Gender Jamboree, Part Two

I heard the squeak of the questing beast,

where it scratched itself in the blank between

the queen’s substance and the queen.

—Charles Williams, ‘The Coming of Palomides’

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Go here for Part One.

CW: genital injury, suicide

The Rebuke of Adam and Eve, Domenico Zampieri, 1646 (source).

Gotta love Adam's 'What?' shrug.

So! God made mankind in his image, male and female, and that’s normally pretty straightforward, but in a small minority of cases we find male and female characteristics mixed; we call this physiology intersex. Accurate estimates of how many people are intersex are difficult to find, as the subject isn’t well-studied, but an estimate of about 1% seems to be a safe generalization from studies that have been done to date, making it only a little less common than red hair.1

Ironically, this knowledge was actually a little more common until a hundred or so years ago. The twentieth century saw an extensive use of surgery on intersex newborns, modifying or eliminating their unusual characteristics; when these surgeries had yet to be developed, and most babies were delivered at home and by midwives, it was familiar enough to them to deliver the occasional intersex baby. Legal cases right down to the eighteenth century make occasional mention of intersex people.

Nor has intersexuality been wholly unknown to the Church. Although there are few references to the phenomenon in Catholic history, they are mentioned in passing (under the title androgynes) by St Augustine, and Gratian, the foremost canon lawyer of the Middle Ages, discusses them briefly. Those canonists who addressed the subject stated that if one sex could be determined to be predominant in an intersex person, that person should be treated as being of that sex (up to and including that a principally male intersex person could be validly ordained2), while allowing that there might be cases in which it was impossible to judge for certain which sex predominated in a person’s body. At least one cleric at that time gave the opinion that, in cases where someone’s physiology was evenly mixed, they were to be given the choice, under irrevocable oath (no pressure), of which was their sex.

However, to the best of my knowledge, only canon law has directly addressed intersexuality to date, and it’s done so rarely. Theological reflection on what defines male and female is not the same thing, though the two are related. St John Paul II’s extensive meditation on male and female in Theology of the Body may, after adequate unpacking, speak to the question; but even understanding, let alone unpacking, that tome is going to be the work of generations. And in the meantime, the sciences do have something more to say, which theology needs to operate upon. (Like any science, theology operates upon facts: the differentia of theology is that some, though not all, of those facts are provided by God’s revelation. The rest are derived from observation and inference, the same place we get most facts.)

The surgical ‘correction’ of intersexuality has come under fire. Initially developed in the 1950s, it was thought at the time that it would be easier for the child to develop as whichever gender they were raised, and that a confused identity would be avoided if the confusing body were adjusted. Nor was the practice even limited to intersex children. Anatomically typical male children who exhibited a micropenis,3 or whose genitals were irreparably damaged in infancy, in some cases received vaginoplasty and were raised as girls.

One notorious and particularly tragic case was that of David Reimer, born in 1965. His penis was destroyed in a botched circumcision4 a little before the age of two. His parents took the advice of Dr John Money (I swear I did not make his name up), a pioneer and advocate of performing sex reassignment in infancy, on the grounds that infants healed much more easily and completely and that surgeries of this kind would be less traumatic if they could not be remembered. Their son was surgically reconstructed as a girl, and raised in a thoroughly female environment. The much-crowed-over success of the procedure, accompanied by some very weird follow-up creepiness from Dr Money, lasted until he was 13. Reimer had never felt like a girl, he had become suicidally depressed, and he told his parents he would kill himself if forced to see Money again. The next year his parents told him the truth about his history, on the advice of his psychiatrist. Reimer then shed his feminine identity and began living as a boy again, seeking multiple medical interventions to restore his physical masculinity, including hormone treatment, a double mastectomy, and phalloplasty. He went public with his story late in 1997.

That story came to an end just over six years later. His relationship with his parents, naturally enough, remained difficult, and he struggled with unemployment; his twin brother died of an overdose in 2002; and in 2004, his wife of over thirteen years asked for a separation. Two days later Reimer shot himself in the head.

A superficially similar, if somewhat happier, case is that of Christiane Völling, born in 1959, who in 2011 became the first intersex person to win a suit for damages over non-consensual sex reassignment surgery. Born with XX chromosomes, her phenotype was unclear at birth: she had ambiguous genitals but was assigned and raised male (an unusual decision at the time, since, to use a very crude phrase, it was considered ‘easier to dig a hole than build a pole’), and experienced a relatively early, vigorous, masculine puberty. Völling was found to have an undeveloped but complete set of female reproductive organs during an appendectomy at age 14; she was told only that she was ‘60% female,’ which caused her severe psychological distress. Her female reproductive organs were removed four years later, despite the fact that the full details of her diagnosis had been withheld from her in the name of protecting her mental health. She continued for some time after that to live as a man, but eventually transitioned into life as a woman. She was awarded €100,000, nearly forty years later, for receiving an unnecessary surgery without being able to give informed consent.

Source.

So cases like these are clear-cut evidence of original biology over imposed sociology, right? Proof that no matter what you do to a person’s body through surgery, you can’t make a man into a woman or vice versa, and that trying to only makes them miserable. Right? Well … hang on. Before we can address that, we need to talk about gender dysphoria.5

Gender dysphoria is the distress a person feels due to their physical sex characteristics not matching their inner sense of gender identity. Most people who identify as transgender experience gender dysphoria, and vice versa, but the two aren’t the same thing. Reimer and Völling exemplify both the experience itself, and the therapeutic and medical steps generally taken to address it; the difference is that they were identifying with sexual characteristics that had been excised from them, whereas gender dysphoria is generally used to talk about people whose bodies have developed normally but whose identity or sense of self is in conflict with their bodies. And the thing is, both transgender identity and the dysphoria that typically accompanies it appear to be just as persistent—just as deeply rooted and intractable to all psychotherapy and socialization—as the gender identities that Reimer and Völling display.

This doesn’t mean that trans identities are therefore automatically valid and unquestionable, no. What it does mean is that our analysis isn’t finished yet. I'll discuss dysphoria and identity further in my next.

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1That the intersex minority is a small one is not, philosophically speaking, significant. What makes intersex bodies important to the discussion is that they exist at all, not how common they are.

2The canonists did say that intersex men could not be licitly ordained, due to canonical requirements forbidding the ordination of men with physical deformities. However, requirements of this kind could in principle be changed (as, e.g., the Church can and occasionally does relax the Roman ban on ordaining married men).

3A micropenis is a penis that is at least 2.5 standard deviations smaller than the mean. It is not a health risk, although it can be caused by growth hormone deficiency, androgen insensitivity, and certain other conditions, as well as by intersexuality.

4The late circumcision was an attempt to treat phimosis, a condition in which the foreskin is too constricting and impedes penile function. Treating phimosis is not generally considered necessary until after the age of three.

5Though it appears in current DSM manuals, this term is controversial in some circles, as some people consider it pathologizing and stigmatory. I can’t really get into that discussion right now; the thing that the term ‘gender dysphoria’ is talking about does exist, and the term is already in use, so, with apologies to any readers who are bothered by it, it’s the term I’ll use for the present.