by Alice Dreger
Eventually I couldn’t stand it anymore. I just burst out laughing, dropping the tour brochure on the floor. I picked it up and found the docent giving me a rather severe look. But I couldn’t help myself. I started laughing uncontrollably again.
Somewhere on the crazy journey of the last few years, I stopped laughing at the image of Galileo’s mummified middle finger and started thinking of it as a personal talisman. I would contemplate it to remind myself of certain propositions: That the mythical Galileo, a perfect man who could see beyond his own needs and his own psychology, never really lived—that uncomplicated heroes don’t exist among the living. That all of us are struggling with the question of who we are. That sometimes people put you under house arrest because they honestly believe it is for the greater good. That it can be very hard in a moment of heated debate to tell who is right—it can take a hundred years and a thousand people to sort it out. As one person trying to get it right, sometimes the best you can do—the most you can do—is point to the sky, turn to the guy next to you, and ask, “Are you seeing what I’m seeing?”
CHAPTER 1
FUNNY LOOKING
YOU KNOW YOU’VE HIT UPON an interesting research topic when in a single week you get interview requests from both Penthouse magazine and Christian Life Radio. And you know you’re doing something promising when both interviewers tell you they agree with your political stance.
That was my life, and this was my stance: Children born with genitals that look funny but work fine should not be surgically altered just because their genital appearance upsets or worries some adult. Big clitorises shouldn’t be shortened, and baby boys with very small penises shouldn’t be sex-changed just because their phalluses induce Freudian crises of confidence in their caregivers. People have the right to grow up with their genitals intact unless there is some dire medical emergency.
Not too surprisingly, the interviewers from Penthouse and from Christian Life Radio didn’t agree with each other on the reasons for backing me up. The Penthouse guy’s attitude was that no one should mess with your sexuality without your consent. He understood that the elective pediatric “normalizing” surgeries in question carry a lot of risk to sexual function and health and that sexual function and health really matter to one’s life. Meanwhile, the Christian radio guy’s position was that God doesn’t make mistakes when he sends babies into the world. He didn’t see the children in question as tragic failures meant to be corrected by some surgeon who apparently thinks he’s more skilled or more compassionate than God.
I liked both their attitudes because, heck, it was 1998, and somebody in the real world was agreeing with me—just what the pediatric surgeons were telling me would never happen. Two somebodies, even! I mean, sure, the surgeons expected my message to be championed by my fellow academic feminists with hair as short and glasses as rectangular as mine, but that, they assured me, would be the limit of the “tolerant” population as far as genital anomalies were concerned.
“Honey,” a very high-up surgeon once said to me right around this time, after hearing one of my talks, “you just don’t understand. The parents in our clinics can’t handle this.” When a baby is born with ambiguous genitalia, he explained to me, the mother cries, and the father gets drunk. If you let a child with ambiguous genitalia grow up without surgery, he went on, the kid will commit suicide at puberty. That’s just the way it is. You can’t change society.
The surgeon telling me this apparently thought that I, a lowly assistant professor not long out of grad school, would simply yield to his authority, as did his medical students and residents and the parents of his patients. But I knew these surgeons’ central argument—you can’t change society—to be simply counterfactual. Here I was, a woman, in pants, with a PhD; my identity had come into existence only because society had been changed—and quite recently, too. But if I tried to tell these surgeons that together we could change society, they would see me as wanting to sacrifice babies on the altar of a radical social agenda. So instead I just took to answering these docs with a joking paraphrase of another uppity historian, Winston Churchill: History will vindicate me, and I will write the history.
I kept reminding myself, you can’t really blame these guys for their myopia. Surgeons are taught to think in terms of days and weeks. They are trained to focus intensely on the surgical field immediately before them. I had an advantage here, being trained in history. Temporal depth perception spanning millennia means you not only can see the potential to enact meaningful social change in terms of identity politics, but also you can see that, no matter what you do, you’ll eventually be forgotten. There’s something really liberating in knowing you don’t matter.
• • •
HUMAN SEX COMES in two big themes—male and female—but nature seems to enjoy composing variations on those themes. Some sex variations occur at the level of sex chromosomes, some at the level of hormones, some at the level of hard-to-detect internal structures, and some at the level of anatomical parts you can see with the naked eye (assuming your eye isn’t the only thing that’s naked). If you call all of these variations intersex, you can then ask how common intersex is. That’s a question people love to ask. The problem is that to answer that question, one has to first decide how subtle a variation to count. How small should a penis be to count as intersex rather than male? How big a clitoris should count? How subtle a difference in hormone receptors? The truth is that human sex isn’t simple. Human sex is practically fractal.
Nevertheless, wherever nature draws unclear boundaries, humans are happy to curate. And the specialist curators of sex tell us this: In America today, about one in two thousand babies is born with genitals so notably intersex that a specialist team is immediately called in. About one in three hundred babies has genitals unusual enough that the average pediatrician will give the parents a referral to a specialist. If you add up all of the dozens of kinds of sex anomalies—including incredibly subtle things you might never know you had without the benefit of a lot of fancy medical scans your insurance company probably doesn’t want to cover—the frequency of intersex in the human population comes to about one in a hundred.
