The Body They Live In

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The Body They Live in

University of Amsterdam (UvA) MA thesis – Neurophilosophy MA Student: Lucas Neto

Supervisor: Dr Julian Kiverstein Number of words: 28.122 Date: 05.01.2015

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Abstract

What does it mean ‘to have’ a body? Are body and self the same thing? The case study of this project are transgender and transsexual subjects; the latter, unlike the former, desire to undergo sex change surgery in order to adjust their wrong body with their true selves (as male or female). By contrast, early phenomenologists, such as Edmund Husserl (1859-1938) and Maurice Merleau-Ponty (1908-1961) have held the view that the self is embodied. In other words, self and body are the same thing; we are a body. But the problem here is, if the self is indeed embodied, how can we make sense of those who say that they have been born with the ‘wrong sex’ or to be trapped in the ‘wrong body’? When claiming that they are trapped in the ‘wrong’ body, do they mean it literally? What does it mean to have the ‘wrong embodiment’? In light of these questions, this master thesis is an attempt to shed some light on discussions involving the notion of self and body, more specifically, on gender (identity) and sex, and to what extent the body determines or shapes the self (if it does).

Transsexuals, unlike transgender, are indeed trapped in the wrong body. The body that appears to them is not the same that appears to others. Put differently, the self that is claimed to be trapped, is the Leib, the body as perceived and experienced from the inside, and the body in which the self is trapped, is the Körper, the physical body. In addition, their feeling of having the ‘wrong embodiment’ is driven by the beliefs of others on what maleness and femaleness mean: to have a ‘body’ that should be aligned with the ‘self’. Drawing on philosophy, biology and sociology, this work offers readers an enlightening interpretation of the trapped in the wrong body narrative.

Keywords: transsexual, transgender, gender, wrong embodiment, sex, self, brain, body,

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“Nothing determines me from outside, not because nothing acts upon me, but,

on the contrary, because I’m from the start outside myself and open to the

world.”

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Foreword

This master thesis is about transsexuality and transgender. In short, transsexual and trans gen-der people experience gengen-der incongruence – that is, the feeling of having a self/gengen-der iden-tity1 that is not aligned with the body they were born with. In most cases, transsexuals, unlike transgender, desire to undergo ‘sex-reassignment surgery’2to adjust their body with their male or female self, but until this happens, they often claim to feel ‘trapped in the wrong body’.

‘The feeling of ‘wrong embodiment’ or the ‘trapped in the wrong body’ narrative3 is often used by ‘trans people’ to help others to make sense of their experience of gender incon-gruence and to illustrate their feeling of having a self that is not aligned with the gender that was assigned to them at birth (the one that also corresponds to the chromosomal information). Many philosophers, however, have held that self and body are identical. In the phenomenological tradition, philosophers have argued for an embodied or bodily view of subjectivity. But if the self is embodied, how are we to account for people who say that they have been born with the wrong sex, people who do not identify with the gender they have been assigned at birth? How is their embodied subjectivity different from that of people who are at home with the gender they were born with?

The question of what it means to have or to be a body is rather complex, yet it is a central question addressed by philosophers writing in the tradition of phenomenology.

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1_{According to Erickson-Schroth (2014), within the transgender community, gender identity is considered to be} their own way of understanding a sense of being male, female, both or neither. This sometimes clashes with the way other people view them physically (p. 614).

2_{Within the transgender community, the term sex-reassignment surgery is increasingly replaced by} gender-affirming surgery (GAS) or gender-confirming surgery (GCS). These are surgical procedures that help to adjust a body such that it matches more closely a desired gender identity (Erickson-Schroth, 2014, p.614). Further, within the transgender community, the term transsexual is strictly used for people who have undergone some form of gender related surgery (p. 610).

3_{“Transsexual subjects frequently articulate their body alienation as a discomfort with their skin or bodily} encasing: being trapped in the wrong body is figured as being in a wrong body, or an extra or second skin” (Prosser, 1998, p. 68). Since the ‘trapped in the wrong body’ narrative is the driving force of this project, chapter one and chapter two will have a closer look at some sociological and phenomenological issues found in this narrative.

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menology is the first-person investigation of the ‘manners of givenness’ of the world to ‘con-sciousness’. Edmund Husserl (1859-1938) was the founder of this school of phenomenology. For him, the ‘body’ was not exclusively a physical substance extended in space. Instead, the so-called ‘lived body’ is the subject of our experiences of the world. For Husserl, we are both physical material bodies and at the same time subjects of conscious experience. For instance, as Husserl stated in some of his later works (e.g., Ideas II, 1913), when someone touches his own hand, he can, objectively, experience that. But he can, subjectively, also experience his own body/hand being touched and doing the touching.

Put simply, in the example just mentioned, the body is a material tool/means which one uses to touch oneself (and other things); at the same time, in order to be touched, the body is also a means through which someone’s experiences are conceived – the living body, which one uses to sense the touching. In short, the former stands for the physical material body (in German: Körper), whereas the latter stands for the lived (or living) body (in German: Leib), the body with which and through which one experiences the world. Put differently: one senses on and in the body. For Husserl, we cannot distance ourselves from the body nor the body from us, as it is our way of perceiving both, the world and the body itself. “The same body that serves me as means of all perceptions stands in my way in the perception of itself and is a remarkably incompletely constituted thing” (1913, p. 159). Put differently, it is not possible to put our body aside in order to perceive the world, since the body will always be in our way. The body is an object of perception and at the same time, it is an organ through which our perceptions are conceived.

Husserl has certainly brought very interesting insights to the study of Phenomenology, especially with the notion of the body constituted in a double way/perception: the material body and the lived body, as illustrated through the image of touching and being touched (as explained above). Nevertheless, later on hermeneutic/existential phenomenologists, e.g.,

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Martin Heidegger (1889-1976), Jean-Paul Sartre (1905-1980) and Maurice Merleau-Ponty (1908-1961), criticized but expanded Husserl’s theory as well.

