The Medical Intervention of Sex

The Medical Intervention of Sex

The relationship between medicine and the intersex community is one with a tempestuous past, and uncertain future. Evoking discussions of gender, biology, sex, and identity, the role of medicine in the lives of intersex individuals is deeply complex and historically under documented. Middlesex, by Jeffery Eugenides, defies this pattern with a narrator who will become the “most famous hermaphrodite in history” (Eugenides 19). Although this term is now outdated, Cal Stephanides narrates the novel through the chronicles of a mutated SRD5A2 gene as it travels through generations of his family’s DNA and eventually manifests itself as the 5alpha reductase deficiency that shapes Cal’s coming of age story. Through a closer analysis of Cal’s experience, and an understanding of the greater issues it raises about the nature of medical intervention for intersex conditions, Eugenides demonstrates the impact of his work by framing questions that have gone unanswered for centuries. By constructing a discussion around notions of power, language, and technology, we can begin to scratch the surface of the problematic reality for intersex individuals through the lens of Western medicine.

POWER

Although the idea of the physician as an authority figure and source of

knowledge is not specific to the experiences of intersex patients, the concept of power manifests itself quite strongly within the novel. In Book 4 of Middlesex, Cal’s parents meet with Dr. Luce, the world renowned sexologist who has taken on Cal’s

case following a recommendation from the emergency room medical staff who are the first to notice his ambiguous genitalia. Milton and Tessie meet their visit to Dr. Luce’s practice with anxious anticipation, and the news that there could be a definitive, genetically based disorder to blame for their daughter’s lack of feminine development is devastating to the idealistic image of the happy American family that they have subscribed to. Their fears are momentarily suspended by Dr. Luce’s professional appearance, which looks “reassuringly medical” (Eugenides 426) owing to his white coat and sketchpad. Cal is retrospectively cognizant of the authority Dr. Luce has over his parents, when, like their conformist understanding of an ideal family structure, they are overcome by the “American belief that everything can be solved by doctors”(Eugenides 426). Milton and Tessie consequently offer their trust to the physician, who reveals to them the results of their daughter’s tests. Lost in the medical terminology employed in his speech, the two are instead “attentive to his manner” (Eugenides 428) to gauge the seriousness of the situation. He identifies the rare genetic condition that explains Cal’s physical anomalies as 5-alpha reductase deficiency, which deprives the body of the enzyme needed to convert testosterone to dihydrotestosterone (DHT). Dr. Luce assuages Milton and Tessie’s fears when he tells them plainly “Callie is a girl who has a little too much male hormone” (Eugenides 428). With surgery to correct Cal’s genitals and hormone treatments to induce secondary sexual characteristics, his parents are ultimately satisfied that Cal’s condition can be essentially fixed without greatly disrupting their family’s image.

While Cal is equally attracted to the “prospect of having everything solved”

(Eugenides 434), his discovery of Dr. Luce’s case notes reveals the reality that Cal is genetically male, signified by the presence of XY chromosomes. Cal’s discovery gives us some insight into the mindset of a physician in such instances, as the file also outlines the doctor’s reasoning behind his assertion of the need for medical intervention. Based on Cal’s behavior and upbringing, Dr. Luce simply finds that artificially developing secondary female characteristics is more convenient than the alternative, despite his genetically male DNA. While the abuse of medical authority that this scenario presents us with is extremely troubling, Cal claims some responsibility for the doctor’s assessment, remarking, “His decision was based on false data. But he had been false in turn” (Eugenides 438). Although Cal ultimately aligns his gender identity with his genetic sex, his experience reveals the larger issues at stake for intersex individuals who are subjected to life changing medical procedures at the will of the physician.

Extending beyond a small-scale understanding of power and authority in the context of the doctor-patient relationship, it is important to consider broader instances of power and control in relation to the body. Employing Michel Foucault’s concept of biopower, we can understand how human bodies are regulated and controlled on a large scale. Described by Foucault himself as “numerous and diverse techniques for achieving the subjugations of bodies and the control of populations”(Foucault 140), biopower’s immense influence comes from its subtle infiltration into a society’s values and behaviors. One example of this is Western society’s strict adherence to categories of classification, namely our understanding

of sex as binary. By regulating and normalizing bodies that fall distinctly under ‘male’ or ‘female’, mass populations can be structured and controlled. Expanding this logic, the intersex body is contextually unruly in that it does not fall neatly into these defined categories. By representing the blurred divisions between sexual classifications, the intersex person signifies heterogeneity in a world that functions on uniformity. Physicians themselves are often players in exercising biopower, armed with the tools to regulate and control sex. Similar to the way that Foucault outlines surveillance as a tool for control, the medical gaze can be understood as a tool to enforce the biopolitical model. This dehumanizing lens is especially pertinent in understanding the subjugation of intersex individuals, who are reduced to a condition, often based solely on their sexual anatomy. Cal finds himself subjected to this gaze during multiple visits to a physician, noting that he experienced the examination of his body “as if from far away” (Eugenides 231). This fragmented approach has been adopted in the treatment of intersexual individuals throughout history, and the evidence of such treatment can be further illustrated by the various sketches and photographs popularly featured in medical literature on disorders of sex development. Cal himself is one of them, describing his featured image “on page 578, standing naked beside a height chart with a black box covering [his] eyes” (Eugenides 3).

