Galileo's Middle Finger (33 page)

One scientist in 1769, following in Galileo’s footsteps, wanting simply to know more about the stars, had literally set the stage for another man in 1776 speaking to the people the truth of their core freedoms.

If—as the investigative press collapses and no longer can function as an effective check on excess and corruption, and people live and die forever inhabiting self-obsessed corners of the Internet, and the government and the ad-selling Google industrial complex ever increase surveillance on us, and we can’t trust people in the government to be our advocates or even to be sensible—if we have any hope of maintaining freedom of thought and freedom of person in the near and distant future, we have to remember what the Founding Fathers knew: That freedom of thought and freedom of person must be erected together. That truth and justice cannot exist one without the other. That when one is threatened, the other is harmed. That justice and thus morality
require
the empirical pursuit.

 • • • 

I
WANT TO SAY
TO
ACTIVISTS
:
If you want justice, support the search for truth.
Engage
in searches for truth. If you really want meaningful progress and not just temporary self-righteousness,
carpe datum.
You can begin with principles, yes, but to pursue a principle effectively, you have to know if your route will lead to your destination. If you must criticize scholars whose work challenges yours, do so on the evidence, not by poisoning the land on which we all live.

To scholars I want to say more: Our fellow human beings can’t afford to have us act like cattle in an industrial farming system. If we take seriously the importance of truth to justice and recognize the many forces now acting against the pursuit of knowledge—
if we really get why our role in democracy is like no other
—then we really ought to feel that we must do more to protect each other and the public from misinformation and disinformation. Doing so means taking on more responsibility to police ourselves and everybody else for accuracy and greater objectivity—taking on with renewed vigor the pursuit of accurate knowledge and putting ourselves second to that pursuit.

I know that a lot of people who met me along the way in this work thought I’d end up on one side of the war between activists and scholars. The deeper I went, however, the more obvious it became that the best activists and the best scholars actually long for the same kind of world—a free one.

Here’s the one thing I now know for sure after this very long trip: Evidence really is an ethical issue, the most important ethical issue in a modern democracy. If you want justice, you must work for truth. And if you want to work for truth, you must do a little more than wish for justice.

I
KNEW WE’D TURNED
A
CORNER
on intersex rights when I attended a support-group meeting in 2010 and got to hear a high school girl tell the story of how she’d recently found out she was born with testes. This girl—a very pretty, Christian, cheerleader type—told of being taken by her mother to the doctor because, although she was obviously maturing, girl into woman, she had never menstruated. The doctor did a pelvic exam and soon realized the girl had an intersex condition—one that meant that, even though she had developed as a near-typical female in genital anatomy and brain, even though she was sexually maturing in appearance like most girls, she had a Y chromosome and testes internally (and no ovaries or uterus). She was born with a genetic condition that left her lacking the androgen receptors required for cells to respond to the masculinizing hormones being made by her body, so even though she had a Y chromosome, her body had developed close to the female-typical pathway except for some of her internal organs, those whose development depends on something other than androgens.

When the doctor realized what was going on with this girl’s body, instead of withholding information from the patient—as was, until recently, pretty standard—the doctor told her the truth. In fact, not only did that doctor tell her the truth, the physician put her in touch with other young women with the same condition so they could offer her loving peer support. No shame, no veil of total secrecy. Before the gathered audience in which I sat, in which women like her probably outnumbered women like me, this teenager concluded by saying that not only was she not upset that she had been born with this condition, she was grateful for it. Being born this way had taught and given her so much.

Although this young woman’s experience is not yet universal in America, telling the truth is becoming the treatment norm. This progress can be traced to the intersex patients’ rights movement started by affected individuals like Bo Laurent, a movement directly inspired by the movements for women’s rights, civil rights, and gay and lesbian rights. Physicians are finally understanding that when it comes to treating people born with intersex conditions, attributed shame and psychological isolation form the basis for
unnecessary
trauma. In 2010, the very year that young woman spoke of her awakening, a prominent American surgical specialist in intersex care openly acknowledged in the
Journal of Urology
that the real problem with intersex is not the child, but the way the child is treated in the clinic: “Secrecy is a recipe for shame, low self-esteem, and psychological disaster, and is to be avoided. . . . It may be that long-term psychological support is of equal or superior importance to the anatomical result [of surgery].”

In Europe, progress seems to be picking up even more quickly. In 2012, following successful political pressure from Swiss intersex activists, the
Swiss National Advisory
Commission on Biomedical Ethics issued a special report regarding “ethical issues related to ‘intersexuality,’” recommending first and foremost that

the suffering experienced by some people with DSD [differences of sex development] as a result of past practice should be acknowledged by society. The medical practice of the time was guided by sociocultural values which, from today’s ethical viewpoint, are not compatible with fundamental human rights, specifically respect for physical and psychological integrity and the right to self-determination.