For instance, Merleau-Ponty – discussing the role that perception plays in understanding the world – argued that the body itself plays a major role in perceiving and knowing the world. The body is the subject of our experience, and with this in mind, he argued that consciousness and body are closely related and mutually engaged with the world. Unlike some other philosophical traditions, which accepted the dichotomy of object and subject, Merleau-Ponty conceived thebody mostly as a subject4_{and rejected the view that the} body is only an object (1964). In other words, for Merleau-Ponty, our embodied consciousness contains both aspects: “I am conscious of the world through the medium of my body.” Thus, likewise Husserl, Merleau-Ponty does not see the body only as a physical object or a chunk of the physical world to which the self is eventually bound. Instead, for Merleau-Ponty, as for Husserl, the body is the bearer of humans’ perceptions of the world, and therefore, there is no distinction between ‘self’ and ‘body’ whatsoever. Or, as he stresses himself, in perception one should understand oneself not as ‘having a body’ but rather as ‘being a body’: “[M]y body is my point of view on the world” (p. 85).

With the above ideas in place, current studies in the philosophy of neuroscience/ philosophy of mind promise to cast new light on the nature of the complex relation between self and body. For instance, studies on ‘bodily subjectivity’ have shown that there are subjects who claim to feel alienated from their bodies. For instance, there are subjects who suffer from what is known as ‘body integrity identity disorder’ (BIID)5_{, people who claim to}

4_{Body as subject/Lived body: Merleau-Ponty (1961/1968) holds the view that self and body are intertwined. In} addition, the self is not constituted of something purely mental but is a combination of mental and physical realms. It is embodied. (The self/body distinction and its relation will be explored a bit more in chapter two). 5_{Also known as ‘Apotemnophilia’, people disown a specific (healthy) body part, for example, a hand.} There-fore, likewise trans people, these subjects obsessively seek for body surgical modification in order to adjust their ‘biological body’ with their true ‘selves’ – with the body image they ‘believe’ fits best with their ‘inner identity’ (as an amputee or with a paralyzed limb). So, as First and colleagues (2005) pointed out, sufferers of BIID seek

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feel alienated from their limbs (e.g., hands, arms etc.). Put in the words of a BIID patient: “My limbs do not feel like they belong to me and should not be there.”6 As an attempt to adjust their self with the desired body – a body that matches the identity they perceive to be in the inside – these subjects seek ‘limb amputation surgery’7.

What is problematic in such cases is that the lived body (Leib), which is conceived by phenomenologists as the body experienced from one’s own perspective, is not aligned with the physical body (Körper) anymore. This, consequentially, affects their self as subject, since it can no longer be understood as inseparable from or identical with the body as the phenomenologists have argued. In short, this seems to suggest that it is not always the case that the self is embodied. The same goes for subjects who claim to be a gender other than the one that was assigned at birth, like they claim themselves: It is as if I’m trapped in the wrong body. Nevertheless, body and self are identical, as phenomenologists argued, but there are subjects who claim to feel they have the ‘wrong embodiment’. This means that, on the one hand, being ‘trapped in the wrong body’ challenges the phenomenological idea of the embodied self; on the other hand, though, one could also argue that these subjects might be actually ‘trapped in the wrong self’. This, however, would question the entire identity, actually the entire being of a person.

With these ideas in mind, this thesis is an attempt to make sense of this controversial yet also very complex claim, which seems to suggest that one can be born with the ‘wrong embodiment’. The research question thus is: If the trapped in the wrong body narrative holds true, how are the ‘body’ and the ‘self’ represented in transsexuals’ notion of gender?

for a sense of completeness/wholeness with themselves, which they do not find under the biological body they were born with.

6_{Quote reported in the research on BIID sufferers, conducted by PhD candidate Rebeca M. Blom from} Amster-dam Medical Center. Find the full research here:

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0034702#s1

7_{In 1997, the Scottish surgeon, Robert Smith, received the first case of a subject who wanted to amputate his} left foot, as he claimed that it felt like an alien and not belonging to him. A few years after amputating his left foot, the patient reported that he feels much better (Furth & Smith, 2002).

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In order to answer the above research question, this work will be structured as follows: in Chapter One, Gender delusions, I will introduce important concepts and terminologies that are relevant for the scope of this research, such as gender, sex, sexuality and subconscious sex. When addressing gender, researchers on the brain organization theory (BOT) claim that gender differences can be found in the brain, so, as the case study of this project is on subjects who claim to have been born with the wrong sex, i.e., trans people, one of the central questions addressed in this chapter is: Can we really say that gender (identity) is ‘in’ the head/brain? Or, is it ‘in’ the body one has been born with? As an attempt to answer the above question, I will offer a diverse and rich dialogue among thinkers from different fields who are very keen on doing research on gender. Further, in order to incite a critical reflection on the question that was posed at the beginning of this chapter (whether we can really say that gender identity is ‘in’ the head/brain), readers will come across with empirical cases which seem to challenge earlier notions of gender identity. For instance, the cases of David Reimer, the ‘boy with no penis’ who was sex-reassigned8 and raised as a girl due to a loss of his penis, of the female athlete María Patiño, born with male chromosomes/hormones, and of intersex infants (subjects who are born with both sexes but choose one gender over the other along their lives) will bring us to the case study of this project: Trans people, who claim to have a gender other than the one assigned to them at birth.

Based on what will presented in the first chapter, Chapter Two, Beyond the gender

binary model, will introduce readers to the case study of this project, that is, transsexual and

transgender subjects. Interestingly, these subjects might challenge researchers on the brain

8_{SRS: A term that can be used to refer to many different kinds of gender-related surgeries, though, it is most} typically used when talking about vaginoplasties. Some people prefer the terms gender-affirming surgery, gender confirming surgery, or genital reconstruction surgery (Erickson-Schroth, 2014, p. 619). The first ‘sex-reassignment surgery’ was performed in 1965 at the Hopkins Hospital in the United States. The Canadian sexologist and psychologist John Money (1921-2006) and the plastic surgeons Milton T. Edgerton and Claude Migeon were the pioneers of the sex-reassignment surgery on infants who were born with both genitals. The doctors developed this surgery after treating intersex infants who were born neither female nor male (Colapinto, 2001).

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organization theory, who claim that gender identity is exclusively in our brain, as well as

others, who defend the idea that gender is socially constructed9. In addition, in this chapter, I will explain the differences between the two groups, transgender and transsexual. For instance, the term transsexual is mostly used within the transgender community to refer to those who underwent sex-reassignment surgery.

