Always trouble

This article investigates how the concept of gender might be located within a broader history of the medicalisation and policing of a binary concept of sexual difference and of reproductive knowledge and control. It begins by tracing the origins of gender as a clinical and behavioural category, which was first introduced to medicalise intersex and trans bodies. It then looks at the re-appropriation of the concept for feminist purposes, first in sociology and thereafter – through the notion of performativity – as a philosophical concept. I argue that Judith Butler’s redefinition in Gender Trouble (1990) of gender as performativity marks a decisive change in the meaning of this term: after her intervention, gender is no longer primarily a clinical or sociological category, but one that asks questions about ontology. However, Butler herself does not engage with the concept’s complicated history. While her belated recognition of trans and intersex concerns in the second edition of Gender Trouble and in subsequent works demonstrates Butler’s political investment in addressing these issues, the question of what centring trans and intersex might do to our notion of gender ontology remains unaddressed. 1

The ontological status of gender, as defined by Butler, is also brought into question in Hortense Spillers’s and Saidiya Hartman’s accounts of how race operates to undo gender. Spillers and Hartman complicate Butler’s notion of the normativity and performativity of gender by questioning the types of histories and range of performances that are deemed normative in the constitution of gender categories. While this article accepts Butler’s redefinition of gender as primarily an ontological category, one that is constituted performatively within a normative framework, it demonstrates how transgender, intersex and Black feminist theories complicate this notion of gender ontology, expanding Butler’s proposition of gender ontology beyond the limited scope of Gender Trouble. Given the omission of intersex, transness and Blackness as integral to Butler’s conception of gender, how can recuperating these histories transform our understanding of the performativity of gender? The aim of this analysis is not to affirm gender once more as the most pertinent category for feminist analysis and critique or to reopen tired debates about whether gender remains a useful category of analysis, but to reframe gender through an engagement with its complicated history and, in so doing, expand our understanding of how gender categories operate.

The conceptual use of gender to name and describe the social dimension of human sexed bodily life was not invented by Butler but was first proposed in a clinical context. Gender emerged not in feminist discourse but in post-World War II psychological and sexological studies of intersexuality and transsexualism in the US. 2 Nonetheless, Butler’s reframing of gender through the concept of performativity marks a critical intervention in the use and understanding of gender, subversively transforming what was a highly problematic term into a philosophical concept and critical feminist tool.

The child psychologist John Money, who treated intersex babies, was the first to use the linguistic category of gender as a clinical and diagnostic tool. 3 In Money’s own words, gender was given ‘a new lease on life’ with the 1955 publication ‘Hermaphroditism, Gender and Precocity in Hyperadrenocorticism’ in the Bulletin of the Johns Hopkins Hospital. 4 Money employed gender not in its common sense usage but as a clinical category to describe one aspect of sexual differentiation in the human body. Gender, as Money conceived of it, names the ways in which people comport themselves in their roles as boys or girls, men or women. 5 As Money remarks, ‘(i)n this paper the word gender made its first appearance in English as a human attribute, but it was not simply a synonym for sex’. 6

In the 1995 Gendermaps, Money observes that this initially medical usage quickly spread into the vernacular, though not without misunderstandings. 7 Money, in this later text, demarcates his ‘invention’ from its use in feminist and queer studies, but also sociological and cultural studies more broadly. Money himself notes that the concept quickly took on a life of its own as it became an analytic category in the social sciences, demography and public policy. Though a somewhat different concept in each of these fields, for scientists, governments and feminists alike, the question posed by ‘gender’, as Jemima Repo notes, revolves around the problem of not only how to understand sex but also how to govern it. 8

The question of governing sex was at the centre of Money’s research, which was mainly focused on the treatment of what used to be called ‘hermaphroditism’ and is more appropriately understood as intersex. ‘Hermaphroditism’, according to Money, demonstrates that the unitary definition of sex as either male or female has to be abandoned. 9 Money argues that the term ‘sex’, as it is commonly used, is too narrow to cover the masculinity or femininity of ‘hermaphrodites’. 10 Characterised as a ‘genital birth defect’, ‘hermaphroditism’ is construed as the medical anomaly or problem to which Money proposes gender as both an explanatory response and a clinical solution. 11 In view of this ‘defect’, which means that the sex of the baby cannot be specified within the binary frame of male and female, gender, according to Money, comes to signify ‘the overall degree of masculinity and/or femininity that is privately experienced and publicly manifested in infancy, childhood, and adulthood, and which usually though not invariably correlates with the anatomy of the organs of procreation.’ 12

While gender is not disassociated from the biological aspects of sex, in his 1955 article Money argues that gender is more connected to early life experience than to chromosomal or gonadal sex. 13 It is this proposition that was enthusiastically taken up by psychoanalyst and psychiatrist Robert Stoller, who popularised the term gender identity, as well as by feminists in the 1960s and 1970s, often in isolation from Money’s other claims.

Money not only proposes the category of gender in addition to sex, he also redefines the latter. Instead of a unitary notion, Money proposes a list of five prenatally-determined variables of sex which can be independent of one another: chromosomal sex, gonadal sex, internal and external morphological sex, and hormonal sex (prenatal and pubertal). 14 According to Money, two postnatal determinants have to be added to this list. First, the sex of assignment or rearing; and, second, what Money terms ‘gender role’ – that is, the private imagery and ideation, and the public manifestation and expression, of masculinity and femininity. 15 For Money, as this list indicates, gender is part of sex, one of its seven variables. It is not to be understood as a psychological term opposed to somatic sex. It is Stoller who makes this distinction in the first volume of his Sex and Gender, owing to the overdetermination of the concept of sex. 16 As a consequence, it is Stoller, rather than Money, who is generally cited in the second-wave feminist literature on gender.

