Saturday, April 3, 2010

My Name Is Jesse - But I am not a boy

http://www.intersex-tr.org/img/intersex_logo_big.jpg

Very interesting - and disturbing - article in Newsweek. One wonders how many boys went through similar experiences as this young girl - and more to the point, how many boys are being feminized right now through ADHD medications, anti-rough-housing policies in schools (and homes), and other methods of making boys behave more like girls.

Some of the most interesting research in this area comes from intersex children (once known, wrongly, as hermaphrodites) who were given sexual assignment surgeries before they were old enough to choose for themselves (John Money, then at John Hopkins, was the leading advocate of this approach). This was done based on the belief that gender roles were completely socialized, just as Jesse's parents believed in this story. They were SO wrong. More on this below.

My Name Is Jesse

But I am not a boy. Inside my parents' failed experiment with gender neutrality.

Jesse Ellison in overalls for gender neutrality story
Courtesy Jesse Ellison

By Jesse Ellison | Newsweek Web Exclusive
Mar 23, 2010

When I was 2 years old, my father started building a big house behind our tiny starter house. For days leading up to the arrival of the giant trucks and backhoes coming to dig out the foundation, my mother tried to get me excited. "Don't you want to watch the big trucks?!" she'd tease. When they finally arrived, the neighborhood boys parked themselves on our property, transfixed. I glanced out the window and immediately turned back to my toys, ignoring the commotion. As my mother recalls, "It was really a wake-up for me."

This now-infamous family anecdote wasn't the first time my parents tried to shake off gender stereotypes. As a toddler, they dressed me in overalls and cut my hair in an androgynous bowl cut. I didn't have Barbies; I had wooden blocks. Even my first name is evidence of their experiment in gender neutrality. You can't imagine how many times I've had to explain, "No, not Jessica, just Jesse. Like a boy."

In 1978, the year I was born, feminists like my mother were embracing the notion that gender roles were entirely rooted in the way that you were raised. In the 1970s, the feminist fringe was giving up bras, shaving, and diets; they were lighting their own cigarettes and opening their own doors. It was the "new feminism," and where the first movement was concerned with legal equality, like the right to vote, these women were focused on de facto equality: asserting that it was nurture, not nature, that made women and men different. To bust out of gender oppression also meant to assert that there was absolutely nothing different about our biological makeup.

My family, by and large, was removed from societal pressure. We lived in rural Maine, we didn't have a television, and my mom and dad had matching short haircuts. (A few years before that, they'd had matching braids that went all the way down their backs.) But my parents' little project in gender neutrality (namely, me) was, from the get-go, a total failure. As soon as I could speak, I demanded they replace my overalls with a long, pink, lacy dress. Far from gender-neutral, I was emphatically, defiantly a "girl."

"We all thought that the differences had to do with how you were brought up in a sexist culture, and if you gave children the same chances, it would equalize," my mom says. "It took a while to think, 'Maybe men and women really are different from each other, and they're both equally valuable.' "

Since then, of course, countless studies have shown that men and women think and behave differently—to the point that it's not the existence of these differences, but the source of them, that is the subject of any debate. By the time my generation came of age, women could call themselves feminists and also embrace the standard trappings of femininity. We could wear pink, spend money on fancy shoes, and simultaneously expect—no, demand—the same success as men. Femininity and feminism were no longer a contradiction.

But maybe my generation is evidence of our having swung too far in the other direction. In the last decade, the reigning role models for young girls included Paris Hilton, swathed in pink and practically bedazzled. "There's so much emphasis on appearance that is part of what women have to do [today]," says gender-studies professor Susan Brownmiller. "You have to be a babe, in addition to everything else. Looking like a sex object but also claiming the rights of women who are not sex objects—that's tricky." By turning our back on our mothers' gender-neutral principles, all while taking it for granted that they had fought the great fight and won, we were unprepared for the fact that sexism still exists.

