New York: Basic Books, 2000, 473 pages. Cloth, $35.00.
Sexing the Body: Gender Politics and the Construction of Sexuality. – Review – book review
Journal of Sex Research, Feb, 2001 by William B. Stanley
The prevailing theory of sexual dimorphism in Western culture can be traced to antiquity, in the work of philosophers like Aristotle and in the Judeo-Christian religious tradition. These early ideas have had a powerful influence on our views of sex and sexuality. Throughout most of our history, the policing of sex categories and related sexual behavior was largely left to religious and civil authorities. During the nineteenth century, however, the power to discipline sex and sexuality gradually shifted to the scientific and medical communities which took the lead in defining sex categories and what was normal with regard to sex, gender, and sexuality (Dreger, 1998; Herdt, 1996).
Among the most significant scientific influences on the reification of a theory of sexual dimorphism in the nineteenth century was the work of Charles Darwin. His evolutionary theory held that the sexual categories male and female emerged to serve the fundamental purpose of species reproduction required for natural selection and survival. The binary sex categories and the characteristics that distinguished them were defined as natural across time and place, a phylogenetically inherited structure of two basic types of human groups. By the end of the nineteenth century, male and female came to be seen as “innate structures in all forms of life … [and] heterosexuality as the teleologically necessary and highest form of sexual evolution” (Herdt, 1996, p. 28).
We outline this brief history to provide a context for the importance of Fausto-Sterling’s book Sexing the Body. This is a most provocative book containing a radical perspective. Fausto-Sterling considers problematic what she describes as our reliance on false dichotomies like nature/nurture, biology/culture, and essentialism/constructivism, and offers a persuasive argument for abandoning our current theories of sexual dimorphism. The persuasiveness of the book comes from its even-handedness and well-researched content (it took Fausto-Sterling more than 6 years to complete her research and writing).
The 225-page narrative portion of the book is clearly written and guides the reader through some very difficult issues and scholarship. Fausto-Sterling also makes creative use of artwork, illustrations, cartoons, and helpful charts and tables. In addition, the book contains 122 pages of footnotes, 67 pages of bibliography, and a detailed index.
Sexing the Body is divided into nine chapters that move from an analysis of the external markers for sex (e.g., anatomy, genitals), to an examination of the brain, sex glands, hormones, and genes as each has become part of the current discourse on sex. The book concludes with a chapter that describes an interdisciplinary, dynamic systems approach to the study of sex, gender, and sexuality.
Fausto-Sterling provides a fair and even-handed treatment of the issues and has taken the time to study the literature in a way that respects the scholarship of those with whom she has significant disagreements. For example, she is careful to explain the complexities of the psychosexual neutrality theory proposed by Money, Ehrhardt, and the Hampsons. She notes that Money’s ideas were never quite as simplistic as some of his critics (e.g., Milton Diamond) have charged.
In addition, Fausto-Sterling, a committed feminist, is not hesitant to criticize the limitations of certain feminist positions that are dualistic or essentialist. She is also open to the criticisms of her own work, crediting social psychologist Kessler for explaining the limitations of her earlier views on sexual categories as represented in the now famous 1993 article on “the five sexes.” And she admits that her earlier characterization of Young’s work in 1995 was not fully accurate, although she still maintains her basic critique of Young’s overemphasis on biological explanations for sexuality.
Fausto-Sterling brings an unusual interdisciplinary perspective to the study of sexuality. As a scientist and biologist, she believes in a material world and understands the importance of experimentation. However, her knowledge of feminist scholarship and the history of science has led her to focus on how the production of scientific knowledge is influenced by and rooted in particular histories, human practices, language, politics, and culture. In her view, scientific “facts” are not universal but always constructed within a particular historical and social context. As our social views have changed, so too have our scientific views of sexuality and the human body.
The influence of Foucault’s ideas on disciplines and regimes of truth is also evident in Sexing the Body. Foucault claimed that the structural constraints of the disciplines shape how we are able to look at the world. He also described how our concepts of normalcy emerge to become taken-for-granted knowledge. The influence of normalcy in the study of sexuality has been particularly pernicious. In chapters three and four, Fausto-Sterling presents an historical overview and analysis of how a medical discourse emerged to provide a scientific rationale for sex assignment and the surgical “correction” of an intersexed infant’s genitals. Given the impact of our theoretical assumptions regarding sexual dimorphism, it is not surprising that the medical community (simultaneously reflecting and shaping the culture) has tended to view the birth of intersexuals as abnormal mutations and medical emergencies. In fact, most of these “emergencies” are determined by cultural considerations.
The development of new medical technologies usually requires (or helps to construct) a scientific/cultural basis for their use. Such an influential rationale for contemporary surgical technology was provided by the work of the Hampsons, Money, and Ehrhardt. These scholars claimed that human sexuality was highly malleable. Money and his colleagues acknowledged that biological factors influenced the course of human sexual development, but they claimed that social learning had a more powerful effect. In essence, all children could be raised as either a boy or a girl, provided the sexual assignment was done within the first two years and adequate genitals could be constructed surgically. This research has provided the epistemic basis for the guidelines used by the American Association of Pediatricians over the past four decades.
The theory of psychosexual neutrality has not gone unchallenged. Research claiming a biological basis for human sexuality had begun in earnest during the second decade of the twentieth century and was well established during the 1950s and 1960s. In 1965, Diamond, Money’s most persistent and perceptive critic, published an article that raised serious questions regarding Money’s research. However, it took more than thirty years to discredit Money’s central ideas.
