4082966
Negotiating intersex: A case for revising the theory of social diagnosis.
The theory of social diagnosis recognizes two principles: 1) extra-medical social structures frame diagnosis; and 2) myriad social actors, in addition to clinicians, contribute to diagnostic labels and processes. The relationship between social diagnosis and (de)medicalization remains undertheorized, however, because social diagnosis does not account for how social actors can also resist the pathologization of symptoms and conditions-sometimes at the same time as they clamor for medical recognition-thereby shaping societal definitions of disease in different, but no less important, ways. In this article, we expand the social diagnosis framework by adding a third principle, specifically that 3) social actors engage with social structures to both contribute to, and resist, the framing of a condition as pathological (i.e. medicalization and demedicalization). This revised social diagnosis framework allows for the systematic investigation of multi-directional, dynamic processes, formalizing the link between diagnosis and (de)medicalization. It also responds to long-standing calls for more contextualized research in (de)medicalization studies by offering a framework that explicitly accounts for the social contexts in which (de)medicalizing processes operate. To showcase the utility of this revised framework, we use it to guide our analyses of a highly negotiated diagnosis: intersex.
205575187
Sociology of diagnosis: a preliminary review.
Diagnoses are the classification tools of medicine, and are pivotal in the ways medicine exerts its role in society. Their sociological study is commonly subsumed under the rubrics of medicalisation, history of medicine and theory of disease. Diagnosis is, however, a powerful social tool, with unique features and impacts which deserve their own specific analysis. The process of diagnosis provides the framework within which medicine operates, punctuates the values which medicine espouses, and underlines the authoritative role of both medicine and the doctor. Diagnosis takes place at a salient juncture between illness and disease, patient and doctor, complaint and explanation. Despite calls for its establishment, almost two decades ago (Brown 1990), there is not yet a clear sociology of diagnosis. This paper argues that there should be, and, as a first step, draws together a number of threads of medical sociology that potentially contribute to this proposed sociology of diagnosis, including the place of diagnosis in the institution of medicine, the social framing of disease definitions, the means by which diagnosis confers authority to medicine, and how that authority is challenged. Through this preliminary review, I encourage sociology to consider the specific role of diagnosis in view of establishing a specific sub-disciplinary field.
141645582
Putting a Name to It: Diagnosis in Contemporary Society
Over a decade after medical sociologist Phil Brown called for a sociology of diagnosis, Putting a Name to It provides the first book-length, comprehensive framework for this emerging subdiscipline of medical sociology. Diagnosis is central to medicine. It creates social order, explains illness, identifies treatments, and predicts outcomes. Using concepts of medical sociology, Annemarie Goldstein Jutel sheds light on current knowledge about the components of diagnosis to outline how a sociology of diagnosis would function. She situates it within the broader discipline, lays out the directions it should explore, and discusses how the classification of illness and framing of diagnosis relate to social status and order. Jutel explains why this matters not just to doctor-patient relationships but also to the entire medical system. As a result, she argues, the sociological realm of diagnosis encompasses not only the ongoing controversy surrounding revisions to the Diagnostic and Statistical Manual of Mental Disorders in psychiatry but also hot-button issues such as genetic screening and pharmaceutical industry disease mongering. Both a challenge and a call to arms, Putting a Name to It is a lucid, persuasive argument for formalizing, professionalizing, and advancing longstanding practice. Jutel's innovative, open approach and engaging arguments will find support among medical sociologists and practitioners and across much of the medical system.
5740608
From diagnosis to social diagnosis.
In the past two decades, research on the sociology of diagnosis has attained considerable influence within medical sociology. Analyzing the process and factors that contribute to making a diagnosis amidst uncertainty and contestation, as well as the diagnostic encounter itself, are topics rich for sociological investigation. This paper provides a reformulation of the sociology of diagnosis by proposing the concept of 'social diagnosis' which helps us recognize the interplay between larger social structures and individual or community illness manifestations. By outlining a conceptual frame, exploring how social scientists, medical professionals and laypeople contribute to social diagnosis, and providing a case study of how the North American Mohawk Akwesasne reservation dealt with rising obesity prevalence to further illustrate the social diagnosis idea, we embark on developing a cohesive and updated framework for a sociology of diagnosis. This approach is useful not just for sociological research, but has direct implications for the fields of medicine and public health. Approaching diagnosis from this integrated perspective potentially provides a broader context for practitioners and researchers to understand extra-medical factors, which in turn has consequences for patient care and health outcomes.
143801043
Medicalization and Social Control
This essay examines the major conceptual issues concerning medicalization and social control, emphasizing studies published on the topic since 1980. Several issues are considered: the emergence, definition, contexts, process, degree, range, consequences, critiques, and future of medicalization and demedicalization. Also discussed are the relation of medicalization and social control, the effect of changes in the medical profession and organization on medicalization, and dilemmas and lacunae in medicalization research.
143790561
Medicalisation: A Multi-dimensional Concept
Originally, the concept of medicalisation was strongly associated with medical dominance, involving the extension of medicine's jurisdiction over erstwhile ‘normal’ life events and experiences. More recently, however, this view of a docile lay populace, in thrall to expansionist medicine, has been challenged. Thus, as we enter a post-modern era, with increased concerns over risk and a decline in the trust of expert authority, many sociologists argue that the modern day ‘consumer’ of healthcare plays an active role in bringing about or resisting medicalisation. Such participation, however, can be problematic as healthcare consumers become increasingly aware of the risks and uncertainty surrounding many medical choices. The emergence of the modern day consumer not only raises questions about the notion of medicalisation as a uni-dimensional concept, but also requires consideration of the specific social contexts in which medicalisation occurs. In this paper, we describe how the concept of medicalisation is presented in the literature, outlining different accounts of agency that shape the process. We suggest that some earlier accounts of medicalisation over-emphasized the medical profession's imperialistic tendencies and often underplayed the benefits of medicine. With consideration of the social context in which medicalisation, or its converse, arises, we argue that medicalisation is a much more complex, ambiguous, and contested process than the ‘medicalisation thesis’ of the 1970s implied. In particular, as we enter a post-modern era, conceptualizing medicalisation as a uni-dimensional, uniform process or as the result of medical dominance alone is clearly insufficient. Indeed, if, as Conrad and Schneider (1992) suggested, medicalisation was linked to the rise of rationalism and science (ie to modernity), and if we are experiencing the passing of modernity, we might expect to see a decrease in medicalisation.
140512869
Medicalization: Changing Contours, Characteristics, and Contexts
Medicalization has become a central analytical theme in medical sociology, a topic in medical sociology courses and the subject of hundreds if not thousands of articles (Conrad P (2007) The medicalization of society: on the transformation of human condition into treatable disorders. Johns Hopkins University Press, Baltimore; Ballard K, Elston MA (2005) Medicalisation: a multi-dimensional concept. Soc Theory Heal 3:228–241; Clarke et al. 2010). Other scholars, including historians (Nye RA (2003) The evolution of the concept of medicalization in the late twentieth century. J Hist Behavioral Sci 39:115–129), anthropologists (Lock M (2001, Press 2006) Medicalization: cultural concerns. In: Smelser N, Baltes P (eds) International encyclopedia of the social and behavioral sciences. Elsevier, New York), medical and public health researchers (Metzl JM, Herzig RM (2007) Medicalisation in the 21st century: an introduction. Lancet 369:697–698; Maloney 2011; Lantz et al. (2007) Health policy approaches to population health: the limits of medicalization. Health Affairs 26:1253–1257), economists (Thorpe KE, Philwaw M (2012) The medicalization of chronic disease and costs. Ann Rev Public Heal 23:409–423), bioethicists (Parens E (2011) On good and bad forms of medicalization. Bioethics doi: 10.1111/j.1467-8519.2011.01885.x), and even literary scholars (Lane C (2007) Shyness: how normal behavior became a sickness. Yale University Press, New Haven) have also examined medicalization. Medicalization has been the subject of newspaper and magazine commentaries (e.g. Welch 2011) and discussion at (President’s Council on Bioethics (2003) Beyond therapy: biotechnology and the pursuit of happiness. The President’s Council on Bioethics, Washington). It seems clear that medicalization has become a topic of interest beyond sociology. Within medical sociology it is a concept that has moved from the periphery of intellectual interest in the 1970s to a central area of interest in the twenty-first century.