I was twenty-five and in graduate school before I ever learned that sex anomalies happen in humans. Years later, when I had become an assistant professor, I found out that a boy I’d grown up with had been born with ambiguous genitalia. My mother revealed this to me after reading some of my work, and when she revealed it, I asked her where that old friend was now. I told her I wanted to connect him with the support groups that had sprung up.
“Oh no,” she answered, “we never told him.”
This was exactly what I was then documenting in my work—how babies born with sex anomalies were “fixed” and then promptly swaddled in shame, secrecy, and lies.
The topic of hermaphroditism had been suggested to me early in my graduate career by Fred Churchill, the man who became one of my dissertation directors. Fred didn’t understand feminism—I remember that, one day, he admitted, befuddled, “I still don’t get what’s feminine about feminism”—but he believed in supporting students’ interests, and mine was gender. Following Fred’s suggestion, I thought I should look at the history of embryology and Charles Darwin’s study of barnacles. (Those barnacles were hermaphroditic.) But Fred kept saying, “Look at medicine.” Why? I wondered. Hermaphroditism doesn’t happen in humans past the embryonic stage. Then a second graduate advisor who knew I was on to hermaphrodites also said, “Look at medicine.”
So I looked. I went over to the university’s main library and pulled the second H volume of the worldwide index of nineteenth-century medical literature, The Index-Catalogue of the Library of the Surgeon-General’s Office—the comprehensive government-run index of medical reports that eventually came to be known as PubMed. To my shock, there I found pages and pages listing case reports of human hermaphrodites from the 1800s. Hermaphroditism in newborns, in children, in adults, and i
n dead old people who just happened to get dissected by some lucky anatomist. Cases recorded in England, France, Germany, Poland, the United States, India, and just about every other locale known to Western medicine.
Why had I never heard of this?
I decided then to do my dissertation work on the history in science and medicine of what happened to the people labeled hermaphrodites in late-nineteenth-century Britain and France. These were people who either had mixed-sex anatomy externally or who were found via surgery or autopsy to have one apparent sex on the outside of the body and the other on the inside. There was a nice set of about three hundred papers, mostly medical journal articles, that I could use as my primary sources, and the period was particularly interesting because it was a time when homosexuals and women had started agitating to loosen gender norms. I figured it would be interesting to see what medical and scientific men, who tended to be politically conservative, did when confronted with natural sex blurring, given that their abhorrence of women’s suffrage and men-loving men was based on the “fact” that such things were fundamentally unnatural. Britain and France also made practical sense because they would be nice places to go on dissertation grants, and I could read English and French. Truthfully, the French was sometimes hard, but Fred helpfully suggested that translations often go faster if you drink a bit of wine from the region where your texts originated. (I still can’t drink French wine without thinking about sex.)
During a cold snap in February 1994, I flew to Bethesda, Maryland, to the National Library of Medicine, to collect more material for my work. On the plane, I was seated next to an army doctor who was in charge of HIV management for the military. He asked me what I was working on, and upon hearing me describe my project, he sternly said to me over his reading glasses, “Hermaphrodites are not a marketable skill.” Even so, it was obvious he wanted to hear more.
In history as in science, you look for what changes and what is stable, you look for correlations, and you pray to find evidence of causation. I had a lot of data to work with—more than I could manage with just my brain and marginalia—so I took my three hundred primary sources and created a computer database of their components to see what patterns I could find. I tracked specific patients based on the demographics the medical reporters gave about them, to see if they might pop up more than once in the medical literature. (This enabled me to “watch” one poor nineteenth-century Frenchwoman with a herniated testicle wander from doctor to doctor looking for some productive help.) I cataloged individual scientists and doctors to track who was reporting what when. And then I cataloged each individual article’s specific report, opinion, or theory—if it expressed one—about Adam’s apples, beards, behaviors, breasts, clitorises, erotic orientations, gonads, hair, interests, labia, menstrual signs, penises, prostates, scrotums, skeletal proportions, uteruses, voices, vaginas, and vulvas. Doing this allowed me to sort, for example, by breasts, to see whether there were patterns or shifts in what medical and scientific men thought about the meaning of feminine breasts in a supposed man, or the meaning of perky nipples in a manly woman.
I ended up with notebooks filled with hundreds of dot-matrix-printed, three-hole-punched pages of data—and a growing clarity about what had happened. Over the course of the nineteenth century, there were more and more doctors, more and more people were going to doctors, and the medical profession was enabling and rewarding publication, so the incidence of reports of humans with sex anomalies shot up and up. This alarmed the medical men even as they were tremendously fascinated. After all, social order was based on the presumption that it reflected natural order, yet nature seemed to have a very bad habit of not picking up after herself.
Upon expert examination, a surprising number of people showed obvious external ambiguity in their genitals. Others mixed a masculine chest and beard with feminine genitalia or feminine breasts with a penis. Still others looked all well and good on the outside but were discovered (during surgery or autopsy) to in fact have the other sex’s organs inside. A very few even claimed they were clearly female as children but had become quite manly at puberty.