Chapter Three then, Politics of bodies and selves, is an attempt to understand why transsexuals, unlike some others who experience gender identity incongruence, desire to undergo sex change. This desire is driven by the notion of wrong embodiment. So, along these ideas, one of the questions that this chapter is also interested in answering is: What does it mean to have the ‘wrong body’? In order to answer this question, I will look at the notion of ‘wrong embodiment’ or ‘feeling of being trapped in the wrong body’ from a social and cultural perspective. So, I find it relevant to offer readers a discussion on some social issues that go right against these groups who still represent a social minority. For instance, this chapter will discuss violence, discrimination and social stereotypes against subjects who do not fit into the gender binary model. Most of the discrimination and social violence that these subjects experience seems to occur due to the fact that, in the eyes of others, their bodies do not match the self they claim themselves to be. Therefore, these subjects might represent a threat to what is considered a ‘real’ woman/man. The discussion about these issues will, po-tentially, help us to understand how the idea of ‘wrong’ body comes about, which might (to certain extent) be the cause for or influence their desire to undergo sex-reassignment surgery.

As this work was built on phenomenological ideas of embodied subjectivity, the final chapter, Chapter Four, Redefining Realness, offers readers a phenomenological interpretation

9_{Social constructivism or a social construct is a concept found in sociology which holds the view that humans’} ideas, beliefs and understandings of social and cultural reality is commonly shared. This means, for instance, that the socially constructed idea of womanhood or manhood is changeable – it is not absolute. Further, according to Lorber (1994), the social construction of gender, for instance, starts right at birth when a baby is sexually assigned either as a girl or as a boy based on the appearance of its genitalia.

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of the findings, ideas and terms that appeared in the previous chapters, such as ‘subconscious sex’, ‘gender identity’, ‘real’ womanhood/manhood, ‘brain organization theory’ and it introduces some other concepts as well, such as ‘body image’, ‘body schema’ and ‘body subject’. The clarification of these concepts will, eventually, enable us to answer the research question raised at the beginning of this work: If the trapped in the wrong body narrative holds true, how are the ‘body’ and the ‘self’ represented in transsexuals’ notion of gender? In short, the last chapter is an attempt to make sense of what has been argued in this work to be an issue or a problem for the phenomenologists, that is, the idea that there are subjects who claim to be ‘trapped in the wrong body’, yet for the phenomenologists the self is embodied.

This master thesis is not only a philosophical inquiry on ‘bodily subjectivity’. Instead, it is an up-to-date scientific research built on some empirical findings on subjects who suffer from body-self incongruence (body identity dysphoria). The body-self dualism, however, seems to have become an ongoing issue within Science and Philosophy, which still provides a lot food for thought for thinkers, researchers or anyone interested in the philosophical inquiry of the ‘body-self relation’ – if there is any relation at all.

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Chapter one

Gender delusions

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1. Gender delusions

“What is the very first thing you remember? How old were you and what were you doing? Can you remember what you were wearing or who you were with? Is gender an important part of your memory? Did it matter that you were a little boy or a little girl? Do you think that, at that point, you were aware of yourself as boy or girl – as a gendered human being? Can you remember the first time you thought of yourself as having a gender?” (Ryle, 2012, p. 109).

Over the last thirty years, doctors, researchers and sociologists have been challenged by many scientific and sociological findings on gender and sex differences. These findings, however, enable them to shed some more light on old gender definitions of maleness and femaleness. Concrete examples are an infant boy10_{sexually reassigned and raised as a girl after an} unfortunate surgical circumcision had destroyed his penis – and later on identifies ‘herself’ as a male person; or a Spanish athlete who has always identified herself as a woman, although she has (without knowing) lived throughout her entire life with male chromosomes, testicles and no ovaries. These findings have certainly challenged thinkers and doctors to rethink what it means to be male or female. Researchers on the brain organization theory BOT, on the other hand, argue that the early exposure to hormones during fetal formation causes differences in male and female brains, affects aspects of sexuality and the broader sense of masculinity and femininity (Garcia-Falgueras & Swaab, 2010). This means that if someone receives for example ‘female hormones’ during fetal formation, it is most likely that this person will be feminine in behavior, desires, interests etc. Therefore, this individual will most likely be a woman. This assumption does not seem to support the case of the Spanish athlete.

10_{Until this case came into the public disclosure, it was popularly known as John and Joan. The infant was first} named by his parents as Bruce Reimer, but after transitioning back from girl to boy, he decided to change his name to David Reimer (Colapinto, 2001). Therefore, to avoid any confusion, whenever I refer to the case, I will use his latter name, David Reimer.

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Though, when it comes to the case of the infant boy who struggled throughout his entire life to live as a girl, the BOT might be quite useful, as it seems to bring us back to the idea that gender (identity) might be ‘in’ the brain – as scientists argue. But how does gender relate (if it does) to the body? One of the complex aspects of the BOT is that, on the one hand, it offers a constrained notion of gender, as it reduces gender differences to hormones; yet on the other hand, this theory should not be discredited either for the reasons that will be explained later on in this chapter.

The questions, though, that this chapter attempts to answer are: To what extent can we rely on BOT researchers who claim to find gender differences in the brain, as they still seem to show certain inconsistencies? To make this question a bit more precise: Can we really say that gender (identity) is ‘in’ the brain? Or, is it ‘in’ the body one has been born with?

This chapter is going to explore some socio-cultural and biological ideas of gender (identity). In addition, it will also explain how the concept of ‘gender’ has been interchangeably used with the concept of ‘sex’ and, eventually, with ‘sexuality’ as well. Within the concept of ‘gender’, this chapter will start with a brief account of John Money’s concept of gender and gender identity – as he was one of the prominent researchers on the study of gender.

The biologist and sociologist Anne Fausto-Sterling (2000) will also offer some interesting insights on the idea of gender identity by referring, for instance, to ‘intersex infants’. Furthermore, Judith Butler with the ‘performativity of gender’ (1991), the Trans Bi woman and writer Julia Serano (2007) with her notion of ‘subconscious sex’ and Rebecca M. Jordan-Young (2011) with her concerns on the brain organization theory will add to this chapter.