206717279
Recognizing medicalization and demedicalization: Discourses, practices, and identities
Scholars of the medicalization of social problems have paid inadequate attention to medicalization’s multiple dimensions – discourses, practices and identities – and to the multiple levels of analysis at which it occurs – macro, meso and micro. As a result, scholars of a given social problem typically examine only a few aspects of its medicalization, fail to recognize changes in medicalization, and miss occasions where medicalization and demedicalization occur simultaneously. Moreover, by conceptualizing medicalization as a category or state rather than a continuous value, and failing to specify the threshold at which a phenomenon becomes ‘medicalized’ or ‘demedicalized’, scholars have discouraged attention to demedicalization. The article provides a new typology of medicalization and illustrates its utility through an analysis of two episodes in American abortion history. Previous analysts of these episodes miss many aspects of medicalization and disagree about whether these episodes involve medicalization or demedicalization. The typology helps resolve these differences.
8284211
Does "difficult patient" status contribute to de facto demedicalization? The case of borderline personality disorder.
A diagnosis of Borderline Personality Disorder (BPD) often signals the quintessential "difficult patient" status to clinicians, with at least one scholar arguing the condition itself was created to name and group difficult patients. While patients who are deemed difficult are often dispreferred for care, does this have an impact on their overall status as medicalized patients who have successfully achieved a sick role? This study relies on (n = 22) in-depth interviews with mental health clinicians in the United States from 2012 to evaluate how they describe patients with BPD, how the diagnosis of BPD affects the treatment clinicians are willing to provide, and the implications for patients. My findings suggest patients with BPD are routinely labeled "difficult," and subsequently routed out of care through a variety of direct and indirect means. This process creates a functional form of demedicalization where the actual diagnosis of BPD remains de jure medicalized, but the de facto or treatment component of medicalization is harder to secure for patients.
3947895
Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S. Biomedicine
The first social transformation of American medicine institutionally established medicine by the end of World War II. In the next decades, medicalization-the expansion of medical jurisdiction, authority, and practices into new realms-became widespread. Since about 1985, dramatic changes in both the organization and practices of contemporary biomedicine, implemented largely through the integration of technoscientific innovations, have been coalescing into what the authors call biomedicalization, a second transformation of American medicine. Biomedicalization describes the increasingly complex, multisited, multidirectional processes of medicalization, both extended and reconstituted through the new social forms of highly technoscientific biomedicine. The historical shift from medicalization to biomedicalization is one from control over biomedical phenomena to transformations of them. Five key interactive processes both engender biomedicalization and are produced through it: (1) the political economic reconstitution of the vast sector of biomedicine; (2) the focus on health itself and the elaboration of risk and surveillance biomedicines; (3) the increasingly technological and scientific nature of biomedicine; (4) transformations in how biomedical knowledges are produced, distributed, and consumed, and in medical information management; and (5) transformations of bodies to include new properties and the production of new individual and collective technoscientific identities.
36910791
The social determinants of health: coming of age.
In the United States, awareness is increasing that medical care alone cannot adequately improve health overall or reduce health disparities without also addressing where and how people live. A critical mass of relevant knowledge has accumulated, documenting associations, exploring pathways and biological mechanisms, and providing a previously unavailable scientific foundation for appreciating the role of social factors in health. We review current knowledge about health effects of social (including economic) factors, knowledge gaps, and research priorities, focusing on upstream social determinants-including economic resources, education, and racial discrimination-that fundamentally shape the downstream determinants, such as behaviors, targeted by most interventions. Research priorities include measuring social factors better, monitoring social factors and health relative to policies, examining health effects of social factors across lifetimes and generations, incrementally elucidating pathways through knowledge linkage, testing multidimensional interventions, and addressing political will as a key barrier to translating knowledge into action.
25526982
Social Determinants and Health Behaviors: Conceptual Frames and Empirical Advances.
Health behaviors shape health and well-being in individuals and populations. Drawing on recent research, we review applications of the widely applied "social determinants" approach to health behaviors. This approach shifts the lens from individual attribution and responsibility to societal organization and the myriad institutions, structures, inequalities, and ideologies undergirding health behaviors. Recent scholarship integrates a social determinants perspective with biosocial approaches to health behavior dynamics. Empirical advances model feedback among social, psychological and biological factors. Health behaviors are increasingly recognized as multidimensional and embedded in health lifestyles, varying over the life course and across place and reflecting dialectic between structure and agency that necessitates situating individuals in context. Advances in measuring and modeling health behaviors promise to enhance representations of this complexity.
144869690
Intersex Bodies as States of Exception: An Empirical Explanation for Unnecessary Surgical Modification
In 2006, the official journal of the American Academy of Pediatrics published a consensus statement on the medical management of intersex traits. Like the profession's first statement, the revision advised against unnecessary surgical modifications. Yet, such surgeries continue in contemporary US society, despite the professional stance and public critiques from intersex activists. Relying on sixty-five interviews with medical professionals, individuals with intersex traits, and parents of intersex children, this article examines why the practice continues. It then analyzes how medical professionals justify their medical interventions and shows that these justifications convey a "covert necessity" to the parents of intersex children. Intersex bodies, situated on the threshold of the gender structure, are treated as "states of exception" where unnecessary medical interventions serve to uphold the sex binary. The article argues that medical interventions aimed at eliminating intersex traits will continue until society disentangles sex from gender, embraces gender fluidity, and no longer constructs intersex bodies as deviant or abnormal in order to disallow or erase them.
145754009
Progress and Politics in the Intersex Rights Movement: Feminist Theory in Action
Since 1990, when Suzanne Kessler published her foundational feminist critique of the modern-day medical treatment of children with intersex, much has changed in intersex politics, practice, and theory. This essay traces some key points of progress and considers in particular the relationship of academic feminism and intersex advocacy; proof of and reasons for success in intersex medical advocacy; and intersex identity politics, especially with regard to the nature-nurture debate and terminology (intersex versus hermaphroditism versus disorders of sex development). The authors are university-based academic feminists who have worked intensively as volunteers and as paid directors at the Intersex Society of North America, the longest-running and best-known intersex advocacy and policy organization. In this work, they draw on the published literature as well as their own activist and academic experiences. They argue that, in the last fifteen years, much progress has been made in terms of improving the medical and social attitudes toward people with intersex, but that significant work remains to be done to ensure that children born with sex anomalies will be treated in a way that privileges their long-term well-being over societal norms. They also argue that, while feminist scholars have been critically important in developing the theoretical underpinnings of the intersex rights movement and sometimes in carrying out the day-to-day political work of that movement, there have been intellectual and political problems with some feminists’ approaches to intersex.
141967805
Medicalization and Biomedicalization Revisited: Technoscience and Transformations of Health, Illness and American Medicine
Medicalization theory has been at the heart of medical sociology or the sociology of health and illness for nearly 40 years (Zola 1972; Freidson 1970) and is also vital to medical anthropology (Hogle 2002; Lock 2001, 2004), the history of medicine (Nye 2003; Sinding 2004), medicine itself (Chervenak and McCullough 2005), bioethics (Bergeron 2007), and beyond. The still robust medicalization thesis is that the legitimate jurisdiction of Western or scientific medicine began expanding by including new domains of human life (such as alcoholism, drug addiction, and obesity) by redefining or reconstructing them as falling properly within medical (rather than legal, religious, etc.) domains (e.g., Ballard and Elston 2005; Conrad 1992, 2005, 2007; Conrad and Schneider 1980a, b).
