COLOFON - nš 22
Birth of gender
Richard Klein
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COLOFON - nš 22 Birth of gender Richard Klein |
| We often think of hysteria and obsessional neurosis as associated with feminine and masculine sexed positions respectively. Can we take them asgender terms as such. No, I don’t think so. Gender plays its role in these structures by not playing its role. The clinic of hysteria and obsessional neurosis puts a question mark over the subject’s gender. “What is a woman?” “What is a father?” The clinic undermines it, and a clinic is not made out of it. None of that means that sexed positions do not exist in this clinic. There is always the Oedipus. Its gender terms are the mother and the father. We do not make a clinic out of them.Gender is a push towards the definite and unambiguous. From the beginning of Lacan’s teaching something intervenes to undermine gender terms by its indefiniteness and ambiguity. Hence the question marks placed on the gender terms which will later be replaced by the object little a. One cannot speak of gender simply as a term. It is a psychologising system first floated in the USA in 1955 by John Money and his associates,(1) and a clinic has been made out of it. The clinic of gender identity disorder follows the notion of gender like night follows day. John Money established both as a field of study, and until recently he set the pace at the clinical level. These notions emerged from his study of intersexed patients begun in 1950, formerly known as hermaphrodites. Intersexed patients begin as babies who have defects of the external genitalia rendering them sufficiently ambiguous that a sex cannot be assigned to the baby on the basis of observation alone. To cover more complicated problems a more encompassing definition of such a patient is an individual in whom different components of biological sex do not match. Everything centres on gender assignment, and the parents’ acceptance of it. The doctor or midwife sexes the body of the baby, and the parents accept it. Gender assignment is already the signifier of the Other to which one gives one’s consent or not. In rare instances there are deformities of genitals, chromosomal and hormonal abnormalities when serious errors can be made in sexing the baby. When there is no parental ambiguity about gender assignment- even when the genitals are ambiguous, a stable core gender identity will develop. In the case of parental ambiguity there will be an ambiguous core gender identity. When parental ambiguity ends, core gender identity is established. Doubts in gender assignment and parental ambiguity about it introduce a delay in the Other’s desire and in turn a delay in the subject’s existence as a girl or boy. When this delay ends, the Other’s desire retriggers, and there is a wanted child, a desired child who is attached to the ego ideal as a sexed being. For insance as shown in Schema R under the aegis of an ego ideal the mirror stage is genderised. Gender identity, core or otherwise, seems to be a concept that is more or less equivalent to the genderisation of the mirror stage. A genderised mirror stage corresponding to the appropriate sex becomes the new conflict-free sphere. John Money invented the term gender role, not just gender. He concluded then that it was determined by postnatal psychological forces. In 1960 the study was extended to include children born without any biological abnormalities who were, nevertheless, showing signs of gender role incongruity, called in the USA “sissy boys”. The term gender identity appeared in a press release in 1966 to announce the new clinic for transsexuals at the Johns Hopkins Hospital. It was disseminated in the world’s press and entered our everyday vernacular, as John Money notes in a little article summing up his work.(2) Before 1955 there was no concept of gender as referring to a person’s sex and no concept of gender identity disorder. Money observes in that article that the terms gender, gender role and gender identity have been elevated to organising principles in the social history of our era. I myself would have thought that they were, or some synonym thereof, the organising principles of Noah’s Ark. That is to say, God understood the necessity of the sexual relation to repopulate earth. Lacan’s logical discovery goes against God’s will by making the organising principle of our social era the impossibility of establishing the sexual relation at the level of the real. It’s at the bottom of the social bond. The principle of the treatment policy of intersexed patients is to provide the patient with the sex that will lead with the least resistance to the establishment of the sexual relation. There also seems to be an assumption despite evidence to the contrary that a sex disorder will lead to a gender disorder. A biological abnormality is a disorder at the level of sex not at the level of gender. The treatment policy is to manufacture a body that will be able to participate in the sexual relation. I could have said that the policy is to manufacture a body that will enable the subject to participate in the sexual relation. That’s not the effect of this policy which overrides the subject. The treatment policy is to manufacture a body that can participate in the sexual relation. The corresponding gender is then encouraged. It seems to me that the treatment policy could itself create a gender disorder. Nothing better than this policy to illustrate that the sexual relation is but a compensation for an absence. Should we really illustrate it with a biological abnormality? A gender identity disorder not based on a biological abnormality also does not lead to the establishment of the sexual relation. One, therefore, suspects that the terms, gender, gender role and gender identity encipher the possiblity of the sexual relation since a disorder of these items excludes that possibility. Money provides us with a phenomenological definition of gender role: it is what a person says or does to disclose his/her status as a girl or a boy, a woman or a man. It includes cultural stereotypes of masculinity and femininity. The difference is judged by demeanour, deportment, mannerisims, content of dreams, of fantasies and erotic practices. He regrets that what he calls the genius of language butchered his concept of gender.