In an even more startling turn of events, in 2013, the United Nations
special rapporteur on torture
recommended that legal actions be taken to stop “forced genital-normalizing surgery” on children too young to consent. The special rapporteur, Juan E. Méndez, said he wished to shed “light on often undetected forms of abusive practices that occur under the auspices of health-care policies,” including abusive “medical” treatments wrought on gender-nonconforming children, gay children, and intersex children.

In the United States and Europe, boys and girls born with sex anomalies are still routinely subject to risky genital-normalizing surgeries that are often medically unnecessary, unsupported by scientific evidence, and difficult or impossible to reverse. When challenged, many American specialists today say that it’s
parents
, not clinicians, who insist on surgery. Nevertheless,
a recent study
backs up what I’ve seen in practice: When faced with decisions about genital-normalizing surgeries, parents are likely to go whichever way the clinician advising them is leaning, and in America, most clinicians still lean toward “corrective” surgery. In Europe, where the evidence-based medicine movement is powerful, in part because medicine is socialized, clinicians appear more inclined to a conservative, “first do no harm” approach. Unfortunately, I expect it will continue to be very difficult to get American clinicians who see these interventions as beneficent to pull back except through threat of legal action.

As I write, there is a case wending its way
through the American courts
brought on behalf of a young boy born with ambiguous genitalia who was surgically made to look female at the age of sixteen months. The surgery occurred at the order of the state of South Carolina while the baby was in foster care. Sometime after the surgery, the child was adopted by supportive parents, who accepted the child’s eventual self-identification as a boy. The family’s lawyers—including Anne Tamar-Mattis, who provided legal assistance to our efforts around prenatal dexamethasone—are arguing that the boy was denied due process as accorded by the Fourteenth Amendment when surgeons fashioned his small phallus to look more like a small clitoris. American intersex clinicians are extremely nervous about what this case might mean to their practices; a ruling in the child’s favor could mean a new era of legal protections for these kinds of children and critical social acknowledgment of the harm wrought on generations of intersex children.

Meanwhile, in the United States, many teenage and adult transgender people still can’t get the kinds of medical and surgical interventions that intersex babies get without ever asking. Fortunately, in the last ten years, there has been a movement toward providing better access to gender-affirming interventions for adolescents and adults who are transgender. More and more clinics at American children’s hospitals are claiming to provide genuinely supportive care to this population.

In fact, the pendulum may be swinging too violently. In the name of being “affirming” of gender nonconforming children, some parents and clinicians now seem
too
quick to assume that such kids must be subject to gender reassignments that include nontrivial hormone regimens and surgical procedures. (Recall that most gender-nonconforming boys in clinical studies have grown up to be gay men, not transgender women. Many gender-nonconforming girls grow up to be satisfied with their birth gender assignments and bodies.) What looks at first like progress may sometimes amount to the same old rush to normalize “deviance” into a heterosexist two-sex vision of the world, rather than accepting that biology and identity are not the same thing. Calm, evidence-based care in the treatment of gender nonconforming children—care that doesn’t rush to “resolve” their identities—is only now emerging.
European clinicians again seem to be leading
.

“Born with one sex’s brain in the body of another sex, so needing rescue by the doctor”—that’s still the transgender narrative that goes down smoothest among straight adults, perhaps especially among parents who long for a simple resolution to their seemingly challenging children. But in the United States, there is a growing movement of parents pushing to let gender-nonconforming children just be who they are, without diagnostic perusal and medical intervention. True radicals, these parents of “
pink boys” and “blue girls
” help other such parents learn to simply love without risky “normalizations,” letting children grow up to decide for themselves what bodily changes, if any, they want to pursue.

I think that not too far in the future, this approach will no longer be seen as radical. American culture has made big strides since the intersex-rights movement began in 1993. Social acceptance of sex and gender variation has certainly increased dramatically in the last decade, and legal protections for transgender people, gay men, lesbian women, and bisexual people have been expanding. That said, many are still subject to housing, employment, and medical discrimination as well as to bullying and bashing. I’m working now on a committee assembled by the Association of American Medical Colleges to try to get medicine to lead in positive social change for people who are in the social minority in terms of their gender histories and sexual orientations. But as of now, American medicine remains a potential venue for oppression as much as for liberation.

