Cis Gender Studies
Sandra Eder | How the Clinic Made Gender: The Medical History of a Transformative Idea | University of Chicago Press | June 2022 | 328 Pages
Near the beginning of How the Clinic Made Gender, an academic monograph on gender reassignment surgery clinics and their effects on intersex patients, scholar Sandra Eder highlights a disturbing anecdote. She focuses on D.W., a three-year-old intersex patient with a severe sodium deficiency who kept himself alive by eating large amounts of salt. Once admitted to the hospital, “he was not given free access to salt but was given the regular ward diet, which contains the normal amount of salt, and as a result died suddenly.” Eder suggests this lead D.W.’s doctor, Lawson Wilkins, to research D.W.’s condition further and devise more effective treatments for intersex patients. His death becomes, in Eder’s framing, a somber beginning to a hopeful field of study.
But there’s another way of reading this event: not as a passing misfortune caused by a basic misunderstanding of Congenital Adrenal Hyperplasia, D.W.’s condition, but as a reinforcement of the main goals of the hospital: to isolate, to discipline, and to standardize. One of C.A.H.’s main symptoms is profound and life-threatening salt loss which, in this context, D.W. intuited and treated himself. Doctors’ disregard for his behavior and failure to investigate and act reflects the way hospitals treat gender-nonconforming and intersex patients: not well.
Eder does not consider this reading because she engages very little with patients. Indeed, throughout much of her book, she doesn’t even engage critically with her preferred subjects—doctors, surgeons, and endocrinologists—much at all. This is the biggest failing of the text; it also marks it in a long lineage of work by cis scholars gazing, disaffected, at the systems that constrain and confine trans and gender non-conforming people. Despite pockets of compassion—the book features a series of short “case studies” in between chapters highlighting different patients instead of doctors—it reinscribes the authority of doctors and healthcare institutions over patients’ lives and stories. According to Eder’s worldview, the doctors were right all along.
“Could a girl be a boy if she did not have a penis?” Eder asks early on. How The Clinic Made Gender is full of questions like this, neatly ignoring entire histories of debate in medical, trans, and intersex communities to focus instead on the crudest possible matter: what’s between our legs. Throughout, she emphasizes a subtle but pervasive worldview: the gender non-conforming are acted on, while cis scholars, doctors, and professionals do the work of theorizing our existence. The history of trans people that she provides consists of:
several brief paragraphs about how we’ve used gender clinics;
a meager reference to Joanne Meyerowitz’s 2002 book How Sex Changed, a history of mainly white trans women, which, like Eder’s own book, was written by a cis scholar and primarily focuses on the doctors who operated on us.
In contrast, Janice Raymond—notorious transphobe who wrote the infamous anti-trans screed The Transsexual Empire—gets several full pages dedicated to her theories of gender, with a two sentence disavowal of her more unsavory views at the end. In Eder’s world, we don’t theorize.
Trans studies scholar Amy Marvin argues persuasively in her essay “Transsexuality, the Curio, and the Transgender Tipping Point” that trans people function most often as curios, “object[s] that [are] alienated from [their] context, history, and world.” Curiotization, Marvin argues, strips our agency, strips our autonomy, and reduces us to objects of mere fascination. There are key differences between Martin’s critique and Eder’s book; namely, that Eder is concerned primarily with intersex patients, not trans. But we see these same narratives: valiant doctors confronted by medical oddities, sob stories and coercive treatments presented as triumphs. We see the same curiotization, the same basic othering and dissolution of agency.
Eder attempts to address some of these critiques. Several short chapters of How The Clinic Made Gender focus on the lives of intersex patients in detail, and these are far and away the most compelling parts. Yet this is undercut by the book’s own methodology: only hospital records are consulted to create narratives of patients’ lives, which means that even when their stories are ostensibly being centered, the voice is still fundamentally a doctor’s. The closest the book gets to actually letting a patient speak for themselves is during a short chapter on Janet, a multiply-medicalized patient (fat, intersex, and quarrelsome) who doesn’t “feel well… upset by both her condition and by her encounters with medicine.” Here, Eder explores Janet’s life with some compassion and empathy, from when Janet was five days old to her disappearance from the medical record at age thirty. Over the course of Eder’s eight pages, Janet evades mandatory cortisone treatments, compulsory genital surgeries, dilators to expand her “Q-tip-sized” vagina, and other unwanted medical interventions. While far too short, this chapter grapples with how much of Janet’s life is ultimately unknowable to a researcher—we only see her medical resistance, moments where she refused hospitalization, refused to dilate, refused to comply with doctors’ care. “What Janet was to herself,” Eder writes insightfully, “emerged on the margins of the record, moments of denial within which she set her own priorities, or in which she refused to be objectified.” Yet even this chapter ends in a narrative dead end, as Janet leaves the hospital and her story abruptly stops. One longs for a more compassionate, expansive understanding of these patients’ lives—one that extends Janet’s reflections on her own life and those of the other patients on theirs. Instead, we get doctors, more doctors, and countless medical details about our bodies and intersex bodies.
