Galileo's Middle Finger - Part One

My book this week is called Galileo’s Middle Finger, and it was recommended to me by my friend Patricia. You need to read this book, she told me. It took me a while to get around to it, but she was dead right.

Alice Dreger

Galileo’s Middle Finger is written by Alice Dreger, professor of clinical medical humanities and bioethics at the Feinberg School of Medicine in Chicago. I had not come across her work before. Her book is a personal account of her own involvement in a series of medical and ethical issues, over two decades of her life. For readers of this blog in particular, the first three chapters will be of greatest interest. The first discusses intersex people; the second and third transgender people. There is so much to talk about that I am going to split this article into two blog posts.

One of the themes of this blog (one I am always going on about) is that, when it comes to the study of sex and gender, hard scientific knowledge is pretty lacking. In its place is often entrenched dogma, coming from people (scientists themselves and their supporters) who insist on a particular paradigm or point of view; and the equally entrenched opposition of the activists and pressure groups, waving flags and making demands.

If someone comes up with a new idea, it can easily fall foul of one or even both of those groups, not because it is wrong, but because it challenges the way people think, and people (even scientists) can find themselves attacked and vilified, especially in this age of instant social media and viral messages.

Dreger is my kind of scholar: the one who is most interested in the truth above all, "a belief in evidence even when it challenges [her] political goals". In her book she describes how she has been on both sides of these debates; at times siding with the activists, pushing hard against dogma and accepted wisdom. At other times, she has sided with the scientists, defending them against unfair or personal attacks from critics.

Let’s cover some concrete examples. In the first chapter of her book, entitled Funny Looking, Dreger comes right to the point on the very first page.

Dreger: This was my stance: Children born with genitals that look funny but work fine should not be surgically altered just because their genital appearance upsets or worries some adult. Big clitorises shouldn't be shortened, and baby boys with very small penises shouldn't be sex-changed just because their phalluses induce Freudian crises of conscience in their caregivers.

Neither fish nor fowl: intersex

She is talking, of course, about intersex children, that 1 in 1000 or so babies who are born with genitalia which seem to be neither quite boy nor girl. In some (rarer) cases, intersex people can possess both testicular and ovarian tissue in an ovotestis. Cases of intersex people have been cropping up in the medical literature for centuries (I recall coming across them as a student) and are depicted in medical textbooks naked, in black-and-white, with a bar over their face to cover their "anonymity".

Originally, of course, medicine had nothing to offer those people. But over the last few decades, increasingly intersex children have been dealt with surgically. Big clitorises (and I'm sorry for wearing my geek hat long enough to point out that the official plural of clitoris is clitorides) were surgically shortened to look more normal (but often causing scarring and the inability to achieve orgasm). Small penises were sometimes completely amputated, and the child raised as a girl. Unfortunately surgery on children's genitals rarely turns out right.

I stress this was usually done with the very best of intentions by most doctors. I believe (and Dreger does too) that the doctors thought they were doing the right thing by these children. They believed that rigidly enforcing an anatomical binary would spare these children growing up different, and make them fit more comfortably. They believed if they did not provide the surgery, the children would commit suicide in puberty.

Dreger: Modern medicine now sought to reinforce the "optimum gender of rearing" by early management of children born with sex anomalies by means of "sex-normalising" surgeries, hormone treatments, delicate euphemisms, and sometimes lies.

This was also the system that led to a lot of really angry intersex adults who discovered that they had been harmed by the medical care meant to "save" them and who knew that the basic system was still being used on children who would likely grow up as hurt and angry as they were. In the early 1990's, a core group of these people formed the intersex rights movement I eventually joined. Some of these intersex adults had been physically harmed--left with damaged sexual sensation, incontinence or repetitive infections. Many had been psychologically harmed--left with a sense of having been too monstrous for their parents to accept as they came, of being sexually freakish, of being fountains of familial shame. All were left with a burning desire to try to save others from going through what they had.

Things were made worse by the actions of people like Dr. John Money. Money's most famous case was David Reimer, a healthy (non-intersex) boy whose penis was destroyed during a botched circumcision attempt. Money suggested that Reimer be raised as a girl, and he underwent removal of his testicles as a baby, together with hormone treatments intended to feminise him. Unfortunately, none of this worked: Reimer always identified as a boy (despite a rigid "girl" upbringing). Worse, Money continued to publish fraudulent reports (in what became known as the "John/Joan" case) that Reimer was doing well as a girl, and his reputation and prestige meant that other doctors followed his example of treatment. Money was a charlatan whose harms extended far beyond this one patient.

How do you measure up?

Together with intersex friend Bo Laurent, Alice Dreger formalised the Intersex Society of North America into a non-profit, tax-exempt organisation. Its purpose was to provide solidarity for intersex people, to realise they are not alone; to campaign to the medical profession for better, more understanding treatment of intersex individuals; and for more acceptance from society for intersex individuals.

Dreger: The problem in intersex care wasn't a problem of gender identity per se. The problem was that, in the service of strict gender norms, people were being cut up, lied to, and made to feel profoundly ashamed of themselves. Bo said it as plainly as she could: Intersex is not primarily about gender identity; it is about shame, secrecy and trauma.

Gradually, they began to gain some traction with doctors. One tool they used was the Phall-O-Meter (pictured), a ruler which is designed to measure the size of a newborn baby's genitals. Calibrated in inches, it was a way of showing how ridiculous it is, that one could use a ruler to categorise something as profound, as far-reaching, as a human being's sex. (This example misses out the humorous captions like "Phew! Just squeaks by!" for a barely acceptable penis).

Dreger: When I would ask treating physicians, "What is the goal of pediatric intersex treatment?" I was amazed at how often they could not articulate an answer. ... It would have been much easier if all these doctors had been evil. Instead they were good-- human, scared. They tried hard to write us off as evil, but when they met us, they realized that we were also good-- and human, and scared.

Giving the finger: Galileo

This is my second reason to love the book: that Dreger talks with compassion and a deeply-sensitive humanity. She adds more than a dash of her own personality to the book, so that, instead of reading like a dry academic treatise, it reads like a personal memoir, and is therefore approachable, funny and poignant. Alice, I would love to have dinner with you!

After some years involved in ISNA, Dreger decided to leave. It is here that the next chapter begins, the chapter involving transsexuals. But I wanted to finish this article by pointing out that the intersex community was very fortunate to find an ally in Alice Dreger: passionate, committed, articulate and seemingly fearless.

You might be wondering where the book's title comes from. It comes from the fact that one of Galileo's fingers (his middle one, of course) is preserved in a jar in the Museo Galileo in Florence. The museum insists that the finger is mounted pointing upward to the heavens which Galileo loved so much. But, because Galileo was fearless in speaking out against the Establishment of his time (getting himself in trouble with Pope Urban VIII over his views of celestial mechanics), Dreger impishly points out that an alternative interpretation is that Galileo is still sticking his middle finger up in the air against stubborn orthodoxy and entrenched dogma.

Join me for Part Two.