Making Sense of Intersex: Changing Ethical Perspectives in Biomedicine by Ellen K. Feder (review)

Learning to love, in Nietzsche’s terms, is the enactment of a corporeal generosity; it entails changes in the one who ‘must learn’ to love. Distinguishing what, following Gail Weiss, we might term an ‘embodied ethics’ (1999, 158) from an ethics of ressentiment is the embodied transformation of the one who loves. Rather than seeking changes in the bodies of children with atypically sexed anatomies, the imperative for change is located in the bodies of parents, in physicians, in the rest of us.

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In Making Sense of Intersex: Changing Ethical Perspectives in Biomedicine, Ellen K. Feder asks what philosophy can add to the understanding of the harmful practices of intersex management. With a strong conviction that narratives of those most acutely affected need to be in focus, Feder has conducted interviews with adult intersex people, parents of intersex children, and physicians. Situating her study in the recent changes in the standards of care, published as “Consensus Statement on Management of Intersex Conditions” (2006), following a conference with U.S. and European endocrinological societies in 2005, Feder sets out to understand why normalizing surgeries are still being performed, and justified as ethically sound, given that intersex activists and allies have testified for decades to the psychological and physical harm caused by normalizing surgeries. Feder opens up with a genealogical inquiry into the scientific and clinical contexts of intersex management. It is a U.S.-centered history, but Feder points to aspects not recognized in contemporary discussions, like the convergence of Western, colonial understandings of genital modification in African tribes and the modernist project of medicalization as the solution to the perceived problem of nature being more diverse than culture bargained for (128).

One of the main points in Making Sense of Intersex is the unpacking of the notion that it is the parents of intersex children that push for normalizing surgery, that parental anxiety is at the root of the status quo. Consequently, Feder argues that the widely held assumptions about parental unconditional love is one of the fundamental problems with the dominating bioethical approach towards intersex management. To challenge this approach, she turns to Eva Kittay’s work on the vulnerability of so-called dependency workers, and the derivative dependency that they experience through their reliance on expert knowledge, i.e., the medical providers. The regulatory ideal for dependent workers is the “transparent self ” (53), which presupposes a complete identification with the caretaker on the dependency worker’s part. Feder explores how this ideal of identification might be complicated by the birth of a child other than the one expected. She asks if the focus on genital appearance and the question of future sexual sensitivity and function—so central in the clinical discussions about the pros and cons of normalizing surgeries—may hinder the expected identification. Through the narratives of adult intersex activists, she also explores the potential harm done by all aspects of intersex management—surgical interventions as well as discourses of shame, secrecy, and pathologization—through putting Lacan’s understanding of the mirror stage in conversation with Merleau-Ponty’s insights into the constitution of body schemata, and ends up arguing for an embodied ethics of corporeal generosity that is based in human vulnerability and relationality.

The stakes in her critical intervention become apparent when Feder engages in direct dialogue with feminist theorists and ethicists; for example, in her discussions about how envy might be an instigating affect in intersex management. Building on Freud’s theory of the infant’s polymorphic desire, and Judith Butler’s and Jane Flax’s readings of the melancholic identification that is an effect of the unmournable loss of this desire, she argues that the disgust physicians express is rooted in envy. Using Nietzsche’s concept of ressentiment as a prism, Feder wants us to focus “not on the bodies of those born with intersex conditions, which have been the privileged objects of attention both in medical...