My generation is different from my mother's, in countless ways. But just because we chose high heels over Birkenstocks, it doesn't mean our commitment to equality should be any less than ardent. Now that I'm older, and a little bit wiser, I love that my parents were so consciously trying to foster androgyny. Ultimately, the whole point was to ensure that I had the freedom, and choice, to be whoever I wanted—which is, after all, what feminism is all about. And even though it's still cause for confusion, I even like my name. Actually, given that the alternatives included—true story—Oyster and Wing, I love it.

For more on feminism, check out NEWSWEEK's article on young women and sexism and the authors' new blog, The Equality Myth .
I have always been intrigued by intersexuality and what it suggests about the possible fluidity (or not) of human sexuality and gender roles. Some of the early surgical interventions have gotten it horribly wrong and seriously screwed up the lives of those children.

This failed approach is a perfect example of what Jesse's mother and so many others believed - and were SO WRONG about - that gender roles are purely about socialization and nothing else. We now know that gender is biopsychocultural - and you cannot remove any one of those factors without disrupting identity.

Here is the story of how wrong they were and what the research shows.

Under the theoretic leadership of psychologist John Money, the Hopkins team believed that gender was all about nurture—that you could make any child into a “real” girl or boy if you made their bodies look right early (before about 18 months of age), and made them and their parents believe the gender assignment.

Though the Hopkins team wrote early on that children should be told the truth about their intersex histories in age-appropriate ways, in practice many medical care providers lied to patients or actively withheld medical history information from them.1 Medical textbooks frequently gave doctors advice about how to lie to patients with intersex.2

As the Hopkins model spread throughout the developed world, surgeons performed cosmetic genital surgeries on intersex children without their consent, believing this was necessary and efficacious. Endocrinologists, meanwhile, manipulated patients’ hormones to try to get the bodies of patients to do what they thought was necessary not just for physical health, but for psycho-social health (i.e., getting the body to look sexually “normal”).

So what was wrong with this model?

To start with, lying to patients is not only unethical, it is bad medicine. Patients who were lied to figured that much out, and often stopped getting medical care they needed to stay healthy. (For example, some stopped taking hormone replacement therapy—critical after gonadectomy—and wound up with life-threatening osteoporosis at an early age.) They also suffered psychological harm from these practices, because they got the message that they were so freakish even their doctors could not speak the truth of their bodies to them. (A lot of doctors still have not told their present and former patients the name of their conditions. Some still withhold medical records from patients and from parents/guardians of minor children.)

Second, the system was and is literally sexist: that is, it treats children thought to be girls differently than children thought to be boys. In this approach (still going on at Hopkins so far as we can tell), doctors’ primary concern for children thought to be girls is preservation of fertility (not sexual sensation), and for children thought to be boys, size and function of the phallus.

Third, the “standards” used for genital anatomy have been arbitrary and illogical. For example, under the “optimum gender of rearing” model, boys born with penises doctors considered small were made into girls—even though other doctors believed (and showed3) they could be raised as boys without castration, genital surgery, and hormone replacement. Girls with clitorises their doctors think are “too big” still find themselves in operating theatres with surgeons cutting away at their healthy genital tissue.4

Paradoxically, though all medical experts agree the identification of intersex anatomy at birth is primarily a psycho-social (not medical) concern, it is still treated almost exclusively with surgery. Parental distress is treated with the child being sent off to surgery. This is not an appropriate form of care for parents or children.5

There is no evidence that children who grow up with intersex genitals are worse off psychologically than those who are altered. In fact, there is evidence that children who grow up with intersex genitals do well psychologically. In other words, these surgeries happen before the age of assent or consent without real cause. “Ambiguous” genitalia are not diseased, nor do they cause disease; they just look funny to some people.

There is substantial evidence that people who have been treated under the “optimum gender of rearing” model have suffered harm, psychological and physical. This does not mean doctors intended to harm their patients; far from it. But good intentions are inadequate reasons to maintain a practice that has shown to be unethical and unscientific.