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1.1. Of gender, sex and sexuality

When talking about ‘gender’, most people think of a ‘gender binary’ – that is, the societal gender model of male and female. Thus, based on this ‘binary model’, there must be no such thing as a ‘third gender’ or nothing in between. However, ‘intersex people’, persons born with a reproductive or sexual anatomy that does not fit societal definitions of female and male (Erickson-Schroth, 2014, p. 616), are an exception. Sooner or later, though, intersex people, as argued in the following pages, have to fit into the societal gender binary model as well – they will, eventually, be sexually reassigned to fit into one of the gender conformity groups, that is, man or woman.

With the above in mind, when it comes to defining ‘gender’, the Canadian sexologist John Money (1921-2006)11_{, known for his controversial theory on ‘gender neutrality’, would} argue that ‘gender’ and ‘sex’ are two different (yet closely connected) things. Therefore, they should be carefully distinguished from one another. For Money (1994), sex is anatomically and physiologically determined. Put simply, one is either born with a female or a male physical body; it is biology and these traits will, eventually, also shape how one thinks of oneself either as a man or a woman. These body features, therefore, enable doctors to label a newborn either as a boy or a girl.

In contrast, ‘gender’, as Money (1994) points out, is what one will become socially, which can be understood as beliefs and values of certain cultures that influence one’s understanding of maleness and femaleness. In his words, “one’s personal, social, and legal

11_{John Money was well known in the past for developing a theory on ‘gender neutrality’, which held the view} that an infant’s gender is variable and malleable. Money’s main research was on psychosexual people who were born with both genitals. According to Money, when children are born, for the first two years, they do not have a fixed gender yet. In other words, gender is changeable and biology does not define one’s gender at an early age. Therefore, gender is flexible and can be shaped/defined by social structures (Ehrhardt, 2007). Money’s ideas on gender, eventually, give rise to the discussion whether gender can be only socially constructed.

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status as male or female, or mixed, on the basis of somatic and behavioral criteria [are] more inclusive than the genital criterion and/or erotic criterion alone” (p. 168).

‘Gender role’, on the other hand, is anything that an individual does that indicates to the self and especially to others whether one is a male or female. For instance, in many societies women are still depicted as fragile and submissive among other things that are conceived as features of woman. Men, on the other hand, are hunters, strong etc. These are behaviors that a society and culture conceive as ideal or appropriate for men and women. In short, men are raised to conform to a male gender role and women to a female gender role, i.e., to positions one takes in social relationships based on one’s gender (for example, men being the income earners and woman being the housewife) (Erickson-Schroth, 2014). Not all individuals, though, identify with all (or some) societal aspects of gender that are attributed to them already at an early age. Further, the notion of masculinity and femininity varies from one culture/society to another. For instance, what might be considered a typical feminine/masculine behavior in one culture might not be perceived in the same way in another culture/society. In short, ‘gender role’ is mainly conceived as a phenomenon of society.

On the other hand, for Money, ‘gender identity’ is the persistence of one’s individuality as male, female or even androgynous to a greater or lesser degree. As he clarifies: “The doctrine of gender identity as a phenomenon of the mind is reduced in some simplistic texts to assertions of I am male or I am female” (p. 166). However, for Money gender identity could also be formed through education and learning. In other words, even though genes were important to determine one’s sense of being a man or a woman, one could still be taught/trained to become a woman/man. His ideas on ‘gender neutrality’, though, led him to develop a tragic and radical experiment on ‘gender’.

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However, it has to be said that Money was also keen on the studies of the brain

organization theory, reflected by a number of articles written by him in which he discusses

that women with CAH12 show a masculine sexual behavior due to the hormonal exposure of their brains when they were embryos (Jordan-Young, 2001). In short, for Money and colleagues, ‘gender’ was a combination of both: the ‘social’ and the ‘biological world’, as he conceived gender identity as a learned phenomenon.

Therefore, after being consulted by the Reimer parents, as they believed Money’s experiment was the solution for their son’s issue (David [1965-2004] had lost his penis during a botched circumcision as a baby), Money decided to test his ideas on the child. Put vividly, since Money believed that David could not develop a ‘male identity’ without having a penis but, as according to him, any infant up to the age of two could be raised either as a boy or as a girl because the ‘gender identity’ is not formed yet, David was partially sex-reassigned13_{a girl and, consequentially raised like one. Contrary to what Money and} colleagues had expected, though, David, raised as Brenda, had never come to terms with his new gender. This led him to reject the sex-reassignment so that he transitioned14 back to be a man, which he had always felt himself to be – and which was biologically true, as he had been born with male traits (penis, chromosomes, hormones etc.). Furthermore, sexually speaking, David was also attracted to women, as he engaged himself in a marriage with one.

12_{As Warrell et al (2005) explain, congenital adrenal hyperplasia (CAH) are scientifically known as several} autosomal recessive diseases resulting from mutations of genes for enzymes mediating the biochemical steps of production of cortisol from cholesterol by the adrenal glands (steroid genesis).

12_{Within the transgender community, transition stands for the process one goes through to discover and to} affirm one’s gender identity. This can, but does not have to, include taking hormones, having surgeries, or going through therapy (Erickson-Schroth, 2014, p. 620).

13_{Up to his adolescence David Reimer received female hormones (estrogen) in order to develop breasts, and, he} used to urinate through a hole that surgeons made in his abdomen. This means that back then, David Reimer had not fully been sex-reassigned, yet he did not have his male genitals anymore, as they were all removed after the accident that destroyed his penis (Colapinto, 2001).

14_{The process one goes through to discover and/or affirm one’s gender identity. This can, but does not always,} include taking hormones, having surgeries, or going through therapy (Erickson-Schroth, 2014, p. 620).

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Additionally, his mother reported that David always refused to wear dresses, and when forced to wear them he tried to tear them off. Furthermore, David never wanted to play with what was considered to be girls’ toys. His feelings and habits of maleness were argued to be often present although he was pushed to be raised as a girl, since doctors dismissed his concerns about his boyish behavior and feelings. As David said afterwards: “They would tell me: you shouldn’t be ashamed of being a girl […] That’s a typical tomboy thing […] you are just a tomboy.” Contrary, as David said: “I don’t think that this is quite true.” David’s story, though, ended with his suicide after a long period of depression and discomfort about his gender (Colapinto, 2001). In other words, even though David decided to live his life as the man he has always felt to be, it seems as if he was still somehow haunted by the sex change experience that he had experienced in the past – which, consequentially, might have affected his self-identity as a man. For instance, he could neither have children nor engage himself in normal sexual intercourse with a woman.