Perhaps the single most important event in this shift from Money’s ideas was Reimer’s (Money’s subject in the John/Joan case) decision to go public and refute Money’s fraudulent claims regarding the success of his case (Colapinto, 2000). Nevertheless, the American Association of Pediatricians still recommends surgical intervention and sex reassignment for infants born with ambiguous genitalia. Fausto-Sterling has joined with intersexual activists (e.g., Chase) in calling for an end to all such unnecessary infant surgery.
The impact of culture and politics on the production of scientific knowledge is well documented throughout Fausto-Sterling’s book. In chapter five, she provides a detailed account of the scientific attempt to verify the differences between males and females with regard to the section of the brain called the corpus callosum. Close examination of this research reveals an alarming number of methodological problems. Consequently, according to Fausto-Sterling, the representations of the corpus callosum found in the current research literature are literary fictions (p. 127). She is not opposed to this sort of research in principle but argues that we should be more sensitive regarding the extent to which such research has been inconclusive and shaped by prevailing cultural assumptions. She believes we would make more progress if we were to focus on individual differences and how “the brain develops as part of a social system” (p. 145).
In chapters six, seven, and eight, Fausto-Sterling traces the history of our conception of “sex hormones” and how this concept was applied to research on sex. By 1940, scientists had identified, named, and reached a general consensus on how to measure sex hormones and their effects. The new science of hormones, endocrinology, became enormously influential in the construction of the modern discourse on sexuality. As this research progressed, it became apparent that what were called sex hormones in fact played multiple roles and affected many areas of the body including the brain, liver, gall bladder, kidneys, blood cell formation, the circulatory system, lipid and carbohydrate metabolism, and muscle activities. However, the assumption that the sex hormones were gendered was deeply ingrained and difficult to abandon. Indeed, the etymology of the terms androgen (to build a man) and estrogen (to create estrus) illustrate the role played by sexual ideology.
An important example of how the course of research on sexuality has been shaped by cultural beliefs is illustrated by research on rodents from the 1930s to the present. Fausto-Sterling describes the development of Beach’s research and how his complex theory of animal sexuality was eventually replaced by the far narrower ideas of Young and his colleagues. Beach, the leading scholar in this area from the 1930s through the 1950s, was critical of what he believed were the unscientific assumptions of the main social learning theories popular during the 1940s and 1950s. He argued that biology had a more significant influence on sexual behavior. However, Beach’s theory was not reductionist. He believed that we had to study the complex interaction of the various physiological systems (e.g., hormones, brain, central nervous system) as they interacted to shape behavior. He also demonstrated the significant influence individual genetic differences within sex and species had on animal sexuality. In addition, Beach’s research documented the important effects context and experience had on sexual behavior. Another important finding was that adult bisexuality and homosexuality were natural, not abnormal behaviors.
In 1959, Young and his colleagues presented what came to be the dominant scientific view of sexual development. The new theory–the organizational/activational (O/A) model of hormone activity–held that “pre- or perinatal hormones organized central nervous tissue so that at puberty hormones could activate specific behaviors” (p. 214, italics in the original). The O/A theory presented a direct challenge to the psychosexual neutrality theory proposed by the Hampsons and Money.
Neither the Hampsons nor Money ever claimed that biology played no role in sexual development; they did argue that early social learning had a more powerful influence on the development of our sexuality. Thus, the debate between Young and his colleagues on one side and Money and his colleagues on the other was around the relative importance of nature versus nurture. This dispute was not trivial, but we should note that both groups accepted that sexual dimorphism was natural and that the nature/nurture dichotomy was the way to approach the issue. Over time, the O/A theory came to dominate research on human sexuality, although Money’s influence on the treatment of intersexuals continues into the present.
Fausto-Sterling claims that the rejection of Beach’s ideas and the shift to the O/A theory has had a negative impact on sexuality research and our understanding of human sexuality. As individual genetic differences (lab rodents were bred to eliminate such differences) and the effects of experience were excluded from the focus of O/A research, biology came to be seen as the foundation for sexual development. For some researchers, biology was the overriding cause of human sexuality. However, even those who believed that an interaction between nature and nurture best explained sexual development assumed that biology provided the basic foundation to be shaped by subsequent experience.
Fausto-Sterling argues that research on sexuality will remain constrained as long as we continue to accept the O/A mind/body dualism, which holds that the body (nature) is the fundamental precursor to behavior. She believes we need to switch our perspective “so that we see nature and nurture as an indivisible, dynamic system.” (p. 228). This is not, in her estimation, a new view, but one that has been neglected. She cites research (animal and human) to illustrate how the environment (including the prenatal environment) can change our anatomy, brain, and central nervous system. In this way, “events outside the body become incorporated into our very flesh” (p. 238).
Fausto-Sterling argues for a more flexible view of sex and sexuality, one that does not give primary signifying status to the genitals but allows an individual the right to redefine his/her sexual identity. She urges researchers to abandon terms such as sex hormones, androgen, and estrogen and to use the more accurate term steroid hormones instead. She also asks that we consider removing the category sex from our major forms of identification (e.g., driver’s license). While such proposals might seem radical to many, they are motivated by her research on the dysfunctional effects of our current views of sex and sexuality.
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Compared to other primates, humans take far longer to reach maturity. One can argue that the evolutionary benefit derived from remaining so long in such a vulnerable state comes from the increased opportunity for environment (cultural and physiological) to shape our behavior. Understanding this sort of dynamic system requires both a change of view and extensive research collaboration across disciplinary boundaries. Sexing the Body promotes the dialogue required to move in this direction. Fausto-Sterling claims to “have written two books in one: a narrative accessible to a general audience and a scholarly work intended to advance discussion and arguments within academic circles” (p. ix). She has succeeded on both counts.
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