There are valid questions raised by Eder’s book; they’re just not especially flattering. Namely, in a time of ever-escalating state violence towards intersex, gender non-conforming, and trans people, what do cis scholars writing about gender owe their subjects? Why is passive observation so often the posture of Eder and others’ work? Why are doctors’ stories so invariably prioritized over patients’? And when patients are in focus, why are their bodies, not their minds or autonomies or strategic tactics when interfacing with doctors, the central object? Why are so many scholars so fixated on gender-nonconforming bodies, as though these bodies were not biological systems like any other? To paraphrase Mariah Carey, why are you so obsessed with us?
I can’t speak to Eder’s intentions, but she can. In her introduction, she positions her book as a corrective to the ways that “feminists and queer communities” have used the word gender “in an uneven and unrestrained manner.” How The Clinic Made Gender is rigorous, scientific; we can tell because it takes the side of doctors and hospitals. But isn’t gender uneven, unrestrained, multivariate? Doesn’t restraining gender, linguistically or otherwise, just reproduce what the clinics did in the first place? In the last few pages of the book, Eder praises the “creativity” of gender expression we see now—but restrained creativity isn’t art, it’s a coloring book. By endeavoring to present gender “evenly,” she launders the same arguments that the medical professionals who killed D.W. and pathologized Janet advanced themselves.
There are other omissions in Eder’s book. Apart from an apologetic paragraph near the beginning excusing the whiteness of the text’s subjects and subject matter, race is almost never mentioned. But to be surprised at these further omissions is to be surprised at the mean-spirited dullness of a Hollywood movie; the very organizational structure of the work tells us what to expect. Janet’s story—a patient who managed to evade doctors’ attempts to control her body, eventually refusing medication amidst intense medical fat-shaming—is encapsulated by Eder in its chapter’s subtitle, “Despair.” Meanwhile, D.W., a child who died because of medical malpractice, is refused the same emotional tint—perhaps because to do so would be to call for actual reforms to the systems that killed him. An unwillingness to think of doctors as wrong, and a lack of curiosity about the ways patients subvert, contradict, and resist disciplinary forces in medicine—these are the building blocks of the book. Of course we should temper our expectations; Eder cannot envision a world outside of the hospital that’s not small, sad, and gray.
Even the terminology the text uses is bizarrely outdated and unnuanced. For a book about intersex identities, the word “non-binary” only appears once, on the literal last page. Rather, Eder classifies intersex patients throughout as strictly “men” or “women.” One is tempted to say that Eder writes about doctors, and writes like a doctor, too, but that gives her too much credit; at least physicians commit fully to their ideologies when they take the Hippocratic Oath. How the Clinic Made Gender commits to nothing. Its failures are the default. Eder’s biases aren’t argued and don’t even seem to have been especially well-formulated; rather, they’re the same boring ones her interlocutors might also advance. These points of omission are society’s, too.
Perhaps I’m being too harsh. I don’t think How the Clinic Made Gender is a malicious book; I don’t think it intends to injure trans or intersex subjects; I don’t think Eder even thinks of herself as opposed to us. But in a world where cisgender scholars and writers cover “the gender beat” more often than we do—as critic Grace Byron notes in her essay calling for more trans-inclusive newsrooms—who is around to draw attention to these biases? Who can tell supposed allies—and Eder, in her concluding paragraph, explicitly positions herself as an ally—when they’re adopting harmful rhetorics of their own? What is the difference between speaking for us and speaking over us—and more to the point, why are you speaking, anyway? Fundamentally, the book is a distraction.
One hungers for a history that engages more precisely with the ways that the hospital, for intersex and trans people, enacts violence. One hungers for a history written by us, in detail—an addition to the canon that C. Riley Snorton’s Black on Both Sides and Jules Giles Peterson’s Histories of the Transgender Child and Hil Malatino’s Side Affects, all recent publications, constitute. Granted, that would be a different and far more expansive book. But in the face of such naked violence coming our way—trans bans sweeping red states, winnowing of insurance coverage, the gutting of social safety nets, further criminalization of sex work that affects everyone but especially vulnerable trans and intersex populations—why shouldn’t we ask for more? When we see another book filled with even mild apologia for those who hold power over us, why can’t our response be to close it, and leave? I hope more books like How the Clinic Made Gender don’t emerge from the current stream—not just by dint of their content, but their authorship as well. We can ask those like this book’s author to do the easiest thing: send money to those they speak for, and pass the mic.