144697804
“We Won't Know Who You Are”: Contesting Sex Designations in New York City Birth Certificates
This article examines shifts in the legal, medical, and common-sense logics governing the designation of sex on birth certificates issued by the City of New York between 1965 and 2006. In the initial iteration, the stabilization of legal sex categories was organized around the notion of “fraud”; in the most recent iteration, “permanence” became the measure of authenticity. We frame these legal constructions of sex with theories about the “natural attitude” toward gender.
146124062
Self-Help Literature and the Making of an Illness Identity: The Case of Fibromyalgia Syndrome (FMS)
Fibromyalgia syndrome (FMS) is a controversial pain disorder. In biomedical lexicon FMS is a functional somatic syndrome, or an illness for which there is no organic explanation or demonstrable physiological abnormality. Approximately six million Americans are diagnosed with FMS; nearly all of those diagnosed are women. I approach FMS using insights from the illness experience and identity formation literatures. In particular, I explore the mechanisms within FMS self-help literature that facilitate the creation of an illness identity. Through a qualitative analysis of the five best-selling FMS self-help books, I demonstrate how a public FMS illness narrative encourages the organization of dissimilar experiences into a unified illness identity. Additionally, I demonstrate how the permissive boundaries of this identity function to reduce self-doubt and alienation in a context were biomedicine is unable to make FMS visible. I support these claims using interviews with FMS sufferers to show how they read these texts into their lived illness experiences and how their lived experiences are read onto these texts. Finally, I contend that the processes of illness identity formation described here are not exclusive to FMS or limited even to other contested illnesses. The formation of illness identities is a common consequence of participation in health-related, self-help communities generally and is integral to contemporary processes of medicalization.
11537282
Are you a cancer survivor? A review on cancer identity
PurposeIndividuals diagnosed with cancer have been shown to interpret the term “cancer survivor” differently and this may have implications for how they cope with their illness. This article reviews the empirical research conducted in the field and aims to formulate recommendations for future research.MethodsA literature search was conducted on PubMed, PsycInfo, Embase and CINAHL using search strategies customized for each database: standardized subject terms and a wide range of free-text terms for “cancer”, “survivor”, and “identity”. Data from 23 eligible papers were extracted and summarized.ResultsAnalysis of the studies revealed that individuals diagnosed with cancer could be categorized into five groups based on their attitudes towards being a cancer survivor: embracing, constructive, ambiguous, resisting and non-salient. Identification as “cancer survivor” was found to be highly prevalent within the breast cancer community (77.9 %) and least among individuals diagnosed with prostate cancer (30.6 %). Self-identifying as a cancer survivor was related to better quality of life and mental wellbeing, with those having a childhood diagnosis more likely to transition successfully into adult care.ConclusionsThe findings show that, for a substantial group of individuals, “cancer survivor” is not a title earned upon receiving a cancer diagnosis or completion of treatment, but an identity that may be embraced in time after deliberation. Future studies should examine the endorsement rate in less common cancers and whether choice of cancer identity varies over time.Implications for Cancer SurvivorsResearchers and healthcare professionals should use caution when using the term “cancer survivor” so as not to alienate anyone who has been diagnosed with cancer but does not identify with it.
13598587
Medicalization, Ambivalence and Social Control: Mothers’ Descriptions of Educators and ADD/ADHD
Conrad notes that non-medical personnel often accomplish the routine, everyday work of medicalization. This is particularly so in the case of Attention Deficit (Hyperactivity) Disorder, where teachers, special educators and school psychologists identify, assess and administer medication to ‘problematic’ children. Drawing on data from interviews with Canadian and British mothers of ADD/ADHD children, this article explores mothers’ perceptions of educators’ roles in medicalizing children who are different, comparing medicalization in two divergent sites. In Canada, where ADD/ADHD is a highly medicalized phenomenon, and teachers have few alternative forms of social control available to them in classrooms, it appears that educators are prepared to identify problem children and press for medical treatment with remarkable vigor. In Britain, where medicalization remains incomplete, and where teachers and special educators have more stringent alternative forms of social control available to them, educators were often described as gatekeepers who will refuse the label or to administer medication.
143377628
Border Children: Interpreting Autism Spectrum Disorder in South Korea
In this article, we describe reluctant mothers on the brink of accepting autism spectrum disorder (ASD) as a diagnosis for their children, but caught in a web of social meanings that push them to resist it. We argue that several tensions underlie this resistance: (1) an opposition between homogeneity and heterogeneity, in which mothers aim to define their child as “normal”; (2) a distinction between social and intellectual domains of child development, in which mothers localize their children's problems as deficits in a discrete area of development, rather than as a global or pervasive impairment; and (3) an opposition between chronicity and recovery, in which mothers reject a label they fear will index a permanent condition. These oppositions help to define the interaction between a diagnosis new to Koreans (ASD) and a particular condition (the child who has the symptoms of ASD but is academically successful) to form a new kind of child that mothers and teachers increasingly call “border children” (gyonggye-seon aideul). This specific ethnographic inquiry informs debates over the ontological bases for psychiatric diagnoses in children, and the processes through which local institutions, classificatory schemes, expertise, and child behavior shape conceptions of child development. [autism, Korea, child development, child psychiatry, border children]
145628952
The Shifting Engines of Medicalization∗
Social scientists and other analysts have written about medicalization since at least the 1970s. Most of these studies depict the medical profession, interprofessional or organizational contests, or social movements and interest groups as the prime movers toward medicalization. This article contends that changes in medicine in the past two decades are altering the medicalization process. Using several case examples, I argue that three major changes in medical knowledge and organization have engendered an important shift in the engines that drive medicalization: biotechnology (especially the pharmaceutical industry and genetics), consumers, and managed care. Doctors are still gatekeepers for medical treatment, but their role has become more subordinate in the expansion or contraction of medicalization. Medicalization is now more driven by commercial and market interests than by professional claims-makers. The definitional center of medicalization remains constant, but the availability of new pharmaceutical and potential genetic treatments are increasingly drivers for new medical categories. This requires a shift in the sociological focus examining medicalization for the twenty-first century.
145537490
Disease Politics and Medical Research Funding
In the 1980s and 1990s, single-disease interest groups emerged as an influential force in U.S. politics. This article explores their effects on federal medical research priority-setting. Previous studies of advocacy organizations’ political effects focused narrowly on direct benefits for constituents. Using data on 53 diseases over 19 years, I find that in addition to securing direct benefits, advocacy organizations have aggregate effects and can systemically change the culture of policy arenas. Disease advocacy reshaped funding distributions, changed the perceived beneficiaries of policies, promoted metrics for commensuration, and made cultural categories of worth increasingly relevant to policymaking.
25432080
Consensus statement on management of intersex disorders.
The birth of an intersex child prompts a long-term management strategy that involves a myriad of professionals working with the family. There has been progress in diagnosis, surgical techniques, understanding psychosocial issues and in recognizing and accepting the place of patient advocacy. The Lawson Wilkins Paediatric Endocrine Society (LWPES) and the European Society for Paediatric Endocrinology (ESPE) considered it timely to review the management of intersex disorders from a broad perspective, to review data on longer term outcome and to formulate proposals for future studies. The methodology comprised establishing a number of working groups whose membership was drawn from 50 international experts in the field. The groups prepared prior written responses to a defined set of questions resulting from an evidence based review of the literature. At a subsequent gathering of participants, a framework for a consensus document was agreed. This paper constitutes its final form.
79092024
“DSD is a Perfectly Fine Term”: Reasserting Medical Authority through a Shift in Intersex Terminology
Purpose – Intersexuality is examined from a sociology of diagnosis frame to show how the diagnostic process is connected to other social constructions, offer new support that medical professionals define illness in ways that sometimes carries negative consequences, and illustrate how the medical profession holds on to authority in the face of patient activism. 
 
