicide, and the suicide was taken as evidence that his innate male gender could not be replaced by feminine gender socialization. This seemingly mismanaged case of sex-gender identity, along with increasing pressure on the medical community by feminist and intersex activists, meant that doctors’ authority over the diagnosis was publicly questioned. When the new diagnostic term ‘DSD’ was proposed, doctors jumped at the chance for a fresh start.

Allowing the medical community to determine the public understanding of ‘intersex’ or ‘DSD’ has important ramifications. For example, the medical community perpetuates biologized understandings of sex, gender, and the body. These understandings are used to justify medically unnecessary surgeries to “normalize” the genitalia (often at the expense of sexual sensation, and almost always at the expense of the patient’s sense of autonomy and self-determination). When coaching parents on how to raise their intersex child, doctors often encourage enforcing gendered expectations—discouraging girls from tomboy behaviors, and encouraging boys into more vigorous activities. In particularly upsetting passages, Davis exposes doctors’ sexual expectations of intersex women in particular, surgically shaping women’s bodies for penile-vaginal penetration.

Davis also documents that the language shapes intersex individuals’ experiences, beyond surgical intervention. Based on her interviews with intersex people, she finds that those who embrace the ‘DSD’ terminology have a more positive relationship with their doctors and parents—in Davis’s terms, they have better access to biological citizenship than those who use the more politicized term, ‘intersex’—but have a more troubled sense of self. She explains that this is likely due, at least in part, to the stigmatizing effect of seeing oneself as ‘disordered.’ In contrast, those who utilized ‘intersex’ had a more positive sense of self and a better relationship to their gender identity and sexuality, but often found themselves at odds with doctors. The terminology is a source of trouble within the intersex community as well, leading some activists to be at odds with one other over wording, something that concerns Davis because in-fighting may take away from more important battles.

Ultimately, this book is an important read for gender and sexuality scholars, as well as medical sociologists. Davis deftly challenges binary categories and the power of medical diagnoses. Her writing is engaging and, at times, personal—she shares her own experience as an intersex person, describing intimate conversations with her parents, problematic medical episodes, and her activist-academic desires. The book would also work well in advanced undergraduate classes or graduate seminars on gender, sexuality, and bodies, but I would highly recommend implementing it in classes aimed at non-sociology majors. For example, I’d love to see this on syllabi for medical sociology classes, which are frequented by pre-med students, who are an important but likely overlooked audience for this book. As teachers, we can also be activists, shaping the minds of our students who, in this case, will be the next generation of doctors encountering intersex bodies.

 

 

Amanda Kennedy is a contributor and founding editor of Masculinities 101.

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