There is much reasonable disagreement
among transgender activists
as to the right role for medicine in transgender politics. Clinicians who work with transgender people know that they are much more diverse in experiences, senses of self, and needs than the general public realizes. Clinicians with whom I speak sometimes express frustration that they have to toe particular party lines (like “transgender always means ‘born trapped in the wrong body’”) or risk being painted as anti-trans, even when they are struggling to put the needs and desires of a patient before politics.

As for Andrea James and Lynn Conway—the two trans women who most intensely went after Mike Bailey and then me—while they are well known among transgender activists, I think it is fair to say that they are not generally viewed as leaders of the rights movement. That kind of leadership comes more from groups like the National Center for Transgender Equality. James and Conway keep up their campaigns against Bailey, me, and pretty much anyone else aligned with Blanchard’s understanding of male-to-female transsexualism as involving sexual orientation as well as gender identity.

My journal article on the Bailey book controversy still brings me frequent mail from men and transgender women who tell me the article helped them figure out that they are autogynephilic in sexual orientation. Some also write to tell me how wrong Blanchard and Bailey are, stating that their gender experiences have nothing to do with eroticism whatsoever or that they are a “third type” not captured by Blanchard’s taxonomy. (Blanchard never said there couldn’t be other types; he simply argued that sexual orientation was salient to requests for gender reassignment among natal males.) In spite of substantial pressures not to do so, in the last five years, more and more people have been openly self-identifying as autogynephilic; some identify mostly as male but live part-time as women, while others identify as transgender women. In 2013, Anne Lawrence, the physician-researcher who self-identifies as autogynephilic, published a
groundbreaking book
analyzing hundreds of autobiographical narratives of autogynephilia. The book encourages all readers to understand that, for those autogynephilic natal males who choose permanent social transition, the gender identity of female makes the most sense for their lives—that fully taking on a female identity is not a game, a fantasy, or a fetish, but a necessary means of survival, just as coming out is for gay and lesbian people. The work of Lawrence and others continues to show that transition greatly improves the psychological and social lives of transgender people who seek it and are given supportive care, including access to the desired hormonal and surgical interventions. Their lives are, on average,
made safer and better
.

Meanwhile, some researchers keep looking to see if they can find evidence that transgender people really do have the brain of one sex in the body of the other. Results of such work are mixed and difficult to analyze, in part because the sex-specific parts of the brain can change even in adulthood—for example, when someone starts taking cross-sex hormones. For my part, I hope we never require biological “proof” to believe someone’s self-declaration of gender. As one wise guardian of a seven-year-old child with intersex once said to me, “We don’t need another blood test to figure out who he is. He’s already told us he’s a boy.” That, it seems to me, is all we ought to require of people as we “decide” what genders they are. How they got there may be scientifically interesting to us (it certainly is to me), but how they identify themselves as individual persons in terms of gender is for
them
to decide.

Anne Lawrence’s career trajectory is typical of researchers who have been put through the wringer for making unpopular identity claims: Such people don’t change course just because they’ve had the snot kicked out of them. Among all of the researchers whom I interviewed specifically because their work got them into trouble, not one has disavowed the controversial research. A lucky few have found their work now generally in favor. Elizabeth Loftus, for example, is now widely recognized as having been right about how fictional “memories” can be implanted in the human brain, even in some cases of alleged childhood sexual abuse. Ed Wilson’s basic idea that there are evolutionary bases for human social behaviors is now more accepted among the general public and even academics.

Like Wilson, some researchers whom I met because of their intense political messes are now doing less controversial work, not because they’re afraid of shitstorms but because they don’t
need
them. (They lack the Galilean personality.) For example, since
A Natural History of Rape
, Craig Palmer has been studying social networks of Newfoundlanders and representations of rescuers in Holocaust museums. Chuck Roselli (the “gay sheep” guy) has continued to be interested in hormonal effects on the brain, but he’s also been working on understanding how certain herbal preparations might help treat prostate cancer.

Among those
with
the Galilean personality, Mike Bailey has continued to study sexual orientation, collaborating on one project looking at the genetic basis of male homosexuality and on another aimed at understanding what sexual arousal looks like in the brains of bisexuals. Although age has taken the sharp edge off his style, life has not exactly quieted down for him. In early 2011, a couple of years after my work on his controversy came out, Mike managed to get himself in a whole new round of trouble by allowing a pair of exhibitionists to demonstrate something called a
fucksaw
in an after-class special for students in his Northwestern human sexuality class. In case you’re not familiar with tools that require shopping at both Good Vibrations and Home Depot, a fucksaw is a do-it-yourself sex toy made by combining a reciprocating saw with a dildo. (At least that’s how it has been described to me; I can’t say I’ve had the pleasure.) News of this event leaked out into the local, then the national, then the international media. I heard about it accidentally via CNN.