Methodology/approach – Data collection occurred over a two-year period (October 2008 to August 2010). Sixty-two in-depth interviews were conducted with individuals connected to the intersex community including adults with intersexuality, parents, medical professionals, and intersex activists. 
 
Findings – Medical professionals rely on essentialist understandings of gender to justify the medicalization of intersexuality, which they currently are doing through a nomenclature shift away from intersex terminology in favor of disorders of sex development (DSD) language. This shift allows medical professionals to reassert their authority and reclaim jurisdiction over intersexuality in light of intersex activism that was successfully framing intersexuality as a social rather than biological problem. 
 
Practical implications – This chapter encourages critical thought and action from activists and medical professionals about shifts in intersex medical management. 
 
Social implications – Intersexuality might be experienced in less stigmatizing ways by those personally impacted. 
 
Originality/value – The value of this research is that it connects the sociology of diagnosis literature with gender scholarship. Additional value comes from the data, which were collected after the 2006 nomenclature shift.
17398380
Divergence or Disorder?: the politics of naming intersex
The conditions once known under the umbrella terms intersex and hermaphroditism are now generally being called disorders of sex development in medical settings. The terms might seem synonymous, but in fact there are significant differences with controversial consequences. Hermaphroditism, an older term that can still be found in many medical writings, is vague, demeaning, and sensationalistic, conjuring mythic images of monsters and freaks. In the 1990s, activists advocated intersex to describe discordance between the multiple components of sex anatomy, but that word alienated many parents of affected children, as it suggests a self-conscious alternative gender identity and sexuality. Disorders of sex development also refers to intersex, but it deemphasizes the identity politics and sexual connotations associated with intersex, avoids the degradation associated with hermaphrodite, and instead highlights the underlying genetic or endocrine factors that cause prenatal sex development to take an unusual path. I argue that using disorder is problematic, because it implies medical conditions in need of repair, when some intersex anatomies, though atypical, do not necessarily need surgical or hormonal correction. I advocate a less pathologizing new term, divergence of sex development, that might reduce some of the conflict over nomenclature and satisfy intersex people, their parents, and their doctors.
145413579
The power in a name: diagnostic terminology and diverse experiences
Soon after the disorders of sex development (DSD) terminology was introduced in the 2006 medical consensus statement on the management of intersex traits, intersexuality became an outdated term within medical discourse. Because of the way the DSD terminology was officially introduced by an international medical consortium, it appears individuals with intersex traits are left to engage with it. Interviews with thirty-seven research participants with intersex traits show that DSD terminology is engaged in different ways by those the terminology is meant to describe, with some arguing against it, others supporting it and a few being indifferent to it. Participants also tended to describe self-understandings that might conflict with the intersex identity that was observed in the 1990s. Patterns across participants’ preferred terminology and their relationships with family members and medical providers are also observed.
143858003
Why do ‘we’ perform surgery on newborn intersexed children?
Few parents-to-be consider that their child may be born with ambiguous sex. Still, parents of a newborn child with ambiguous sex are expected to make a far-reaching decision for the child: should the child be operated upon so that it has either female or male genitals? The aim of this article is to examine, phenomenologically, why parents decide to have their children undergo genital surgery when it is not necessary for the child’s physiological functions. Drawing on phenomenological work by Maurice Merleau-Ponty, Simone de Beauvoir and Sara Ahmed, we examine parents’ frustration when their child’s sex is ambiguous and their experiences of the practice of medical sex assignment. We also examine parental identity work when the child has been assigned a sex and the interaction between parents and medical professionals when parents make decisions regarding surgery on their child. Furthermore, we provide a critical perspective on the surgical practice.
141783861
Fixing Sex: Intersex, Medical Authority, and Lived Experience
Acknowledgments ix Introduction 1 Part 1. What is Intersexuality? History and Theory 1. Taxonomies of Intersexuality to the 1950s 31 2. Complicating Sex, Routinizing Intervention: The Development of the Traditional Treatment Paradigm 47 3. From Socialization to Hardwire: Challenges to the Traditional Treatment Paradigm 63 Part 2. Making Decisions For and About a Baby with an Intersex Diagnosis 4. Boy or Girl? Bodies of Mixed Evidence and Gender Assignment 89 5. Fixing Sex: Surgery and the Production of Normative Sexuality 133 Part 3. Living the Medicalized Body 6. Waning and Deciding What is Best: Parents' Experiences 179 7. Growing Up under the Medical Gaze 216 8. The Intersex Body in the World: Activism and Social and Medical Change 236 Notes 291 References 321 Index 343
29560193
Sexing the Intersexed: An Analysis of Sociocultural Responses to Intersexuality
explore here the social construction of gender in North America through an analysis of contemporary and historical responses to infants who are born genitally ambiguous, or intersexed (hermaphroditic).' Bodies that are sexually ambiguous challenge prevailing binary understandings of sex and gender. Individuals who are intersexed have bodies that are quite literally queer or "culturally unintelligible" (Butler 1993, 2). That is, their bodies do not conform to an overarching and largely unexamined social expectation that all humans belong to one of two clearly delineated sex categories, female or male (Wilson 1998). While being born with ambiguous sexual organs indeed problematizes binary understandings of sex and gender, the majority of intersexed children do not require medical intervention for their physiological health (Diamond and Sigmundson 1997b; Dreger 1998b; Kessler 1998).2
37611516
Normalizing Medicine: Between “Intersexuals” and Individuals with “Disorders of Sex Development”
In this paper, I apply Michel Foucault’s analysis of normalization to the 2006 announcement by the US and European Endocrinological Societies that variations on the term “hermaphrodite” and “intersex” would be replaced by the term, “Disorders of Sex Development” or DSD. I argue that the change should be understood as normalizing in a positive sense; rather than fighting for the demedicalization of conditions that have significant consequences for individuals’ health, this change can promote the transformation of the conceptualization of intersex conditions from “disorders like no other” to “disorders like many others.” Understood in these terms, I conclude, medical attention to those with atypical anatomies should be recast from a preoccupation with “normal appearance” to the concern with human flourishing that is the proper object of medical attention.