So Money’s theory and experiment on ‘gender neutrality’ went rather wrong. However, for Money and his colleagues the above experiment was meant to show that gender is also determined by nurture and not only nature. Nevertheless, David’s case suggests that ‘nature’ (or ‘biology’ if one prefers to say) played a greater role in determining his sense of being a boy and not a girl as what others were trying to perceive him. In other words, this particular example shows that the role of (male) hormones seemed to have been quite important to define David’s gender identity. In sum, even though he was raised as a girl and sexually reassigned as one, David Reimer’s story tells us that his ‘gender identity’ and original (biological) ‘sex’ were closely related. Therefore, independently of having a penis or not, unexpectedly, the boy named Brenda has always been David.

This finding brings us back to the question brought up at the beginning of this chapter: Is gender identity in the head/brain or in the body? If it is in the head, that does still not mean

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that if David Reimer had not undergone ‘sex-reassignment surgery’, he would have lived happily as a boy, yet without his sex. This might be something that this research will not be able to confirm, though. If ‘gender identity’ is in the body, this would leave room open to question why David Reimer had never came to terms with his ‘new sex’ then.

The biologist and social activist Anne Fausto-Sterling (2000) has come up with illuminating ideas regarding the notions of sex and gender, which might offer us some more food for thought on the above discussion. To start with, she argues that the medical notion of

sex is merely restricted to a body anatomy model, which is, in a way, partially socially

constructed. Relying on physical and genetic traits, on the one hand, enables us to establish some clear differences between women and men. On the other hand, one has to bear in mind that to label someone either a man or a woman is a ‘social decision’, albeit based on scientific knowledge that enables doctors to make the definition. More precisely, doctors define a newborn as a male or female based on how the body appears to them at birth.

Nevertheless, if Money’s theory of how gender identity is formed is correct, there might be still the case that the gender assigned to a newborn might not be the same one he/she later on experiences inside or identifies him/herself with. Concretely, subjects who claim to be born in a wrong body (as discussed briefly in in the coming pages and more in chapter two) illustrate how ‘gender identity’ and the ‘gender’ assigned at birth come apart. David Reimer’s case (as addressed above) can also be used as a concrete example for this dualism between an innate experience of gender identity and the social construction of gender. As Fausto-Sterling adds, in a way, it is society’s beliefs about gender (not scientific, as she stresses) that affect what kind of knowledge doctors will produce about ‘sex’ when, for instance, labeling a baby as a girl or a boy at birth. The following example illustrates her point. When an intersex infant is born, doctors come to parents explaining the basic differences between male and female. And although the physical difference between bodies is

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in fact biological, the labeling/naming of an infant as a girl or boy is rather socially constructed. However, this should not be understood as a rule, as there are exceptional cases where one’s sex or male/female traits are not as clear as they should have been, which might generate confusion. As Fausto-Sterling adds:

“A normal boy is born with a penis, defined as phallus that has a urethral tube through which urine flows running lengthwise through its opening at the tip […] this boy also has an X and Y chromosome (XY), two testicles descended into scrotal sacs, and a variety of tubing, which in the sexually mature transports sperm and other components of the seminal fluid to the outside world” (p. 49).

So, in order to be defined a boy, a newborn has to fall under certain physical categories. Hence, sex is, to a certain extent, a physical and biological characteristic of one’s body. However, it might not tell someone’s gender identity or shape one’s conviction of having one. For instance, individuals born with anatomical traits of both sexes challenge those who argue that sex also influences one’s sense of ‘gender identity’, as it is closely related to it. They might be right to a certain extent, but what does intersex people eventually drive to opt for one gender over the other?

Further, with the above in mind, one of the questions that might remain unclear is: Is one’s gender identity fixed by one’s sex or does it lie in a sort of private feeling of ‘femaleness’ or ‘maleness’, as Money has potentially suggested? If gender is in the brain, why can a boy who feels like a girl not be assigned as a girl instead (and vice versa)? From the point of taxonomy, though, it is understandable that people who present the same physical characteristics receive the same gender labeling (e.g., a boy or a girl/male or female), as it would be impossible to classify every single particular thing with a different name, since it would require a prodigious memory and even go for infinity (Leibniz, 1646/1982).

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With Fausto-Sterling’s ideas in mind, it is clear that every infant who is born with physical characteristics that resemble others that look alike will, eventually, be grouped together and labeled accordingly (male or female). This seems to go along the line that in order for us to make sense of the world as it appears to us and to give meaning to particulars that appear in it, we have to generally label them. And in this case, the ‘label’ is restricted to physical characteristics. However, as one will see in the coming pages, not all beings that share the same traits are the same.

The case of Maria Patiño, a Spanish top hurdler, illustrates the point Fausto-Sterling and I want to make. The athlete was banned from participating in the World University Games 1985 after being identified as a man – she turned out to have Y-chromosomes, testes and neither ovaries nor a uterus. Yet, Patiño presented all the physical traits of a female (e.g., strengths, female genitals), so that anyone, especially doctors, could name her a girl at birth. Independently of perspective (societal or scientific), she cannot simply be disqualified to be a woman, although she presents biological traits of a man. However, this may not be sufficient to define someone as a man. In other words, regardless of how she was biologically born (with male chromosomes and lacking some female organs, such as ovaries), Maria Patiño’s sense of femaleness has remained intact. As she says: “I knew I was a woman” (p. 3).

Therefore, Fausto-Sterling points out that relying on characteristics of ‘biological sex’ to distinguish ‘sex ‘ from gender identity (male from female/girl from boy) is only one level of understanding the relation of ‘sex’ and ‘gender identity’ (if there is any). What should be taken into account is that ‘sex’, as argued earlier, should not be used to determine gender identity, as one’s biological sex is more complex than it appears: “Experience is not individual and fixed, but irredeemably social and processual” (p. 17). “Our bodies are too complex to provide clear-cut answers about sexual difference. The more we look for a simple basis for sex, the more it becomes clear that sex is not a pure physical category” (p. 5).