Finally, parents consenting to intersex surgeries do not appear to be fully informed about the available evidence, about alternatives available to them, about the risks associated with surgeries, or about the theoretical problems underlying the “optimum gender of rearing” approach. For example, they are typically not told the evidence that gender identity may emerge to an important degree from prenatal hormonal actions on the brain—and thus, that you can’t “make” a child a maintain a particular gender identity in the long term by doing surgery on him or her in infancy.6

To read more about the problems with the traditional treatment of intersex, see Alice Dreger’s ‘Ambiguous Sex’—or Ambivalent Medicine, The Hastings Center Report, May/June 1998, vol. 28, issue 3, pp. 24-35.

1 For examples of people who were lied to and deceived, check out Hermaphrodites Speak and Chrysalis.

2 For documentation, see Alice Domurat Dreger, Ambiguous Sex—or Ambivalent Medicine? Ethical Issues in the Treatment of Intersexuality. Hastings Center Report, 28, 3 (May/June 1998): 24-35.

3 For evidence boys with small penises do well without sex re-assignment, see Justine M. Reilly and C. R. J. Woodhouse, “Small Penis and the Male Sexual Role,” Journal of Urology, 142 (1989): 569-571, and see the autobiography of Hale Hawbecker in Intersex in the Age of Ethics.

4 See what UCSF’s Laurence Baskin and Indiana’s Richard Rink had to say at the American Academy of Pediatrics Urology Section’s 2004 annual meeting.

5 See Edmund G. Howe, “Intersexuality: What Should Care Providers Do Now,” Journal of Clinical Ethics, 9, 4 (Winter 1998): 337-344, reprinted in Intersex in the Age of Ethics.

6 On this point, see William G. Reiner and John P. Gearhart, “Discordant sexual identity in some genetic males with cloacal exstrophy assigned to female sex at birth,” New England Journal of Medicine, 350, 4 (Jan. 22, 2004): 333-341, summarized and reviewed by Vernon Rosario; see also our FAQ Who was David Reimer?; and see Pediatric Assignment of Sex: A Critical Reappraisal.

Now, the Intersex Society of North America opposes any kind of sexual assignment surgery, but does advocate medical testing and basing gender role socialization based on those results.

But how do you pick a child’s gender if she or he is intersex?

The child is assigned a gender as boy or girl after tests (hormonal, genetic, radiological) have been done and the parents have consulted with the doctors on which gender the child is more likely to feel as she or he grows up.

We know, for example, that the vast majority of children with complete androgen insensitivity syndrome grow up to feel female, and that many children with cloacal exstrophy and XY chromosomes will grow up to feel male.

Why shouldn’t children with intersex be raised in a “third gender”? We advocate assigning a boy or girl gender because intersex is not, and will never be, a discrete biological category any more than male or female is, and because assigning an “intersex” gender would unnecessarily traumatize the child.

In cases of intersex, doctors and parents need to recognize, however, that gender assignment of infants with intersex conditions as boy or girl, as with assignment of any infant, is preliminary. Any child—intersex or not—may decide later in life that she or he was given the wrong gender assignment; but children with certain intersex conditions have significantly higher rates of gender transition than the general population, with or without treatment.

That is a crucial reason why medically unnecessary surgeries should not be done without the patient’s consent; the child with an intersex condition may later want genitals (either the ones they were born with or surgically constructed anatomy) different than what the doctors would have chosen. Surgically constructed genitals are extremely difficult if not impossible to “undo,” and children altered at birth or in infancy are largely stuck with what doctors give them.
The more we understand about the biological, psychological, and cultural foundations of gender identity, the better equipped we are to help boys (and girls) develop appropriate and healthy gender identities.


1 comment:

MissMysterics said...

The problem here isn't neccisarily the idea that gender roles are completly socialised is wrong.

The gender roles ARE completly socialised, that does NOT mean that men and women are not inherently different, got it?
(even then, it's the majority, not the whole lot of them.)

Becuase I hate makeup and do not like dresses does not mean I have a 'distrupted identity' as a woman, I just think dresses and make-up look tacky and gaudy, like spending all your money on a beautiful but usless car.

The problem here is that Jesse's parents were denying her of her personality, not her gender role.