27967569
Intersexuality and sexual rights in southern Brazil
This paper reports of the socio‐medical management of intersexuality in a teaching hospital in southern Brazil. Findings reveal that the ‘search for sex’ in the body treats sex as a medical‐diagnostic category constructed during decision‐making negotiations. In the course of the various bodily ‘regulations’ and ‘corrections’ imposed, the insufficiency of a model in which categories are based around a sexual dichotomy is revealed. By questioning this dichotomy, it is possible to examine theoretical and ethical limits circumscribing the field of bioethics and the notion of sexual rights as human rights. The paper also explores the tensions that can arise from the application of sexual rights to health issues in general, and the medical sphere in particular.
145807168
Imperatives of Normality: From “Intersex” to “Disorders of Sex Development”
In May 2006 the U.S. and European endocrinological societies published a consensus statement announcing a significant change in nomenclature. No longer would nineteenth-century variations on the term hermaphrodite, or the more newly introduced term intersex, be used in a medical context to describe “congenital conditions in which development of chromosomal, gonadal, or anatomical sex is atypical”; instead the preferred term henceforth would be disorders of sex development (DSDs). The announcement met with significant controversy, which I here examine in terms of the historical convergence of the treatment of homosexuality and intersex. The contemporary association of homosexuality with intersex risks obscuring genuine medical concerns unique to the treatment of intersex conditions and the consequences for affected individuals. At the same time, we must reckon with the ways that the complex and persistent identification of homosexuality with intersex has shaped the motivations both for the prevailing standard of care that has been so harmful and for the organized resistance to these practices in the intersex movement. Michel Foucault’s understanding of the power of “normalization” can help us make sense of the history of medicalization and its pernicious effects, but in addition can allow those with intersex conditions and their allies to understand the positive possibilities that the change from intersex to DSDs can bring.
20546012
‘They did not have a word’: The parental quest to locate a ‘true sex’ for their intersex children
Given the paucity of research in this area, the primary aim of this study was to explore how parents of infants with unclear sex at birth made sense of ‘intersex’. Qualitative methods were used (semi-structured interviews, interpretative phenomenological analysis) with 10 parents to generate pertinent themes and provide ideas for further research. Our analysis highlights the fundamental shock engendered by the uncertain sex status of children, and documents parental struggles to negotiate a coherent sex identity for their children. Findings are discussed in light of the rigid two-sex system which pervades medicine and everyday life, and we argue that greater understanding of the complexity of sex and gender is required in order to facilitate better service provision and, ultimately, greater informed consent and parental participation regarding decisions about their children's status.
143524538
The Intersex Enchiridion: Naming and Knowledge
The 2006 Lawson Wilkins Pediatric Endocrinology Society (LWPES) consensus to alter clinical language from ‘intersex’ to Disorders of Sex Development (DSD) has not met its stated objective of destigmatizing the ‘intersex’ label. Rather, DSD works to paper over a problematic understanding of morphological variation as disease. This article interrogates the development of DSD terminology in the clinical context of treating intersex and argues that ‘DSD’ reinstitutionalises clinical power to delineate and silence those marked by the diagnosis; that this silencing is precisely the point of the new terminology; and that it is against that retrenchant impulse that we must protect the viability of ‘intersex’ by continuing its critical deployment. This paper is based on an application of embodiment studies models of critique, combined with an orientation grounded in queer theory to critically interrogate the development of both DSD language and of the ‘new’ guidelines for clinical use, and of the Handbook for Pare...
17767717
Shaping parents: impact of contrasting professional counseling on parents' decision making for children with disorders of sex development.
INTRODUCTION
The management of disorders or differences of sex development (DSD) remains complex, especially with respect to parents' decision for or against early genitoplasty. Most parents still tend to disfavor postponing surgery until the child is old enough to provide consent.


AIM
To identify the determinants of parental decisions for or against early sex assignment surgery in DSD children, and in particular to assess the influence of contrasting behavior of health-care professionals and the information they dispense.


METHODS
Preliminary data analysis from a focus group identified two broad approaches to counseling information. Two six-minute counseling videos were produced on this basis: one medicalized, by an endocrinologist, the other demedicalized, by a psychologist. Third-year medical students (N = 89) were randomized to watch either video as prospective parents and report its impact on their decision in a self-administered questionnaire.


MAIN OUTCOME MEASURES
Statistical analysis of questionnaire responses regarding decisions for or against surgery, including self-assessed impact of potential determinants.


RESULTS
Thirty-eight of eighty-nine "parents" (43%) chose early surgery for "their" child, including 27/41 "parents" (66%) shown the medicalized video vs. 11/48 (23%) shown the demedicalized video (P < 0.001). Desired aims for "their" child also differed significantly depending on the counseling approach viewed. Yet "parents" perceived their personal attitudes on a four-point Likert scale as the main influence on their decision although their "attitude" was significantly shaped by the video.


CONCLUSIONS
Parental decisions concerning early sex assignment surgery for DSD children depend on the health professional counseling received, to a degree of which neither parents nor professionals appear fully aware. In the absence of conclusive data for or against early surgery, there is a danger of medicalized or demedicalized parentalism resulting in irreversible and inadequately grounded decisions, regardless of the consensus statement of 2005 and the subsequent call for multidisciplinary management.
6008766
Parents' narratives about their experiences of their child's reconstructive genital surgeries for ambiguous genitalia.
AIM
The aim of this study was to initiate an exploration of parents' understanding and experiences of their child's reconstructive genital surgeries for ambiguous genitalia.