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In contrast, doctors and surgeons, as Fausto-Sterling argues, are mostly looking for clear-cut categories in order to put individuals into the ‘gender binary’ – there should be no such a thing as a gender that is ‘in between’ or a ‘third gender’ (e.g., intersex infants). One has to fit into a fixed societal model that enables one to define individuals either as male or female15. As Fausto-Sterling adds, doctors have to be careful when dealing with intersex newborns, as it can be very risky to decide one’s gender already at birth. There should be options for intersex newborns (or parents) to choose their gender throughout their life, and not the doctors should be responsible for covering the parents’ anguish. Concretely: “Surgeons make decisions based on their own beliefs and what was current practice when they were in training […] whatever treatment they choose, however, physicians who decide how to manage intersexuality act out of, and perpetuate, deeply held beliefs about male and female sexuality, gender roles” (p. 48).

Fausto-Sterling might be right when it comes to thinking wisely about the risk of deciding the intersex’s sex at an early age. Nevertheless, for the parents it might also be important to know how to raise their child (either as a boy or a girl). It might be quite challenging for them to raise a child with a neutral gender, and therefore, the newborn may, ultimately and unconsciously, still fall into the gender binary model. This means that the newborn’s gender, or the way he/she experiences his/her ‘gender identity’, might be influenced by the social environment as well. The case of the Spanish athlete, though, brings new findings to our discussion, as it seems to go in the opposite direction than the earlier case. Throughout her entire life, Maria Patiño lived with male inner traits (without anybody knowing it), yet she was raised (or ‘educated’, if one prefers to use Money’s words) as a girl, since her body’s appearance suggested so. But why has Maria Patiño not felt like a man in the

15_{Chapter two, Beyond the gender binary model, will discuss the ‘gender binary’ issues, when introducing} readers to the case study of this project, transsexual and transgender people, who reject the gender/sex that was assigned to them at birth.

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inside as David Reimer did? Can one conclude that Maria Patiño learned to be a woman? If so, why has David Reimer not learned the same lesson? There still seems to exist some obscure relation between body and self.

But, as Fausto-Sterling stresses, “every time we try to return to the body as something that exists prior to socialization, prior to discourse about male and female, […] we discover that matter is fully sedimented with discourses on sex and sexuality that prefigure and constrain the uses to which that term can be put” (p. 22). That is where the next author comes in to defend the social constructionist theory of gender – the ‘performativity of gender’.

American philosopher Judith Butler (1990) has come up with a very interesting yet complex theory on gender (identity). Butler holds the view that ‘gender identity’ should be understood in two ways: ‘Performativity’ and ‘Performance understanding’ of gender. The first concept, performativity, states that gender produces a series of effects in the world. One acts/behaves/walks in certain ways that consolidate whether one is a man or a woman. As Butler says: “Nobody is a gender from the very beginning” (p. 32).

On the other hand, the ‘performance understanding of gender’ argues that gender is ‘performed’ based on the sex one is. So, when gender is performed, one behaves based on a certain cultural role which one is enacting. Therefore, gender becomes what one ‘presents’ to the world. In Butler’s words:

“Gender ought not to be constructed as a stable identity or locus of agency from which various acts follow; rather, gender is an identity tenuously constituted in time, instituted in an exterior space through a stylized repletion of acts. The effect of gender is produced through the stylization of the body and, hence, must be understood as the mundane way in which bodily gestures, movements, and styles of various kinds constitute the illusion of an abiding gendered self” (1990, p. 179).

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Butler has certainly offered a very insightful theory on gender when recognizing the importance of social and cultural constructions of the world and the constitution of subjects to illustrate the character of social structures that naturalize the body and the sex differences between males and females. Put differently, in our society we experience a ‘mandatory order’ supported by what is known as ‘gender norm’16. This norm entails certain expectations on how people from different designed genders (e.g., trans, gay, bisexual, queer people etc.) are supposed to live their lives (Erickson-Schroth, 2014). In short, it requires symmetry between ‘sex and ‘gender’. For instance, ever since an infant is in the mother’s womb, if he has a penis, it automatically makes him a man, and therefore, society already expects this baby to be attracted to girls and behave accordingly. These are features of ‘gender role’, which conceives that gender is socially constructed17 and that the ‘body’ plays its role in shaping the societal definition/understanding of ‘gender’ – of what maleness or femaleness means. Put differently, (gender) identity comes about from certain ideals of femininity and masculinity, which is already framed right at one’s birth. For instance, “’it is a girl’ anticipates the eventual arrival of the sanction, I pronounce you a man and woman” (p. 232). In other words, the labeling as a girl or a boy defines all the meanings that are associated with that label. Therefore, femininity and masculinity are not a product of a choice but rather a social imposition onto the subject.

As an example, an eighteen years old boy was thrown over a bridge and killed by his classmates who used to tease him on his way to school, as he used to walk with a distinct swing of his hips, a walk considered very feminine (Abrams, 2011). This example illustrates how our gender is perceived as a continuation of our bodies; a man is supposed to have a

16_{Chapter three, Politics of body & selves, will shed some more light on this discussion by bringing up social} issues that involve subjects who do not fit into the societal gender binary model. According to this model, one is supposed to be either male or female (a man or a woman) and the body/sex one has been born with has to be aligned with one’s gender identity.

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manly walk and a woman a female one. That is, the societal idea of gender takes the body as a tool to define gender. So, when one’s body moves/acts in a way that is not seen as a typical masculine/feminine body movement, one’s maleness/femaleness is brought into question.

These are social expectations about how one’s body should move or what one’s body

should be like which are tied to a fixed notion of masculinity and femininity18. With the above in place, the definition of how a male and a female ought to act can be understood as a social concept. One question arises: Why can a man not have a feminine walk or the other way around? One answer to this question could be given through biology. For instance, a man’s anatomical body is clearly different from a woman’s body. This might influence the way a man moves/walks in space. Women, on the other hand, seem to have a lighter body structure than men, which consequentially, might influence the way they move their legs, hips etc. in space. These two groups, obviously, present some clear (biological) distinctions which, nevertheless, should not determine their experience of being male or female.

From another angle, though, Butler might be also reducing (to a certain extent) a complex concept such as ’gender’ by fully relying on social-cultural philosophical explanations for it without taking into consideration that the way one experiences one’s sense of femaleness/maleness may occur independently of any social phenomena.

