Cynthia Kraus

Classifying Intersex in DSM-5: Critical Reflections on Gender Dysphoria

The new diagnosis of Gender Dysphoria (GD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) defines intersex, renamed “Disorders of Sex Development” (DSD), as a specifier of GD. With this formulation, the status of intersex departs from prior editions, especially from the DSM-IV texts that defined intersex as an exclusion criterion for Gender Identity Disorder. Conversely, GD—with or without a DSD—can apply in the same manner to DSD and non-DSD individuals; it subsumes the physical condition under the mental “disorder.” This conceptualization, I suggest, is unprecedented in the history of the DSM. In my view, it is the most significant change in the revised diagnosis, and it raises the question of the suitability of psychiatric diagnosis for individuals with intersex/DSD. Unfortunately, this fundamental question was not raised during the revision process. This article examines, historically and conceptually, the different terms provided for intersex/DSD in the DSM in order to capture the significance of the DSD specifier, and the reasons why the risk of stigma and misdiagnosis, I argue, is increased in DSM-5 compared to DSM-IV. The DSM-5 formulation is paradoxically at variance with the clinical literature, with intersex/DSD and transgender being conceived as incommensurable terms in their diagnostic and treatment aspects. In this light, the removal of intersex/DSD from the DSM would seem a better way to achieve the purpose behind the revised diagnosis, which was to reduce stigma and the risk of misdiagnosis, and to provide the persons concerned with healthcare that caters to their specific needs.

Linking Neuroscience, Medicine, Gender and Society through Controversy and Conflict Analysis: A “Dissensus Framework” for Feminist/Queer Brain Science Studies

This chapter outlines a programmatic proposal linking neuroscience, medicine, gender, and society, with consequences for research, training, and action. I suggest we work with what I call a ‘dissensus framework,’ i.e. a critical framework centered on the study of conflicts and controversies, including their absence, unsuccessful controversies, etc. I explore how we could work with a dissensus framework, taking as an illustration the controversial question of which is the most important sex organ for gender identity formation in intersex people: their brain or their genitals? I then consider how to make a controversy and conflict-centered analysis relevant to social scientific interventions in the current debates about best practice issues in the clinical management of intersex conditions. Reflecting on the productive tensions surrounding training and multidisciplinary team-building that we have been working out since 2005 in Lausanne to improve standards of care, I end up proposing a new project that captures my overall argument: organizing the first ‘Dissensus Conference’ to follow up on the controversial 2005 “International Consensus Conference on Intersex,” and the no less controversial “Consensus Statement on Management of Intersex Disorders” issued in 2006.

Hypospadias surgery in a West African context: The surgical (re-)construction of what?

Since the late 1980s, intersex adults and activists have critiqued the clinical recommendations defined in the 1950s to treat children born with ‘ambiguous genitalia’ with normalising medicine. While their struggles continue, in particular to halt the practice of genital surgery in early infancy, some European surgeons travel to African countries to transfer standards of care that have become highly controversial in the North, including in the medical community. Simple disapproval of these tours as ‘surgical safaris’ forecloses the possibility of analysing more complex situations in which the so-called transfer of competence involves surgeons who promote ‘less cutting and more talking’. Such is the case – and the interest – of the surgical missions in West Africa in which I conducted recent fieldwork, accompanying a team of paediatric surgeons from a European university hospital collaborating with a renowned international NGO. This article analyses the ways in which a variation of sex development called hypospadias is framed and managed in this context through what I call a surgical script for hypospadias. I examine the conditions of (im-)possibility for Northern surgeons to operationalise, and sometimes revise, this script at the missions (but also closer to home). I discuss what the surgeons do in practice to reflect critically on the normative work of the surgical script for hypospadias as a social script on morphological ideals of sex, gender and reproductive heterosexuality. I consider in what sense genital surgery can be said to (re-)construct ‘normal’-looking genitalia, but also, fundamentally, the very idea of genitalia.

Of epistemic covetousness in knowledge economies : The not- nothing of social constructionism

This paper seeks to inquire into the constructionist knowledge practices by further exploring the interchange outlined by philosopher Gaston Bachelard between the naive realist’s conjuration of reality as a precious good in her possession and the miser’s complex of savings the pennies. In fact, this elective affinity holds true not just for naive realism, but also for its very critiques, most of which remaining passionately attached to a little something that is prior to any socio‐historical process. This realistic little something is better understood as a double negation, namely as a not‐nothing, in that it precisely survives the critique of a pre‐existing reality out there as is the case for the discourse of social construction. I will suggest here that this not‐nothing proceeds from knowledge practices that enact “epistemic covetousness” as their critical gesture.