BACKGROUND
The determination of gender for a child born with ambiguous genitalia is a complex medical and social process influenced by biological, psychological, social and cultural factors. Two main approaches exist; one promotes interventions (optimal gender policy) while the other suggests delaying interventions (informed consent policy) until the child can contribute to the decision.


METHODS
An exploratory narrative inquiry design was chosen. Data were collected through narrative interviews with a purposive non-random sample of 10 parents of eight children (aged 0-11 years) who had ambiguous genitalia.


RESULTS
Parents' stories reflected strong protective instincts towards their children along with feelings of shock and disbelief. Parents' social construction of gender influenced their attitudes and beliefs about their child's ambiguous genitalia and the need for surgery. Parents' desired to be 'good parents' and do what they perceived as 'right' for their child. They considered genital surgery as a necessity primarily relying on medical advice to guide them at times of uncertainty and confusion. Parents rarely shared stories about their child's surgeries/genitalia outside of the couple relationship and these stories were often referred to as 'secrets'.


CONCLUSION
Having a child with ambiguous genitalia was perceived as problematic and brought about changes in roles, responsibilities, goals and social status as a parent beyond those usually associated with parenthood.


RELEVANCE TO CLINICAL PRACTICE
These early findings help increase awareness of parents' experiences and of the problems and emotional challenges that parents face when their child is born with genital ambiguity.
33554668
Defining, assigning and designing sex.
This article challenges the distinction the law draws between male and female. It focuses on the legal and medical treatment of intersexual people. Analysing the nature and rate of intersexuality it argues that there is a significant number of people who cannot be described as either male or female and instead exhibit a range of sexual characteristics. Until recently the law and medicine have insisted that intersexual people should be categorized as either male or female. Surgery was performed to ensure that they had the appearance assumed to be the 'norm' for a man or woman and the law followed this medical assignment of sex. Over the last couple of years the established medical practice and the legal treatment have been challenged. This article discusses the nature of these challenges and argues that there is a strong case for rejecting the traditional legal and medical approach to intersexual people. Cosmetic surgery on intersexual babies should be delayed until the individual is old enough to be able to choose their own sexual identity, which may be neither male nor female. The insistence that every person must either be male or female is no longer supportable in medical or social terms and a much wider range of sexual identities must be recognized by the law.
45457522
Fear of devaluation: understanding the experience of intersexed women with androgen insensitivity syndrome.
OBJECTIVES
We aim to provide an understanding of the psychological sequela of androgen insensitivity syndrome (AIS) in phenotypic females in order to begin to inform psychosocial health care services.


DESIGN
Eight adult women with AIS were recruited through the Androgen Insensitivity Syndrome Support Group-United Kingdom (AISSG-UK). Data was collected via two semi-structured interviews with each woman.


METHODS
Transcripts were analysed using grounded theory and a conceptual model was developed which suggests a way of understanding the AIS distress experienced by the participants.


RESULTS
The pivotal concept is a woman's fear of devaluation. This is connected to her level of adaptation and perception of having a compromised womanhood. These, in turn, are related to her medical management and involvement with others via a support group and in talking about AIS.


CONCLUSIONS
Participants showed a clear preference for open communication about their condition throughout the process of medical management. We recommend sensitive, pacing of information to allow young women and their families to make informed decisions about treatment and a realistic adaptation to life with AIS.
10403224
Congenital adrenal hyperplasia patient perception of ‘disorders of sex development’ nomenclature
BackgroundAs the benefits of patient-centered care have become more widely recognized, it is important to understand patients’ sentiments regarding aspects affecting their care. In an effort to display more sensitivity to patient concerns, the term “disorders of sex development” (DSD) was proposed in 2006 as new nomenclature to replace older terms that were considered to have negative connotations.MethodsThe objective of the study was to examine the views of congenital adrenal hyperplasia (CAH) patients and their caregivers regarding the new nomenclature. The study was observational to evaluate the views of the CAH community, and the primary endpoint was perception of the term DSD. The study was conducted as a survey about views regarding DSD nomenclature. The survey was sent via email to eligible subjects. Along with a short introduction explaining the term DSD, the survey was sent to eligible CAH patients and their caregivers. 589 CAH patients or family members participated in the survey.ResultsA total of 589 responses were received (255 classical females, 104 non-classical females, 174 males, 56 not specified) (547 U.S., 42 international) (128 CAH patients, 408 parents or other family members). 70.6% had never heard the term DSD. 71.0% disliked or strongly disliked the term DSD. 83.6% stated they did not identify with the term DSD. 76.0% felt that the term DSD has a negative effect on the CAH community. There was no significant difference in opinion of DSD between classical females and other CAH patients, between US and international, between surgical and non-surgical patients, or between patients and parents. There was no correlation with patient age.ConclusionsOur results indicate that the majority of parents and patients with CAH are dissatisfied with the term DSD. Our results highlight the challenges within the field of DSD to reach a consensus regarding a sensitive topic and to bridge the gap between current medical practice and patient satisfaction. It is the authors’ belief that reconsideration of the current nomenclature and ongoing dialogue between the medical community and patients will eventually lead to removal of stigmatization, better management protocols, and improved outcomes.
39000863
Sexual function and attitudes toward surgery after feminizing genitoplasty.
PURPOSE
Sexual function and attitudes toward surgery were evaluated in females who had undergone feminizing genitoplasty in childhood.


MATERIALS AND METHODS
Sexual function and attitudes toward surgery were assessed by a questionnaire in 24 females who had undergone genitoplasty in childhood. Of 16 females who were prenatally exposed to androgens 15 had congenital adrenal hyperplasia and 8 had androgen insensitivity. A total of 18 patients who had reached adulthood were compared with 900 age matched normal controls by using the Female Sexual Function Index questionnaire.


RESULTS
Of the 24 patients 19 had undergone clitoral reduction and 21 had undergone reconstruction of the vaginal introitus. Sigmoid bowel had been used in vaginal reconstruction in 5 patients. There were 17 patients who believed that the genital operation was performed at a proper age, 3 who thought it was done too late while none thought it was performed at too young an age. Two patients regretted the operation, 1 of whom had undergone clitoral resection without nerve preservation and the other had a sigmoid vagina. The control group had more often and earlier (median age 17 vs 19 years) experiences with sexual intercourse. Overall sexual function was similar in the sexually active controls and patients. Decreased sexual desire and problems in achieving orgasm were common but severe pain experiences during penetrative sex were rare in both groups.


