Imposition of Gender-Williams - Intersex Peer Support::Bodies Like Ours

Intersexed experience has been explored in only a handful of psychoanalytic reports, none of which examine the effects of this treatment paradigm . This paper presents the case of a woman who feared she is intersexed. The dynamics, transference, and countertransference configurations reenact the empathic failure implicit in her medical treatment and her family life, namely a caretaker’s preoccupation with the patient’s unusual anatomy, rather than her trauma.

Introduction

Intersex conditions - the term refers to a range of anomalies of the reproductive system - are not especially rare; estimates are that 1 in 100 babies are born with genitals, genetics, or hormones that differ from standard male or female anatomy (Blackless, Charuvastra, Derryck, Fausto-Sterling, Lauzanne, & Less, 2000; Dreger, 1998). Physicians and parents faced with the birth of such a child must choose a treatment strategy that promises the best outcome given the current understanding of the complex genetic, hormonal, psychological, and social factors that form an individual’s sense of gender identity (Reiner, 1996).

Beginning nearly fifty years ago, Money argued that the stigma faced children with atypical genitalia could be prevented by the immediate, authoritative assignment of the infant to a sex and surgical alteration of the genitals to remove any hint of ambiguity; about one of every two thousand children are currently treated in accordance with this paradigm (Blackless et al, 2000). Money theorized that children under the age of two were psychosexually neutral, so assignment was based on projected

genital appearance, sexual function, fertility, and the desires of the family (Reiner, 1996). Because the success of this treatment was believed to depend on the conviction with which it was presented, any uncertainty by the parents as to the sex of the child was believed to threaten the parents attachment to the child and the child's forming a gender identity to match the sex of rearing (Kessler, 1998).

Although this seems an inarguably sensible approach, a considerable, heated controversy hinges on the phrase, “current understanding.” Each of these factors has been reexamined in the last decade: the psychosexual neutrality of the infant, the effect of prenatal hormones on gender identity, the outcome of surgery on sexual function and sensation, and the impact of repeated medical procedures on psychological development and family functioning.

This treatment approach has been based on extremely limited data, many of which have been subsequently challenged, and there is virtually no long-term follow-up research demonstrating its efficacy (Colapinto, 2000; Diamond & Sigmundson, 1997; Meyer-Bahlburg, Gruen, New, Bell, Morishima, Shimshi et al., 1996). Criticism raised about the existing paradigm by adults who were treated within it and advances in biomedical science, which are shedding new light on the complexity of sexual differentiation, have spurred the debate among physicians, ethicists, and patient advocates about how to help intersex children (Dreger, 1999a; Warne, Zajac & MacLean, 1998; Kessler, 1998).

One side argues that this treatment has been psychologically and physically harmful to at least some of its recipients, and that it violates the ethical principles of truth-telling, informed consent, beneficence, and authonomy (Dreger, 1999a). For instance, there is no evidence that the stress parents experience at the arrival of an intersexed child is alleviated or that attachment is facilitated by surgery, although this is the most often cited justification for the approach (Wilson and Reiner, 1998). Families and children were often discouraged from counseling “because of the almost certainly misguided assumption that talking about the reality...will undo all the ‘positive’ effect of the technological efforts aimed at covering up doubts” (Dreger, 1999b. p. 190). Surgical technique frequently sacrificed sexual sensation for cosmetic appearance and even by that measure yielded poor results (Creighton, 2001). Advocates contend that such surgeries have also not been demonstrated to determine gender identity; instead, clinicians who have encountered intersex adults whose gender identity does not match their sex-of-rearing concluded “we should be able to give an accurate prognosis regarding...gender identity on which to base gender-assignment decisions, but we are far from being able to do so at present” (Meyer-Bahlburg et al., 1996, p. 320). Patient activists argue that the patient should decide whether or not to have sexual surgeries when they are old enough to decide the consequences of this choice.

Supporters of the current paradigm of treatment argue that only a minority of patients have voiced dissatisfaction, more sophisticated surgical techniques and advances in basic science have improved results, one cannot develop a gender identity with ambiguous genitals, and virtually all parents want their children to receive surgery in infancy, before they are aware of their difference from typically sexed peers (Hendricks, 2000; Wisniewski, Migeon, Meyer-Bahlburg, Gearhart, Berkovitz, Brown et al., 2000, Meyer-Bahlburg et al., 1996; Money, Devore & Norman, 1986; Slijper et al 1999).

One of the few studies of the psychological adjustment of intersexed people was done by Money, the psychologist later responsible for the argument that intersex children should be surgically altered in infancy. Money’s study, done before the advent of modern treatment protocols, led him to conclude that his subjects were “living testimony to the stamina of human personality in the face of sexual ambiguity of no mean proportions” (in Colopinto,1999, p. 235). Inexplicably, Money would later call intersexuality, “the syndrome that stigmatizes the child as a freak - a sexual freak” (1987).

Nearly fifty years later, virtually the only long-term outcome study to evaluate psychological functioning found the picture was dramatically different for a contemporary sample treated with sex assignment, genital surgery, and psychological counseling of parents and child. Nearly forty percent of these intersexed children had developed psychopathology by age sixteen (Slijper, Drop, Molenaar, & Keizer-Schrama, 1998).

A full review of this controversy is beyond the scope of this article, but it is clear there are almost no contributions from psychoanalysis to it. In fact, one might conclude from a review of psychoanalytic literature that such anomalies and the treatment of them are nonexistent or meaningless. This seems a puzzling silence from the inheritors of the 20th century’s most elaborate theory connecting psyche to body ego. Psychoanalytic debate on gender identity argues the relative preeminence of biology, culture, and philosophy in forming theory. It is as if psychoanalysis has left these patients to the physicians who promise to reform the outlaw body, as Freud threatened to leave his defiant female homosexual patient in the hands of the genital surgeon of his time (1924). Clinicians who encounter intersexed patients have little more for guidance than their own beliefs about binary gender identity and its role in psychological health.

<< Start < Prev 1 2 3 4 5 6 7 8 9 10 Next > End >>

< Prev

[ Back ]