(3) I don’t know what else could have made it if not language. When he says that the genius of language butchered his concept of gender, one supposes he is referring to university departments of gender studies where his beautiful concept was butchered by the geniuses of language. Nevertheless, he does manage a structural definition despite it all, and, of course, without knowing it. For him it is not like the language of the theatre which would make of gender role a script handed to an actor. But never mind that. It is, he continues, a role incorporated into the actor generating a metamorphosis by assimilation of the role and living it. He gives the role a sense of property: it belongs to him or her.(4) The actor here holds the subjective position. I can’t vouchsafe that John Money would go along with this. There is a priori an actor which is to suppose a subject, der Arbeiter, the worker, as Lacan called it.(5) The subject is the actor through which an action is achieved, namely an identification, metamorphosising the subject. The actor must take a lot of responsibility for gender effects. Could one then consider gender identity disorder as a disorder of the subject, as a bad actor? The concepts of sex and gender can be found in John Money’s doctrine. Stoller made the binary famous. However, if Money ever did wish to assert a strong distinction between sex and gender, in 1994 he refutes it, still in the same article.6 As far as he is presently concerned, the binary sex andgender creates doctrinal carnage. Money began to reassert the doctrine of gender as belonging to psychology and psychiatry. It was cut off from these practices in three ways. Firstly, as noted above, it was butchered by the genius of language. One supposes that he is not happy with the gender epidemic in the USA. Secondly, it was butchered by separating gender role from gender identity. The psychoanalysts are responsible for this one, it seems. Gender identity covers the workings of the mind and gender role the workings of society. Money himself now makes no distinction between gender identity and gender role, if he ever did, writing it as a formula, G-I/R. He writes in 1994 that gender identity is the private experience of gender role, and gender role is the public manifestation of gender identity. Thirdly, doctrinal carnage continues, according to him, in the dichotomy sex and gender. Nature and nurture work together, he says, hand in glove. He wants to put an end to the binary sex and gender. Gender identity and gender role is a rather more imprecise rehash of the suture between the symbolic and the imaginary. My impression is that the notion of gender saved ego psychology from going out of business. After the heavy critique emanating from Paris for 30 years, pressure was building up against the notion of ego psychology. It’s only an impression that the notion of gender came along at the right moment to allow ego psychology in through the back door. The question is whether gender is the new American ego psychology. According to Person, there is a contemporary cultural injunction in the USA supported by some literary critics and a few psychoanalysts that one can expand psychically by embracing cross-gender identifications.7 I think this means that you can expand your ego. Otherwise, gender identity disorder would be a disorder of the ego. That, no doubt, happens. But would it not be primarily a disorder of the subject? Gender identity as the private experience of gender role and gender role as the public manifestation of gender identity is more or less how it is also expressed in the first paragraph under gender identity disorders in DSM-III-R in 1987. Money is on the committee for gender identity disorders of DSM-III-R, though that doesn’t make him the writer of the entry. He is not on the committee of gender identity disorders for DSM-IV-TR. The term gender identity disorder is being replaced in DSM-IV-TR with the term gender dysphoria, which is the term Money recommends in 1994 to win back the field for psychology and psychiatry. In DSM-IV-TR gender identity disorders exclude the intersexed patient. It all began with the intersexed patient who is now, it seems, being squeezed out of the category. Perhaps, it has been decided that by including the intersexed patient in this category, there is a risk of an iatrogenic gender disorder. It looks like changes are afoot for the category of gender identity disorder. Whether this is in deference to a patient who overturned Money’s doctrine or not, I don’t know. In 1967 a male baby of 7/12 lost his penis during circumcision by electrocautery. It quite literally went up in smoke. Sicut palea. A decision was made to reassign the baby as female on the grounds that core gender identity had not yet been established and that, presumably, it was the path of least resistance to the ultimate aim of establishing the sexual relation- surgically, if necessary. His name was changed from John to Joan. Hair style and dress were changed. But the parents described as young and confused, did not decide to raise the child as a girl until it was 17/12 old. I don’t see how they could have been anything else but confused. 