CONCLUSIONS
Sexual intercoital relationships started later in females who underwent genital reconstruction in childhood. Early surgery is preferred by the patients and satisfactory sex life is possible in adulthood.
6639804
"Differently normal" and "normally different": negotiations of female embodiment in women's accounts of 'atypical' sex development.
During recent decades numerous feminist scholars have scrutinized the two-sex model and questioned its status in Western societies and medicine. Along the same line, increased attention has been paid to individuals' experiences of atypical sex development, also known as intersex or 'disorders of sex development' (DSD). Yet research on individuals' experiences of finding out about their atypical sex development in adolescence has been scarce. Against this backdrop, the present article analyses 23 in-depth interviews with women who in their teens found out about their atypical sex development. The interviews were conducted during 2009-2012 and the interviewees were all Swedish. Drawing on feminist research on female embodiment and social scientific studies on diagnosis, I examine how the women make sense of their bodies and situations. First, I aim to explore how the women construe normality as they negotiate female embodiment. Second, I aim to investigate how the divergent manners in which these negotiations are expressed can be further understood via the women's different access to a diagnosis. Through a thematic and interpretative analysis, I outline two negotiation strategies: the "differently normal" and the "normally different" strategy. In the former, the women present themselves as just slightly different from 'normal' women. In the latter, they stress that everyone is different in some manner and thereby claim normalcy. The analysis shows that access to diagnosis corresponds to the ways in which the women present themselves as "differently normal" and "normally different", thus shedding light on the complex role of diagnosis in their negotiations of female embodiment. It also reveals that the women make use of what they do have and how alignments with and work on norms interplay as normality is construed.
144052141
Rethinking the Meaning and Management of Intersexuality
Given that ample research has established that surgery to `correct' the appearance of intersexed genitals is socially motivated, this article is concerned how actual medical practices obfuscate social interests, and what the results of that obfuscation can be. By applying Eric Parens' distinctive means of categorizing medical procedures as either `enhancements' or `treatments' this article argues that the current means of managing intersexuality fit neither category. The article then proceeds to question the logic of dominant medical practice concerned with intersexuality and proposes new ways to think about intersexuality and provide care for intersexed children. Case studies form exemplars that demonstrate the consequences of the medical and cultural illogic at work in early childhood diagnosis and clinical management.
144835064
:Sexing the Body: Gender Politics and the Construction of Sexuality
Need a wonderful electronic book? sexing the body gender politics and the construction of sexuality by , the most effective one! Wan na get it? Find this excellent e-book by right here now. Download and install or read online is available. Why we are the best website for downloading this sexing the body gender politics and the construction of sexuality Certainly, you could choose guide in different data kinds and also media. Look for ppt, txt, pdf, word, rar, zip, and kindle? Why not? Obtain them here, now!
41857961
Gender Eugenics? The Ethics of PGD for Intersex Conditions
This article discusses the ethics of the use of preimplantation genetic diagnosis (PGD) to prevent the birth of children with intersex conditions/disorders of sex development (DSDs), such as congenital adrenal hyperplasia (CAH) and androgen insensitivity syndrome (AIS). While pediatric surgeries performed on children with ambiguous genitalia have been the topic of intense bioethical controversy, there has been almost no discussion to date of the ethics of the use of PGD to reduce the prevalence of these conditions. I suggest that PGD for those conditions that involve serious medical risks for those born with them is morally permissible and that PGD for other “cosmetic” variations in sexual anatomy is more defensible than might first appear. However, importantly, the arguments that establish the latter claim have radical and disturbing implications for our attitude toward diversity more generally.
22381577
Surgical options in disorders of sex development (dsd) with ambiguous genitalia.
Disorders of sexual development (DSD) include three main groups of patients: (1) The virilised 46,XX DSD essentially represented by congenital adrenal hyperplasia (CAH) ; (2) The undervirilised 46,XY DSD essentially represented by hypospadias; and (3) the chromosomic jigsaws essentially represented by mixed gonadal dysgenesis. It is in this last group that gender assignment remains a difficult decision involving various indicators, which can be split into four categories: (1) the inside sex (i.e., genes, hormones and target tissues); (2) the outside sex (i.e., anatomy of genitalia including size of the genital tubercle, mullerian cavity and potential adult height of the patient); (3) the functional sex (i.e., potential sexuality and fertility); and (4) and the social sex (i.e., the cultural medium in which the child is brought up). The challenge is to outline the future individual identity of the child in the postnatal period using these indicators. Current evolutions of surgical techniques of 'feminisation' and 'masculinisation' are described as well as their outcomes.
9316947
Changes Over Time in Sex Assignment for Disorders of Sex Development
BACKGROUND AND OBJECTIVE: It is unclear whether the proportion of infants with a disorder of sex development who are raised as male or female has changed over time. The temporal trends in sex assignment of affected cases entered in the International Disorder of Sex Development (I-DSD) Registry were studied. METHODS: Cases of disorders of sex development reported as partial androgen insensitivity syndrome (PAIS; n = 118), disorder of gonadal development (DGD; n = 232), and disorder of androgen synthesis (DAS; n = 104) were divided into those who were born before 1990, 1990–1999, and after 1999. External appearance of the genitalia was described by the external masculinization score. RESULTS: The median (5th–95th percentile) external masculinization scores of those infants with PAIS, DGD, and DAS who were raised as boys were 6 (2–9), 6 (3–9), and 6 (1–12), respectively, and were significantly higher than in those raised as girls (2 [0–6], 2 [0–7], and 0 [0–5], respectively); this difference was maintained in the 3 temporal birth cohorts (P < .01). Of the 118 cases in the pre-1990 cohort, 41 (35%) were raised as boys; of the 148 cases in the 1990–1999 cohort, 60 (41%) were raised as boys; and of the 188 cases in the post-1999 cohort, 128 (68%) were raised as boys. CONCLUSIONS: Although there is an association between the external appearance of the genitalia and the choice of sex assignment, there are clear temporal trends in this practice pointing toward an increased likelihood of affected infants being raised as boys. The impact of this change in practice on long-term health outcomes requires additional focus.
145294114
Intersexes and the end of gender: Corporeal ethics and postgender bodies
Constructionism depends upon the stability of the body as a self-evidential, neutral and passive object of cultural activity that shapes sex through gender. The medical treatment of intersexed bodies suggests otherwise: although medicine seeks to enact a binary gender imperative upon the bodies of intersexed people, it produces instead an awareness of the multiplicity of factors that results in a plurality of sex categories. In this essay we will explore the ramifications of taking seriously multiple human sexualities upon gender theorizing. We will consider seriously the 'corporeal ethical imperative' at work even in gender constructionism when confronted with bodies that do not conform to clear sex dualism. We will propose an alternative theoretical foundation for a critical sex-gender theorizing that is premised upon the body as an interactive force, thereby demanding a fundamental recognition and respect for pluriform sexualities. Instead of embracing the nature/culture, sex/gender dualism at the heart of gender theorizing produced during the last decade, we will propose a 'postgender' alternative that views bodies as active participants and contributors to sex identification, formation and practices.
7331095
The Social Costs of Preempting Intersex Traits
Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content.
142813842
What Parents Don't Know: Informed Consent, Marriage, and Genital-Normalizing Surgery on Intersex Children
