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Elizabeth Reis, Bodies in doubt: an American history of intersex, Baltimore, Johns Hopkins University Press, 2009, pp. xix, 216, £28.50, $55.00 (hardback 978-0-8018-9155-7).
“To be human is to be physically sexed and culturally gendered” (p. ix), writes Elizabeth Reis in Bodies in doubt, a much needed comprehensive history of intersex in the United States from the colonial period to the present. Reis's long-term perspective allows her to show changing medical, legal and lay interventions around humans who do not fit this description. In colonial America, hermaphrodites were often considered examples of “monstrous births”. By the nineteenth century, physicians had replaced the older conception of hermaphrodites as monsters with a “newer emphasis on personhood” (p. 28) that combined anatomy and moral evaluations of a person's life. Hermaphrodites were considered suspicious, and closely related to the other newly emerged figure, the “homosexual”—sometimes conceptualized as “mental hermaphrodite”. Nineteenth-century middle-class fears of deceit, fraud, and racial instability also structured the unease in dealing with ambiguously sexed persons. Medical experts claimed the expertise to find a person's true sex in his or her gonads, though in practice uncertainty persisted. In the twentieth century, concepts of hormonal, chromosomal, and psychological sex were added to the mix. In the 1950s, the Hopkins protocol consolidated the diverse medical approaches under a new treatment regime: they recommended assigning sex early and operating on genitals to make them fit the chosen sex.
Reis's long-term perspective allows her to make a set of claims regarding the periodization of American intersex. She shows that—contrary to Europe—in the US hermaphroditism was proclaimed to be “impossible” (p. 54) long before the late nineteenth century. But as in Europe, in America gonads ruled as the ultimate determiners of sex only in theory. In practice, cases of ambiguous sex were settled in the old way: by external anatomy and social and behavioural cues. Reis also shows that societal expectations of gender performance, thought to be an item of mid-twentieth-century intersex treatment protocols, were already part of nineteenth-century treatments. Finally, she argues that a diverse and seemingly random approach was typical for medical interventions on intersexed persons from the seventeenth century onward. Doctors chose a person's sex on a case-to-case basis, weighing ethics, patients’ wishes, biological markers and social indicators of sex. When in the early 1950s, John Money, and Joan and John Hampson argued that sex of rearing was the determining factor in the development of a person's gender role, they were building, as Reis shows, on a sense of the importance of psychological sex that had been rising since the 1920s.
With all the idiosyncrasies in the conception and treatment of intersexed persons, there are also constants. Reis argues convincingly that, right up to the present, most medical interventions have been framed by norms of heterosexuality; that is, the desired outcome would be clearly sexed and gendered heterosexual men and women. Treatment success was measured by fulfilment of social goals such as a heterosexual marriage, a desired happy ending that at times led physicians even before the mid-twentieth century to ignore what they perceived as biological evidence of sex. Reis dates interventionist surgery on genitals to the late nineteenth century and reveals how these corrections were already based on heterosexual norms: promote marriage, heterosexual intercourse and avoid homosexual acts.
Reis's long-term approach allows for historical comparison as she excavates consistencies and changes in the conception, perception and medical management of intersex. At times, however, it also makes “intersex” a seemingly stable category, rather than an umbrella term for a wide array of divergence, variation and disorders that shared one symptom only—sexual ambiguity. One misses—especially in the twentieth-century chapters—a structured and critical engagement with what the physicians’ conceptualization of their patients’ pathology and physiology beyond their ambiguous sexuality was. Nevertheless, Bodies in doubt is a thoughtful contribution to the historical analysis of intersex in the US and provides valuable insights for contemporary debates on the ethics of modern medical management of intersex. This linkage makes it an important read for gender scholars, medical historians and health professionals alike.