The Technical Invention of Gender (Notes from Johns Hopkins)

Gender, understood as a psychic identification and set of norms for presentation of the self and body, is often conceptually attributed to feminist analyses of the representational subordination of femininity to masculinity. In the infamous “sex/gender” split reflected in field-defining texts like Judith Butler’s Gender Trouble, gender is a squarely cultural norm that is laminated over the body, giving it a subject and constituting sex only as its retrospective effect.

Transgender studies has emphasized more consistently, however, that gender is a historical and techno-medical apparatus. Susan Stryker and Nikki Sullivan’s formulation of the “somatechnics” of the trans/gendered body, for instance, or Beatriz Preciado’s hormonal “auto-intoxication” of female masculinity in Testo Junkie, attend to gender from the organizing premise that there is no culture-nature or body-technology dualism in gender’s “construction,” its ontogenesis and transmission from generation to generation. In my dissertation’s genealogy of the transgender child I return to the mid-century invention of gender by “the dean of sexology” at Johns Hopkins University, John Money, and his clinical work in the 1950s and 1960s with intersex and “hermaphroditic” children. Although the commitments of Money and the physicians and psychiatrists working around him were deeply normative and painfully dehumanizing for patients, their non-dualistic, technologically oriented concept of gender as a biocultural plasticity opens onto a very different understanding of gender not only for transgender studies, but also feminist theory and queer theory. I spent some time in the medical archives at Johns Hopkins recently and these notes reflect some of the emergent genealogical work I am embarking on with this assemblage of material.

The term “gender” grew out of Money’s work in his 1952 dissertation, Hermaphroditism: An Inquiry into the Nature of a Human Paradox, which he completed at Harvard. Its first published use in 1955 was in an article for the Johns Hopkins Medical Bulletin, in which he reviewed his casework with intersex children to argue against a genetically or gonadally determined sex differentiation: “The term gender role is used to signify all those things that a person says or does to disclose himself or herself as having the status of a boy or man, girl or woman, respectively. It includes, but is not restricted to, sexuality in the sense of eroticism” (254).

Variations on the this phrasing are repeated in most of Money’s publications over the following decade, particularly in his collaborative work with other doctors at Hopkins. In arguing that sex and gender are not programmed by genes, nor chromosomes, gonads, or hormones, Money and his colleagues explicitly likened the biocultural assumption of a gender to the acquisition of a language. The infant’s brain and body are born with a capacity to learn a language, and there is a restricted period of development during which a child’s first language is adopted and after which it is very difficult to learn a second language as proficiently. Before Lacan’s re-staging of sexuation through the unconscious structured as a language, Money and his colleagues were promoting the view that “a gender role is established in much the same way as a native language.”

The normative medical ends of this account of developmental plasticity and gender role performativity avant la lettre are unsettling. In their next breathe, Money, Joan and John Hampson counsel physicians in another 1955 Bulletin piece to approach intersex patients by leveraging the plasticity of the body to reinforce sexual dimorphism. “It should be the aim of the obstetrician and pediatrician,” they assert, “to settle the sex of an hermaphroditic baby, once and for all, within the first few weeks of life, before establishment of a gender role gets far advanced” (288). It is also here that their empirical reasoning becomes uncharacteristically humble. The case management of intersex children led Money and his colleagues to doubt that sex is determined by any one factor, particularly because the chromosomal sex of patients, newly identifiable thanks to a skin biopsy test invented in 1954, yielded no consensus: some patients were reared in an incongruous sex from their chromosomes, while others were reared with a consistent chromosome/gender role alignment, but neither group seemed more troubled nor more well adjusted than the other. Indeed, Money and his colleagues therefore abandoned all somatic markers of sex held in esteem by the medical community and argued that psychological gender was the best criterion for treatment, that “the sex of assignment and rearing is consistently and conspicuously a more reliable prognosticator of a hermaphrodite’s gender role and orientation than is the chromosomal sex, the gonadal sex, the hormonal sex, the accessory internal reproductive morphology, or the ambiguous morphology of the external genitalia” (333).