LANGUAGE

Although the importance of terminology is usually directly apparent in the

field of medicine, Cal is particularly aware of the words he chooses to describe the events that unfold. This decisive use of language can give us an insight into the

intricacies of his condition, and lends us the perspective of his experience. Perhaps the most apparent example of this occurs when Cal makes use of the resources available to him at the New York Public Library. Taking it upon himself to reveal the truth of his condition, Cal seeks to define the word ‘hypospadias’, used by Dr. Luce to describe his anatomical anomalies. His search guides him through the Webster’s dictionary from one synonym to the next, from ‘hypospadias’ to ‘eunuch’ to ‘hermaphrodite’ to ‘monster’ (Eugenides 430). Cal is understandably affected by this unearthing, and his reaction demonstrates the definitive, authoritative quality that language can have. The instant dread that Cal feels as he gazes upon the word ‘monster’ is indicative of the inherent truth that we often associate with the appellation of a medical condition. In another way, Cal’s journey through these definitions is indicative of the temporality of language. This is further exemplified by the changing accepted terminology associated with intersexuality, a word that replaced ‘hermaphrodite’ and is possibly being replaced today with the term, ‘disorders of sex development (DSDs).’

While sometimes fleeting, the impact of specifically chosen language is undeniable. This is particularly apparent in the delivery of a diagnosis or medical verdict, where news is often communicated in a way that minimizes an extreme emotional response. After the meeting with Dr. Luce, Milton divulges to Cal that he will have an operation, following up by saying, “‘Operation’ isn’t really the right word. I think the doctor called it a ‘procedure’” (Eugenides 432) This use of language exemplifies the care with which such conversations are navigated in an effort to control the intended meaning. In a different way, we also see the characters

use language to comfort themselves. Dr. Luce’s constant reference to Cal as Tessie and Milton’s ‘daughter’ reassures them in that it minimizes the realities of his condition. Similarly, Cal’s parents tell both him and themselves that the treatment will be “no big deal” (Eugenides 433) and that “no one would ever know” (Eugenides 433).

The narrative form of Cal’s account in Middlesex is another telling mechanism through which he communicates his ideas. His methods are no secret to the reader, as the novel begins by revealing to us the “feminine circularity” (Eugenides 20) of his narrative that will unfold. Jumping often from the present to his childhood, and back to decades before his birth, Cal asks us to consider the intertwined nature of time and forces us to consider how deeply connected the identities of Callie and Cal are. In another way, Cal’s resistance to linear storytelling is also representative of his opposition to strict boundaries, and by extension to binary understandings of sex.

TECHNOLOGY

Another layer to our discussion of the practices and treatments of intersexual

individuals involves a consideration of the changing technology used to understand, diagnose, and treat these cases. Although intersex individuals have always existed in societies around the world, technologies and methods in place for determining sex have varied greatly over time. People like Geoffroy Saint-Hilaire, James Simpson, and Theodor Klebs dominate the Pre-20th century medicine concerning intersexual individuals. While Saint-Hilaire’s and Simpson’s models for determining sex relied

fundamentally on the internal anatomy of the individual, Klebs’ approach is representative of the shift in medicine denoted by the “Age of the Gonads’”(Dreger 144). A pathologist, Klebs focused on the analysis of gonadal tissue in determining sex. This thinking aligns with the late 19th century view that the fundamental difference between men and women lie in their reproductive capabilities. Due to the invasive nature of these approaches, without the presence of ambiguous or excess genitalia, intersex individuals were sometimes not identified until after death, or in cases of castration. Modern approaches to determining sex are characterized by the discovery of sex hormones and the ability to test for sex chromosomes.

Furthermore, the visibility of intersexuality has increased in the medical field due in part to the 20th century’s medicalization of childbirth, owing to more deliveries taking place in hospital, and consequently more infants subject to examination at birth.

Despite Cal’s hospital delivery, his ambiguous genitalia were overlooked,

remaining hidden until an unrelated emergency room visit at the age of 14. Despite his life being relatively unaffected until the discovery by Dr. Luce, medical intervention is considered immediately necessary and possibly unavoidable.

Coupled with the fact that the physician decides to medically treat Cal as female based on limited interactions, his case notes reveal the likelihood that Cal’s feminizing operation will result in “erotosexual dysfunction” (Eugenides 437). Such unnecessary procedures are reminiscent of demonized cultural practices of female mutilation; depicting intersex individuals as experimental subjects rather than patients. Indeed, Dr. Luce notes, “it is hoped that new methods of surgery will

minimize the effects�(Eugenides 437), though he makes no attempt to wait for such technological developments.

CONCLUSION By examining power, language, and technology as categories of inquiry into the medical understanding of intersex conditions alongside the fictional but personal narrative outlined in Middlesex, we can identify where medical practices have historically fallen short in representing and protecting these individuals.

Understanding how our accepted notions of sexuality have been traditionally inadequate but prevailing, is one way to frame the issues of intersexual individuals today. Furthermore, by considering how hierarchical structures of power are shaped by language and enforced using various and ever-changing technology, the interconnectivity of these factors can be highlighted and revealed as pervasive and significant.

RESOURCES

Dreger, Alice Domurat. Hermaphrodites and the Medical Invention of Sex. Cambridge, MA: Harvard UP, 1998. Print.

Eugenides, Jeffrey. Middlesex. NY, NY: Picador, Farrar, Straus and Giroux, 2002. Print.

Foucault, Michel. The History of Sexuality. New York: Pantheon, 1978. Print.

Hsu, S. "Ethnicity and the Biopolitics of Intersex in Jeffrey Eugenides's Middlesex." MELUS: Multi-Ethnic Literature of the U.S., vol. 36 no. 3, 2011, pp. 87-110. Project MUSE, doi:10.1353/mel.2011.0045.