17/12 is pushing the upper limits of core gender identity. Core gender identity means that the subject is irreversibly a boy or a girl by 18/12. At 21/12 it had an orchidectomy, later a vagina was constructed. At 12 years she was given oestrogens. Whereupon at 13 years of age he reasserted his maleness. His breasts were removed and his penis reconstructed. I don’t know why this wasn’t done in the first place. The case challenges the doctrine that gender identity, core or otherwise, is socally constructed. I cannot say if any account of the fact was taken that this patient was raised with a male twin. It looks like Money’s reputation has declined because of this case. Transsexualism as a term is not even mentioned in DSM-IV-TR. There is simply a description of cross-gender identifications that can go as far as not wanting the accessories of the sex that the subject has which if it persists into adolescence and adulthood may lead to requests for sex change treatment. Such a demand for sex change treatment does not occur in childhood. A major pillar of the diagnosis has always been based on the demand for sex change treatment. This demand is absent in childhood. Therefore, there can be no such thing as childhood transsexualism as Stoller called it, taking the term from Harry Benjamin. Person and Coates recommend the term boyhood femininity.(8) Stoller’s findings are no longer accepted. In male to female transsexualism Stoller considered that core gender identity was reversed. He observed blissful closeness between mother and son and feminine charm in the boy. Person at Columbia University finds that core gender identity is ambiguous and not feminine, that the mother doesn’t pay much attention at all to the boy, that the boy does not exude feminine charm who may or may not be effeminate but always uncomfortable in boyish activities. Primary transsexuals are schizoid, socially withdrawn, asexual, unassertive, who suffer from separation anxiety, depression, emptiness, oral dependency, are mistrustful, fear intimacy, exhibit as-if phenomena, have defective self identity.(9) Stoller’s own unit at UCLA, according to Person, reports observations that there is pervasive psychopathology not restricted to gender problems.(10) When Judith Miller suggested the non clinic of gender, I did not at that time realise that from one edition of the DSM to the latest one, the clinic does, in fact, seem to be in a decline. The Americans do not have the structural concept of foreclosure which is causing the ambiguity in core gender identity which we might also translate as the fertile moment of the delusion which comes out of Lacan’s phenomenological moment or as captial Phi subscript zero. Gender as a psychologising system excludes drive. Drive as constructed by Freud is prohibited to psychologising thought, according to Lacan on p.851 of the Ecrits.(11) I think this probably refers to the beginning of Freud’s paper “Drives and Their Vicissitudes”. He introduces the drive there as indefinite. At the beginning of scientific activity, says Freud, the material on which the science works may not be susceptible to clear definition.(12) The material in this case is the drive marked by indefiniteness. Two years later he is still characterising drive sexuality as indefinite, indefinable and ambiguous.(13) In other words, it is unavailable to psychologising thought. That provides a strong contrast with what Freud called genital sexuality which for him was definite and unambiguous. Drive jouissance is indefinite and ambiguous. Phallic jouissance is definite and unambiguous. Person thinks that there is enough clinical evidence to suggest that genital sexual activity maintains masculine gender which is a variable feature in the case of feminine gender.(14) A psychologising system excludes drive which cannot be grasped, according to Freud, in a clear definition. Gender is such a system which excludes drive, but it doesn’t exclude phallic enjoyment. One cannot include something as indefinite as the drive in a system as definite and unambiguous as gender. For instance, under the concept of the pregential Freud says that the contrast between masculine and feminine plays no part.(15) The pregenital is drive sexuality, and drive sexuality is not genderised. The drive is an object a-sexue.(16) The drive is included in sexuation. It can be exploited in the service of supplementary jouissance in the table of sexuation. The man can, if it works for him, register himself on the feminine side of the table of sexuation, according to Lacan, the right hand side. It does not result in a gender identity disorder, although it has to do with the body. Since it is a registration at the level of enjoyment, it does not affect gender. Gender falls under the sexed identifications that occur on the left-hand side of the table.The drive, according to Freud is the sign of the internal world,(17) by which he means it arises from within the body. The jouissance that is the function of the phallus which is so definite and unambiguous does not then arise from within the body. Lacan calls the phallus an hors corps. To make a differentiation on the basis of hors corps and encorps includes drive. It, in fact, includes two forms of jouissance.
1. Money, J., Hermaphroditism, gender
and precocity in hyperadrenocorticism:
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