Notably, most of the people who showed up in the nineteenth-century medical literature with sex anomalies seemed either not to know or not to be terribly bothered. Sometimes a woman wanted an explanation as to why her vagina seemed to be too small to accommodate her husband’s penis. A man and his wife wanted to know why the husband seemed to bleed on a monthly cycle, while a chambermaid in another city wanted to know why she never seemed to menstruate. On rare occasions, a child or an adult was reassigned from one gender role to another after being diagnosed as a victim of “mistaken sex.” (The “mistake” was often blamed on some stupid midwife.) But most often, nineteenth-century patients with such traits just went on with their lives as before their clinical exam, probably never knowing just how high they’d made the doctors’ eyebrows rise.
Late-nineteenth-century medical and scientific men had little interest in changing social mores just because nature was turning out to be a bit churlish where sex was concerned. Instead they opted to impose order on nature as best they could. They came to a consensus by the 1890s that made sex look a lot more organized than it really was. They decided that “true sex” would depend only on the gonads: If you had ovaries, no matter how many manly traits they came with, you were really a female (though perhaps a female pseudohermaphrodite); if you had testes, then you were really a male (though perhaps a male pseudohermaphrodite); and only if you were absolutely positively proven to have both ovarian and testicular tissue were you a “true hermaphrodite.”
Conveniently, because biopsies were not possible at this time, the only people who could be conclusively labeled true hermaphrodites were at least castrated and more often dead. This approach pretty much neutered any threat that hermaphroditism might have posed to the social order. Virtually everybody was really male or female; sex just looked blurry to the untrained eye. Problem solved. As I documented this cleverly constructed solution to blurry sex, I decided to label this period the Age of Gonads.
Of course, not too much later—in the 1910s—biopsies did become possible, and the Age of Gonads had to cease. Suddenly doctors could conclusively diagnose working ovaries in men, working testes in women, and ovotestes in both—not a happy thing unless you’re a gender radical. So again doctors did what they had to do to preserve the two-sex social order. Although they still categorized a patient’s “true sex” according to gonadal tissue, in practice they classified patients according to which gender was most believable. If an attractive housewife happened to have testicles, no one besides her doctor needed to know her diagnosis of male pseudohermaphroditsm. If a man really was menstruating, you just quietly took his ovaries out and hoped no one found out about his insides. Doctors continued to clean up nature’s little indiscretions and thus take care not only of individual bodies, but also the social body.
Given the way intersex could always threaten a sexist two-gender society, this approach of “cleaning up” nature’s sexual “mistakes” persisted in American medicine, leading in the 1950s to the key collaboration at Johns Hopkins University of Lawson Wilkins, the founder of pediatric endocrinology, and the psychologist John Money. Together Wilkins and Money formalized this cleanup approach to sex anomalies. Modern medicine now sought to reinforce the “optimum gender of rearing” by early management of children born with sex anomalies by means of “sex-normalizing” surgeries, hormone treatments, delicate euphemisms, and sometimes lies.
This, then, was the system of concealment that led one day to my mother’s remark to me about my childhood friend: “Oh no, we never told him.” This was also the system that led to a lot of really angry intersex adults who discovered that they had been harmed by the medical care meant to “save” them and who knew the same basic system was still being used on children who would likely grow up as hurt and angry as they were. In the early 1990s, a core group of these people formed the inter
sex rights movement I eventually joined. Some of these intersex adults had been physically harmed—left with damaged sexual sensation, incontinence, or repetitive infections. Many had been psychologically harmed—left with a sense of having been too monstrous for their parents to accept as they came, of being sexually freakish, of being fountains of familial shame. All were left with a burning desire to try to save others from going through what they had.
I knew about the nascent intersex rights movement as I worked on my dissertation in Bloomington, but I mostly ignored it. My graduate school professors had taught me that history is about the dead. Yet shortly after I started to make public my research findings, I found myself in dialogue with Bo Laurent, the founder of the Intersex Society of North America (ISNA). As I recall, I first talked to Bo by e-mail using her public activist name, Cheryl Chase, a name she had hastily chosen as a nom de guerre early in her activism. As soon as I learned that another intersex activist named Bo Laurent lived in the same region of northern California as Cheryl Chase, I tried to bring Bo and Cheryl together. She politely explained I was trying to introduce her to herself. I easily fell into the habit of publicly referring to my work colleague, the leader of ISNA, as Cheryl, and privately calling my new friend Bo.
Bo was fascinated by my findings and immediately proved herself to be a voracious and intelligent audience of intersex history. Besides being geeks and history buffs, Bo and I shared what I later realized was a rare trait in activists: a belief in evidence even when it challenged our political goals. While it would have been convenient for Bo if I could have told her that no one in the nineteenth century sought surgeries to make their own genitals look or act more normally, she readily accepted my data that a few people did. She also readily accepted my conclusion that we couldn’t know much about why a few people in the 1800s seemed distressed about their own anomalous sex while most seemed fairly unconcerned. The data was incomplete, and rarely could it tell us about something as obscure as the psychological history of an unnamed, one-time patient who probably died before we were born.