When most children are born, the first words out of the doctor’s mouth are “It’s a boy!” or “It’s a girl!” When Mani Bruce Mitchell was born, however, she was welcomed into the world by the words, “It’s a hermaphrodite!” Initially determined to be a member of the male sex, Mitchell was given the name Bruce and raised as a boy until just before her first birthday when “invasive surgery determined her sex as female and she became Margaret.” When Mitchell was eight years old, she underwent additional surgery to remove “what she describes as a small penis or very large clitoris, and [to] bring[] [her] uterus and vagina forward.” The surgery left Mitchell with outwardly female genitalia and impaired sexual functioning. After years of living in secrecy and shame, Mitchell is finally comfortable with herself and her past. She is now open about her status as an intersexual and advocates against surgeries like those performed on her when she was a child. She hopes that one day the decision to undergo genital-normalizing surgery will “be left for the person who owns the body” and that “society [will] get to a place where it’s comfortable with bodies that look different.” Unfortunately, Mitchell’s story is not unique. It has been estimated that somewhere between 1 in 1500 and 1 in 2000 children are born each year with sufficiently ambiguous genitalia such that the sex of the child cannot be immediately determined.
31172437
“A Rose is a Rose”
Gender is perhaps the most pervasive, fundamental, and universally accepted way we separate and categorize human beings. Yet in recent years, U.S. courts and administrative state agencies have confronted a growing challenge from individuals demanding to have their gender reclassified. Transgender people create a profound category crisis for social institutions built on the idea that biological sex is both immutable and dichotomous. During the past four decades, the central legal question shifted from how to allocate specific individuals to categories to the permeability of gender categories themselves. This analysis of 38 judicial gender determinations provides a glimpse of the literal construction of the gender order and of the ways institutions gender individuals. It also provides powerful evidence that cultural anxieties about reproduction and the heterosexual, conjugal family underscore institutional efforts to manage the uncertainty of postmodern gender identities.
37795522
Ethical and legal aspects of management for disorders of sex development
Intense controversy surrounds the management of disorders of sex development, particularly in relation to the validity of parental consent for genital surgery and the removal of gonadal tissue carried out during infancy or childhood. Past practices have been heavily criticised on ethical grounds by patient advocacy organisations, who have demanded a moratorium on these kinds of operations unless authorised by a court. Some doctors and hospital administrators have been influenced by the controversy and have referred cases to the Family Court of Australia, where a series of judgements have now established legal precedents that apply across Australia, restricting the circumstances in which parents can give consent for surgery. An alternative approach is to use a hospital‐based Clinical Ethics Response Group and, if necessary, Clinical Ethics Committee, which has lay and legal representatives as well as health professionals, as a semi‐independent committee of review. Finding a solution that protects the human rights and best interests of children is an ongoing challenge.
115945339
[Medical and legal aspects of treating ambiguous genitalia].
Treatment of ambiguous genitalia has reached high standards. Damage caused by the anomaly can be reduced significantly or eliminated. In a well-defined minority definite early sex assignment is not possible but preliminary, and surgical genital correction therefore is delayed. Poor results and continuous misunderstandings regarding the nature of intersex caused strong opposition from activist groups against all forms of early diagnosis, sex assignment and surgical treatment. Supported by psychologists and the media, jurisdictional actions are underway trying to change the law and prevent parents from allowing treatment of their children. In addition, institution of a moratorium has been requested to stop genital surgery on children and to establish a third sex of hermaphrodites. All this led to irritations and insecurity concerning treatment and legal risk.Analysis of the current medical situation and the laws concerning the subject reveal that there is no alternative to early sex assignment and treatment, with the exemption of a very small, but defined group. At this moment, there is no realistic legal possibility to remove the right from parents to decide for their children, create a new sex and solve problems of intersex patients by pushing them into"hermaphroditism". This would be a decision against their and their parents' will, in a society which is based on male and female gender.
41481531
Medicine as an Institution of Social Control
The theme of this essay is that medicine is becoming a major institution of social control, nudging aside, if not incorporating, the more traditional institutions of religion and law. It is becoming the new repository of truth, the place where absolute and often final judgments are made by supposedly morally neutral and objective experts. And these judgments are made, not in the name of virtue or legitimacy, but in the name of health. Moreover, this is not occurring through the political power physicians hold or can influence, but is largely an insidious and often undramatic phenomenon accomplished by 'medicalizing' much of daMy living, by making medicine and the labels 'healthy' and 'ill' relevant to an ever increasing part of human existence. Although many have noted aspects of this process, by confining their concern to the field of psychiatry, these criticisms have been misplaced.̂ For psychiatry has by no means distorted the mandate of medicine, but indeed, though perhaps at a pace faster than other medical specialities, is following instead some of the basic claims and directions of that profession. Nor is this extension into society the result of any professional 'imperialism', for this leads us to think of the issue in terms of misguided human efforts or motives, li we search for the 'why' of this phenomenon, we will see instead that it is rooted in our increasingly complex technological and bureaucratic system—a system which has led us down the path of the reluctant reliance on the expert.̂ Quite frankly, what is presented in the following pages is not a
161880961
Third sex, Third gender – Beyond Sexual Dimorphism in Culture and History
In the 1990s, questions of sex roles and individual identity have taken a central position in intellectual debates. These eleven essays in history and anthropology offer a novel perspective on these debates by questioning the place of sexual dimorphism in culture and history. They propose a new role for the study of alternative sex and gender systems in cultural science, as a means of critiquing thinking that privileges standard male/female gender distinctions and rejects the natural basis of other forms of sexuality.The essays cover a wide range of times and cultures, starting in the Byzantine Empire and moving eclectically forward, with a special focus on the seventeenth through nineteenth centuries. The anthropological studies include the Native American berdache, the Indian Hijras caste, hermaphrodites in Melanesia, third genders in Indonesia and the Balkans, and transsexuals in America.Third Sex, Third Gender emphasizes desires on the margins of society, and pleasures and bodies outside the assumed arenas of social reproduction. It opens up the possibility of understanding in new ways how, for example, Byzantine palace eunuchs and the Hijras of India met the criteria of special social roles that necessitated self-castration, and how heartfelt yet forbidden desires were expressed among seventeenth-century Dutch Sodomites, the Mollys of eighteenth-century England, and the Intermediate Sex or so-called hermaphrodite-homosexual of nineteenth-century Europe and America.Gilbert Herdt is Professor of Human Development at the University of Chicago. He is the author, coauthor, or editor of a dozen books, including Ritualized Homosexuality in Melanesia, Gay and Lesbian Youth, and Intimate Communications.The essays: Introduction, Gilbert Herdt. Living in the Shadows: Eunuchs and Gender in Byzantium, Kathryn M. Ringrose. London's Sapphists: From Three Sexes to Four Genders in the Making of Modern Culture, Randolph Trumbach. Sodomy and the Pursuit of the Third Sex in Early Modern Europe, Theo van der Meer. Woman Becomes Man in the Balkans, Rene Gremaux. A Female Soul in a Male Body: Sexual Inversion as Gender Inversion in Nineteenth Century Sexology, Gert Hekma. The Hijras: An Alternative Sex and Gender Role in India, Serna Nanda. How to Become a Berdache: Toward A Unified Analysis of Gender Diversity, Will Roscoe. The., Third Sex Among the Sambia, Gilbert Herdt. The Waria of Indonesia: A Traditional Third Gender Role, Robert Oostvogels. Transcending and Transgendering. Male to Female Transsexuals in the United States, Anne Bolin. Historical and Cultural Reconsideration of the Mabu Third Gender in Tahitia, Niko Besnier.