The demand for an utterly normative, non-consensual assignment of sex based on dimorphic genital morphology is unmistakable: “a great deal of emphasis should be placed,” continue Money and the Hampsons, “on the morphology of the external genitals and the ease with which these organs can be surgically reconstructed to be consistent with the assigned sex” (334, emphasis added).” In short, in cases of intersex infants, the medical authority in charge should wager what sexually normative genitals could be conceivably constructed out of existing plastic surgery and endocrinological technologies. The sooner the choice is made and the normative surgery is completed, the sooner the child can be raised as its assigned sex, regardless of whether that choice is in any way consonant with its chromosomes, gonads, or other bodily systems. Psychological gender is so actionable in the minds of the Hopkins researchers that it can safely override the body’s otherwise unknown sexed machinations.

And yet, out of this violent procedure for producing and enforcing a legible gender, one that has since been rightly contested by intersex advocates, comes an oddly circumspect epistemological concession: Money and his mid-century colleagues implicitly admit that they do not know how gender is formed, nor even what gender is. The most they are able to positively affirm is that “The salient variable in the establishment of a person’s gender role and orientation is neither hereditary nor environmental, in any purist sense of those terms, but is his own decipherment and interpretation of a plurality of signs, some of which may be considered hereditary or constitutional, others environmental” (335).

This non-dualist concept of gender as a biocultural product, so blatantly in tension with the brutally normative surgeries and therapies performed on children at Hopkins, would eventually tarnish Money’s medical career in the late 1990s when David Reimer, who was raised a girl after his penis had been nearly amputated by circumcision, publicized the suffering and anguish of having grown up in ‘the wrong body’ and chose to live as a man in adulthood before completing suicide. Although not treated by Money directly, Reimer was nevertheless treated under the formula developed by Money in the 1950s and 60s, and the physician in charge of the case consulted Money before assigning the infant as a girl. (Anne Fausto-Sterling and Butler have both written about this in greater detail.)

What, then, is there to extract from this conceptual tension that came at such a material cost? The technical invention of gender in the mid-century is important because it historically subtends the concept of gender we have all inherited in the West. In other words, to begin with gender as performative in the restricted sense of culture is, astonishingly, to willfully ignore gender’s own genealogy. Gender has always been technical, from the very beginning of its history. Despite his treatment of intersex children, Money never argued that psychological gender trumped the body’s intrinsic capacities. “The observation that gender role is established in the course of growing up,” he wrote in 1955, “should not lead one to the hasty conclusion that gender role is easily modifiable. Quite the contrary!” (309). His non-medical writing on science, epistemology and ontology from the beginning of his career (1949) also demonstrate a consistent interest in relational onto-epistemologies based on a passing knowledge of feedback from cybernetics  and the “reciprocal interaction” of components in any living system (213).

From this conceptual milieu, then, it is possible to historicize gender as a technologically mediated intervention into the body’s plasticity, rather than just an ideological ruse. In looking at the development of gender across Money and his colleagues’ decades of work, it is clear that they never claimed to know what gender actually is or how it is produced (although that includes disavowing that the important fact that they themselves produced gender through the discourse and material practices of medicine). Rather, with medical inventions like the synthesis of hormones, or the ability to test chromosomes, they expanded the range of actionable gender through new technologies like cortisone therapy or sex reassignment surgery. Money rejected chromosomal sex in the mid 1950s as the basis for understanding intersex bodies because chromosomes could not be modified by medicine. Hormonal circulation and the physical appearance of the genitals, however, could, and this has conditioned the entire range of not just medical, but legal, political and social options for intersex, transgender and cis-gender bodies today.

In seeking to both account for the medical violence and political limitations of a pathologized mode of reactive gender politics, not only for intersex and trans bodies, but also cis-gender bodies and queer bodies, then, feminist, queer and trans studies would do well to leverage the technical capacities of gender virtually stored in the non-dualist genealogy established by Money. Indeed, to continue to think and analyze “gender” while disavowing its technical invention in the mid-century is not only historically foolish, but comes as the cost of ignoring the ontological dimension of how technics carry with them the potentiality for re-tooling, for a different kind of political embodiment and body politics–as I have written about on race and originary technicity. The ethical question of “doing justice,” as Butler frames her essay on Reimer, I would argue is impoverished to the extent that she ignores that gender is technical–it is a historically arbitrary technology that relies on the ontological and originary technical capacities of the body. Although the technical dimensions of gender have been stratified towards brutally normative ends since the mid-century, that certainly does not divest us of the ethical responsibility to work with them far differently in the future.

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