Changing Sex: Transsexualism, Technology, and the Idea of Gender (review)
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Reviewed by
Bernice Louise Hausman, Changing Sex: Transsexualism, Technology, and the Idea of Gender. Durham: Duke University Press, 1995. xi + 245 pp., illus. $49.95, $17.45 paper.

Bernice Hausman tackles one of the hottest topics in current gender and sexuality studies: transsexuality and its implications for the understanding of sex-gender systems. She asks how doctors and transsexuals conceptualize and legitimize physical, bodily interventions for the sake of a phenomenon increasingly understood as psychological. Furthermore, she examines the relationship between transsexuality and the development of endocrinology and “sex reassignment surgery” (SRS) in order to historicize our current concepts of “sex” and “gender.” Her research challenges feminist claims to having coined the notion of “gender”—namely, she argues that “it is through an analysis of the emergence of transsexualism in relation to the developing medical technologies of ‘sex change’ [specifically, John Money’s work in the 1950s] that we can trace the introduction of ‘gender’ as a term referring to the social articulations of sexed identity” (p. 196). This central thesis takes on different theoretical shades as she reviews a broad and rich set of materials: medical literature (on endocrinology plastic surgery, transsexualism, and intersex conditions), transsexuals’ autobiographies, and semiotic theories of sex/gender.

While I admire Hausman’s ambition, I find the book disappointing. It is riddled with factual errors, oversights, and misrepresentations of the medical documents. [End Page 243] As an example, I have chosen the most accessible primary source: the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association (Washington, D.C.: vol. III, 1980; vol. III-R, 1987; vol. IV, 1994). Hausman repeatedly claims that “the psychiatric diagnosis of transsexualism takes as its central symptom the subject’s demand for sex change” (p. 118); however, in the notes she observes that SRS “is not discussed in the DSM-IV as a treatment option (as is true of the DSM-III and the DSM-III-R)” (p. 228n88). First of all, the DSM (as its title indicates) is a diagnostic guide and makes no therapeutic recommendations. Furthermore, the DSM-IV does discuss the “request” (not “demand”) for surgery and hormones in relation to Gender Identity Disorder—not as central or pathognomonic symptoms, but as two among several others (DSM-IV, p. 537). She states (p. 228n89) that the diagnosis of “ego-dystonic homosexuality” remains in the DSM, when in fact it only appeared as a specific diagnosis in DSM-III and is entirely absent from DSM-IV. This and other faulty reporting of the technical, scientific literature undermines the book’s reliability as medical history.

Hausman’s central historical claims—that Money developed the notion of psychological “gender identity,” and that this was critical to transsexual subjectivity—are also shaky. As she notes, Money’s research in the 1950s dealt with intersexed infants and the criteria for recommending surgical “correction” of their ambiguous genitals. First, intersexed infants are a vastly different population from adult transsexuals who willfully seek (or refuse) SRS; Hausman never convincingly connects these two groups. Second, it is hard to give full credit to Money for inventing gender identity when late-nineteenth-century doctors, such as the Italian forensics expert Arrigo Tamassia, clearly defined the conflict between psychological gender identity and physical sex appearance in certain cases of “sexual inversion”: “the individual, although recognizing himself of a given sex, psychologically feels all the attributes of the opposite sex” (“Sull’inversione dell’instinto sessuale,” Rivista sperimentale di freniatria e di medicina legale 4 [1878]: 99). (Tamassia, of course, like the Italians and French of today, lacked a linguistic means of making the current, English “sex”/”gender” distinction.)

There is no single, correct genealogy of these various sexual “perverts” and “intermediates.” As Hausman rightly points out (p. 116), it would be ahistorical and presentist to facilely identify transsexuals throughout the millennia—but every genealogy has its own politics. She denies any relationship between “inverts” and transsexuals thanks to a nominalist and circular definition: SRS permitted the historical appearance of transsexuality because the only real transsexuals are those who demand SRS. This allows her to pit homosexuals against transsexuals: homosexuals emancipated themselves from medicine, whereas transsexuals clamor for more...