Concretely, there might be individuals who, for instance, experience their gender differently than how it is performed. The case of David Reimer, the ‘boy who was turned into a girl’, as described above, seems to illustrate the points this chapter wants to make. This case, to some extent, seems to discredit Butler’s notion of performativity of gender. Yet, Butler might be partially right when arguing that one cannot be born with a fully formed

18_{More of this argument on the notion of body and gender will be addressed in the coming pages by the trans bi} woman writers Julia Serano (2007) and Talia Mai Bettcher (2012) and will be deeper explored in chapter two,

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‘gender identity’ (e.g., an innate sense of femaleness/maleness). For instance, defenders of BOT (brain organization theory) suggest that the same hormones that trigger the formation of female and male brains during the pregnancy determine their sense of being male or female at an adult age. In other words, it is argued that the exposure to these hormones during fetal formation influences the way one thinks about one’s gender as an adult (2014, Erickson-Schroth). For instance, the way ‘women’ and ‘men’ behave/act and experience their sexuality (e.g., being attracted to the opposite sex) could be explained through the BOT, as it argues that our brains are sexed at a very early stage of fetal formation.

Contrary to the BOT, Butler shares the same view as Rebecca Jordan-Young (2011), who argues that the environment, not only biology, shapes one’s brain as well. As Jordan-Young adds, in the past women were for example barred from studies such as Medicine, Engineering, Mathematics or Physics, as these fields were considered to be for men only. The situation nowadays is rather different, as women are very influential in those fields as well. The question then is, as Jordan-Young poses in a news article: “How could their hormones during gestation suddenly change and modify their brains to allow them to enter such fields?” (Siegel-Itzekovitch, 2011).

Further, as she argues, researchers of BOT accept that hormones do affect the brain during the baby’s formation with consequences throughout their lives. Therefore, BOT is seen as a reliable theory to explain, for instance, differing personal preferences of girls and boys. For instance, as the brain is permanently hardwired (as explained above), girls will, eventually, prefer to play with dolls rather than with trucks, cars or dinosaurs, like most boys do. And boys, unlike girls, will do better in physics, chemistry or mathematics. As adults, women will dream of becoming a mother and to have a family, whereas men will be good at fixing things at home (e.g., TVs, windows, cars etc.).

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What should be clear, though, is that Jordan-Young does not fully discredit BOT; instead, one should be a bit more careful in taking it as a truth. As she says herself: “The extent and nature of physical differences in the brains of human females and males is highly controversial, with some scientists claiming that there are no clear-cut differences, other claiming that there are some subtle average differences, and still others claiming that the differences are dramatic” (p. 49).

Further, as she adds, in some sort of radical research, scientists claim that the sex-related structure of a male’s brain is two times larger than that of most female brains. As there are different arguments about BOT and controversial standpoints without consensus, Jordan-Young ironically states: ”This may be an amusing comparison but from the standpoint of neuroanatomy it is pure imagination, beginning with the assertion that there are sex-related centers in the brain” (p. 50). In short, Jordan-Young is saying that none of these findings can actually reliably prove that what is argued has anything to do with differences between male and female brains. As she puts it, there are obvious differences between the human brains; for instance, the difference in volume of INAH3 (the sexually dimorphic nucleus of humans) seems to be real (p. 51). Furthermore, the basic differences in male and female reproductive physiology have to be, in a way, represented in their brains. However, as she alerts, if there are any differences between male and female brains, they are subtle and elusive and, therefore, cannot easily be pinned down.

Departing radically from Butler’s notion of ‘gender performativity’ and Fausto-Sterling’s insights on ‘intersex infants’, the trans woman, writer and feminist Julia Serano (2007) seems to be at odds with some of the assumptions defended by the above authors, especially Butler. Although I doubt that Serano would fully agree with some of the views defended by specialists of BOT, she could probably relate herself to some of the points that Jordan-Young seems to be stressing. Clearly against Butler’s notion of ‘performativity of

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gender’, Serano ironically says: “If one more person tells me that all gender is performance, I think I am going to strangle them. What’s most annoying about that sound-bite is how it is often recited in a somewhat snooty ‘I-took-a-gender-studies-class-and-you-didn’t’ sort of way, which is ironic given the way that phrase dumbs down gender.” In short, for Serano, to claim that gender is merely performance means to ignore one’s sense and inner experience of femaleness or maleness, which, according to her, can, to a certain extent, be explained through biology. “It seems as if, on some level, my brain expects my body to be female” (2013; online source). This experience seems to generate a feeling of wrong embodiment. As metaphorically pointed out: “I think how nice it would be to unzip my body from forehead to navel and go on vacation. But there is no escaping it, I’d have to pack myself along” (Feinberg, 1980, p. 20). One’s sense and innate feeling/experience of being male or female can be correlated to the notion of body image (as explored more in the coming chapter). In short, the way these subjects experience their sense of maleness/femaleness seems to be related to how their body is perceived by others but also by themselves.

With the above in mind, Serano holds the view that the way one experiences one’s gender or sense of self from the inside, which is a rather subjective and private feeling, does not necessarily depend on/relate to the act of performing a particular ‘gender role’. One might behave according to a particular gender role, nevertheless one might experience one’s gender differently from what was taught or performed. Unlike Butler, Serano adds that one can act and dress in the same way, even after being on female hormones. In other words, regardless of one’s habits, the way one senses one’s gender identity from inside could therefore remain intact. Thus, as she stresses, one should see that gender is more than performance. Assuming gender is only performance does not explain how one might experience one’s gender identity as a girl, a boy, a bi, trans or queer person etc.

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However, like some of the previous authors, such as Jordan-Young (2011) and also Fausto-Sterling (2000), Serano (2007) does not agree with the misleading notion that the formation of gender should be reduced to genitals, sex hormones or chromosomes. According to her, gender is a combination of these things – and even more. Hence, as an attack on those who hold the view of gender as merely a performance, Serano argues: “One can certainly act in a particular way, throw[ing] like a boy or bat[ing] the eyelashes”. Nevertheless, these acts cannot explain why certain individuals have a somewhat biological behavior. In Serano’s words:

“It doesn’t capture the very real physical and emotional changes that I experienced when I hormonally transitioned from testosterone to estrogen. Performance doesn’t even begin to address the fact that, during my transition, I acted the same – wore the same t-shirts, jeans and sneakers that I always had – yet once other people started reading me as female, they began treating me very differently” (2013; online source). On the one hand, Serano seems to be in favor of specialists on BOT, especially concerning her claims to have always felt also physically like a female from the inside (e.g., the female thoughts she claims to have had) and how her sense of gender identity has made even more sense after she started taking female hormones. As she puts it: “Personally, I am drawn to the brain-hardwiring hypothesis, not because I believe it has been proven scientifically beyond a doubt, but because it best explains why the thoughts I have had of being female always felt vague and ever present, […] it would also account for how I knew there was something wrong with me being a boy” (p. 58).

