Is it a sign of the times that this long book review, appearing in the “Science and Society” section of the prestigious journal Science, actually approves of a book questioning the ubiquity of gender surgeries? I haven’t read the book, but you can be that Nature wouldn’t give a positive review such prominence.
Here’s the book (click the cover to see the Columbia University Press page). According to Wikipedia, Morland also writes from experience:
Morland was born with an intersex condition and subjected to numerous surgeries in childhood. Much of his writing focuses on the impact of those interventions, in explorations of the ethics of medical intervention, but also the ethics of touch, “desire’s reach” and the relationship between intersex experiences and queer theory. He has a doctorate and formerly lectured in cultural criticism and gender studies at Cardiff University in the UK.[6]
And I couldn’t help notice the cover’s resemblance to that of Salman Rushdie’s recently-published account of his near-fatal stabbing attack in New York:
At any rate, back to the Science review written by Amanda Lock Swarr, the Chair and Professor of Gender, Women & Sexuality Studies at the University of Washington. Click on the title below to go to her one-page review, or download the pdf here
Swarr, to her credit, doesn’t shy away from underlining the dangers of gender surgery recounted by Morland, which include (but are not limited to) mastectomies and the two forms of genital surgeries—all to make people look more like a member of the sex that is not their natal sex but the sex that they feel like and want to look like. Excerpts:
Since the 1950s, doctors have used genital surgeries, including sterilization, to reduce or remove human body parts that they deem ambiguous, grounded in the erroneous belief that early interventions provide a preemptive defense against gender confusion. Whereas most discussions of intersex have addressed complications and consent with an eye toward reform, Iain Morland marks the urgency for a new approach in Intersex: A Manifesto Against Medicalization, issuing a call to “think critically about the irredeemable strangeness of intersex medicine.”
With writings that span three decades, there is no one more qualified to offer directions forward than Morland. He is arguably the foremost theorist of critical intersex studies, and his work offers expert interventions into thorny conundrums ranging from diagnostic nomenclature to patient care. But Intersex deftly moves beyond these debates to illuminate the faults of intersex medicine by its own internal logic. While purporting to create “normal” bodies, intersex medicine is typified by failures that create lasting damage and necessitate ongoing medical intervention, he argues. Additionally, he maintains, the field lacks definitive measures for the achievement of this so-called normality. And although surgeries are posited as protecting children from the psychological harm of not fitting binary expectations, they are inherently wounding.
Activists and advocates have long argued that intersex is a social problem, not a medical problem, framing surgical protocols as cosmetic, nonconsensual, and injurious. Morland aligns with these critics but goes further, demonstrating that by attempting to provide patients with an “ordinary gender,” doctors create an “extraordinary event”—childhood genital surgery. These intimate surgeries and the paradoxes that underpin them are the core of this book.
Morland forces readers to face the reality of intersex medicine, convincingly arguing that “we should take early genital surgery more literally—as brutal, macabre, and inherently traumatic.” In devastating matter-of-fact prose, he likens common practices to childhood sexual abuse, characterized by intense physical pain, intimate bodily scrutiny and manipulation by adults, and protocols of secrecy. Children are confused and harmed as they are forced to undergo procedures they do not understand to correct something that was never wrong. The focus of this book may be uncomfortable for some readers, but no one is made more uncomfortable by genital surgery than those who live with its effects.
Presumably it is childhood gender surgery, not adult gender surgery, that Morland criticizes. While adult surgery of this type can be just as injurious to the body, at least it can be defended on the grounds that it’s chosen by a recipient who’s old enough to understand the risks (I vary between 18 and 21). And remember that no doctor is obligated to perform such surgeries since they can be considered, at least by many, as rectifying a dangerous condition. (Remember that something like 80% of adolescents or children with gender dysphoria not given “affirmative care” (rah-rah therapy, surgery, or hormones) turn out to be gay if they’re not given “affirmative care.”
Could such surgeries on those of age be justified? Well, if there are doctors willing to perform them—and there always will be so long as the surgeries are legal—then I suppose there will be extreme cases in which people who are not just feeling “suicidality,” but are either liable or have even tried to kill themselves without such transitions, could justifiably undergo surgery. But these are far fewer than the number of people actually transitioning now, especially given the social pressure to transition. Morland, it seems may have even more stringent views. More from the review:
One of Morland’s strongest emphases is that regardless of outcome, intersex is never erased by surgery. Indeed, postsurgical experiences routinely include pain and desensitization. Morland recounts bodies, including his own, as “the location of bad old practice that cannot be narrated away.” Scars represent hidden histories, fractured knowledge concealed from patients, and make surgery ever-present for a lifetime to all who encounter them. Morland shares stories of parents’, partners’, and classmates’ negative reactions to scarred postsurgical bodies that are intensely scrutinized yet hidden from patients’ own memories. He asserts that these medical interventions make bodies inherently “strange” and more intersex, rather than no longer intersex.
This book is not an easy read. It is explicitly theoretical and challenging, yet it is more than worth the effort. Morland takes a measured tone and carefully presents all viewpoints, drawing on his deep knowledge of the interdisciplinary history of intersex science and medicine. But he does not shy away from lived consequences. Readers are left with a scathing critique of practices that are sanctioned and commonplace. If we take this critique seriously, as I believe we must, what are the best directions forward?
At the time of this writing, six countries have outlawed unnecessary surgeries—Malta, Germany, Iceland, Greece, Spain, and Portugal. However, these legal reforms still depend on medical authority to determine necessity. Through Intersex, we can begin to imagine the true demedicalization of intersex. By admitting the failure of the promise of normalization and examining the layers of physical and emotional scars that this failed promise has created, we can see the necessity of charting a new way forward that eschews sex/gender as a simple binary, embracing those whose bodies defy this false opposition.
Right there, because of the anecdotal nature of the evidence, I can see some opposition. People will say, “I know people who had surgery as an adolescent/adult and they are very happy with it.” And there are clearly such cases (though I oppose surgery below the ages of either 18 or 21). But even the “good outcomes” constitute anecdotal evidence. What constitutes “unnecessary” surgery is something that Swarr should have discussed. But never mind for the nonce. What is clear is that one can now say this kind of stuff in a scientific journal and get away with it without being canceled or demonized. Not that Swarr won’t be called a “transphobe” for saying this. She will, but she seems to have a thick skin.
What I don’t understand is why the “new way forward” must eschew sex/gender as a simple binary. First of all, sex is not the same thing as gender. Second, sex is binary. It seems to me that the way forward involves medical ethics, education, and prohibition of elective surgery for those not of age. What a simple binary has to do with all this defies me.