The brain organization theory, as pointed out, argues that gender differences can be found in humans’ brains. Jordan-Young and Fausto-Sterling’s work, though, is an attempt to show that hardwired differences in the brains of men and women do not exist. However,

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when thinking of subjects who claim to be a gender other than the one that was assigned to them at birth, there were studies in the past that claimed that a sexually dismorphic region of the brains of trans women closely resembles that of other women (Zhou et al, 1995). For instance, the trans bi woman Julia Serano argues that the way she has always felt or experienced herself as a female subject (with a female biological body) is, partially, aligned with what researchers of BOT argue. In short, for her, as someone who feels as a different gender than the one assigned at birth, there seems to be indeed a close relation between BOT and what Serano defines herself as her ‘subconscious sex’19. In other words, unlike the previous authors, for Julia Serano, to a certain extent, the brain organization theory does seem to enable her to make sense of her sense of being a woman – or feeling like one.

However, on the other hand, Serano could potentially also argue against the BOT specialists who defend the view that the hormones affect one’s brain during fetal formation and therefore, explain why a girl, for instance, likes playing with girly toys and a boy with boyish ones. Also the claim that BOT can explain why women present a different sexual appetite, or have different emotional attitudes towards themselves than men, has to be carefully analyzed. For instance, as Serano explains as well, there were certainly some changes (sexually, emotionally) in her behavior while she was on hormone therapy but these changes cannot be fully explained through the brain-hardwiring theory only. “Hormones do not simply act like unilateral on/off switches controlling female/feminine or male/masculine development” (p. 48).

Defenders of the BOT theory could probably still argue that female ‘behavior’ or even ‘sexual preferences’ occur after being exposed to female hormones. To claim that female

19_{As explained by Serano in her ‘Whipping Girl’ (2007), the notion of subconscious sex can be used to explain} transgender people’s sense of ‘gender incongruence’ – that is, the discomfort with the gender that was assigned at birth. Serano’s idea of subconscious sex holds the view that our brain always expects a certain biological sex (either female or male); it is one’s sense and conviction of being male or female (her ideas on subconscious sex will be further explored in chapter four, as it is an attempt to give a phenomenological interpretation of some of the ideas and findings presented in the previous chapters in order to adequately answer the research question).

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hormones make one more emotional, assuming that all women are ‘drama queens’, is a socially constructed stereotype. As Serano says, when the testosterone was predominant in her body, her emotions were deeper than after being on female hormones. Her emotions nowadays come in crystal clearly compared to before. However, Jordan-Young argues that hormones do not or cannot simply create male or female brains by themselves. Scientific researchers who raised questions on sex differences and who took into account the brain seem to neglect the social factors, though.

On the other hand, as Jordan-Young (2014) adds, in the 1990s the brain organization

theory returned, and then lower levels of libido, sexual activity, sexual preference and fertility

of women among other women with CAH20 were interpreted as indicators of a masculinized brain. In other words, male sexuality is often defined as ‘male is more’ – that is, more libido, more partners and many ways of being sexually aroused. In contrast, the typical feminine (female) sexuality is understood as less emotionally stable, has less libido, is not versatile in terms of sexual preference etc. Along the same lines, scientists often interpreted behaviors such as masturbation or expression of intense physical desire or better skills in mathematics as typical masculine traits. Female sexuality, on the other hand, is more responsive and less autonomously driven. Their sexuality is often attributed to their partners. In short, as Jordan-Young explains, according to researchers, the prenatal hormones create or are responsible for determining a masculine or feminine sexual orientation.

Nevertheless, likewise Jordan-Young, what interests this project is not so much what affects or (might) influence masculine and feminine sexuality but what people think of, and how they define, masculinity/femininity and sexuality.

20_{As Warrell et al (2005) explain, congenital adrenal hyperplasia (CAH) are scientifically known as several} autosomal recessive diseases resulting from mutations of genes for enzymes mediating the biochemical steps of production of cortisol from cholesterol by the adrenal glands (steroidogenesis).

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Jordan-Young, though, has always thought of gender, sex and sexuality as a ‘three-ply yarn’, since they appear to be distinct from one another, yet very much interrelated. Nevertheless, her definition of the above is quite comparable to some of the authors mentioned earlier, that is, to refer sex to characteristics of the physical body. By contrast, gender is what she defines as psychological attributes and social behaviors that are associated with masculinity and femininity. And sexuality is the erotic desire and pleasure of sexual practice (p. 15).

So, with the above discussions in mind, many issues and misinterpretations come together with the societal definition of what is taken as masculine or feminine. And this is the point, as Jordan-Young argues, which current scientists overlooked. Serano (2007), on the other hand, claims that one of the aspects of sexism is perceiving women (femininity) as inferior to men (masculinity). Further, in Serano’s case, for instance, some of the above points (argued to be typically male or female) are not applicable, which eventually has caused in her a desire to reconcile her inner feeling of femaleness21 with her boyish preferences. Concretely, “unlike other MTF22 spectrum children, I never really wanted to take part in girlish activities, such as playing home. […] It wasn’t clear to me how to reconcile my vague subconscious feelings with my passion for dinosaurs and my desire to be a Major League baseball player when I grew up” (p. 57). So, unlike what BOT defenders argue regarding male and female preferences being related to brain-hardwiring, Serano had preferences of a boy and, eventually, also performed in a way so that others still kept on perceiving and thinking of her as a boy – which in fact, biologically she was.

The point is that, as in the earlier case of David Reimer, nature seems to play its role in defining one’s sense of femaleness/maleness. However, Jordan-Young seems to be right in

21_{Serano attributes her inner feelings of maleness/femaleness to how her brain seems to have expected her to} have a female body and not a male (2007).

The Body They Live In