Though not conceived as opposites, gender nonetheless marks a radical intervention in the thinking of sex. Money reverses the categorial order of importance. While all variables of sex are important, they are not all equally decisive. In Money’s work, what is projected as stable or enduring is no longer what was previously known as sex – the five prenatally determined variables – but rather the potential of every human being to achieve a stable gender identity and role.

For Money, the putative importance of a strong binary gender role and identity justifies early infantile correction surgery and pubertal or life-long hormonal intervention. It is in this sense that the invention of gender, as a variable of sex and as potential overall organising principle, allows for the appearance and development of a series of new biopolitical techniques for the normalisation and transformation of living beings. 17 Thus, while Money does not precisely split off gender from sex, he reverses the order of stability and, with it, the order of importance. Gender is proposed as a response to the question of how to govern sex. As such, gender is not simply an explanatory concept but a strategic response, invented above all to rationalise and ‘correct’ those bodies which appear not to conform to medical norms. Given this origin, as Repo argues, gender has been a site of political struggle from its inception. 18

While Money’s research is focused on establishing a treatment protocol for intersex children, his writings on intersex often make mention of and include an analysis of transness. 19 According to Money, research on intersex and trans – as well as homosexuality – are interconnected, though primarily by way of their negative denomination as gender identity anomalies. Transness in particular is deemed pathological. Transgender people, according to Money, impersonate the opposite sex, while cisgender men and women are referred to throughout his works as ‘the normal male’ and ‘the normal female’. 20 Money nonetheless comes to the conclusion that transgender people should receive surgery if they request it. Recognising that transgender people cannot be convinced that their gender ‘contradiction’ is a delusion, Money concludes that the only responsible medical reaction is to offer transgender people hormones and surgery. 21

Although Money is an early advocate for the kind of transgender medical rights that are increasingly, if unevenly, recognised today, this comes at the same time as a more problematic promotion of early infantile surgery in intersex children. In 1966, under Money’s influence, the Johns Hopkins Hospital became the first research institution in the US to perform gender-affirming surgeries. 22 Prior to this, the Institute for Sexual Science in Berlin, founded by the German physician Magnus Hirschfeld in 1919, had performed the first such surgeries in the 1930s. However, the Institute was taken over and dissolved by the Nazis in 1933 when Hirschfeld, a gay Jew, emigrated to New York. In a sense, the Johns Hopkins Hospital followed in the footsteps of the Institute for Sexual Science, but the knowledge of how to perform gender-affirming surgeries and administer hormonal treatment was gained from Money’s research on intersex children. As such, Money’s legacy of problematic medicalisation reveals some of the commonalities and differences in the medicalisation of intersex and trans people.

Since Money’s concept of gender intends to provide a theoretical explanation as well as a standardised treatment protocol for intersex and trans people, it can be concluded that gender was from the start a discourse about intersex and trans bodies and a site of their medicalisation. As Talia Mae Bettcher points out, ‘(b)oth transgender and intersex politics arose in reaction to the problematic medicalisation of, respectively, transsexual and intersex people’. 23 The oppressive dynamics of identity invalidation, undermining a person’s chosen gender, and the medical, political and cultural enforcement of a gender, provide a further basis for coalition among intersex and trans activists and suggest possibilities for understanding the intersections of intersex, trans and sexist oppression. 24

At the same time, despite raising similar issues, intersex and trans experiences are not identical. For example, while protection from discrimination in employment, housing and public accommodation is vital for trans people, as activist and writer Emi Koyama points out, it is inadequate as a strategy for intersex people since much of the violation of their rights takes place in other areas. 25 Thus, recognition of the common generative contexts for intersex and trans politics in John Money’s work and conceptualisation of gender should not diminish the distinctness of these struggles.

As will be shown in more detail later on, Butler only engages with Money once in her 2004 publication Undoing Gender, in the context of an essay on the Reimer case – Money’s most prominent study. But Butler offers no analysis here of Money’s role in conceptualising ‘gender’ more broadly. This omission is significant as it obscures how the term gender was, from the start, a discourse about intersex and trans bodies, albeit with the intention to normalise them. Circumventing a more thorough confrontation with Money, Butler finds herself in search of theoretical tools to adequately address trans and intersex concerns, but what remains missing is the theoretical acknowledgement that trans and intersex theory and activism are foundational to, not simply exemplary of, the very concept of gender itself.

While Gender Trouble does not directly address transness, it argues that drag exposes the imaginary relations of compulsory heterosexuality and the contingent nature of gender and identity. The use of drag as illustration and example has been criticised in trans scholarship. Vivienne Namaste contextualises Butler’s use of drag as example by complicating queer culture’s relations to drag, gender and gender performance. Namaste points to the paradox that ‘at precisely the moment that it underlines the constructed nature of gendered performance, drag is contained as a performance in itself. Gay male identity, in contrast, established itself as something prior to performance.’ 26 The relegation of drag queens and the containment of gender transgression to the stage works against transgender people in a variety of ways and is, Namaste argues, a move that excludes transgender people even as it seeks to include them. 27

With gender being a key category of feminist thought, trans and intersex issues should take centre stage. While her work facilitates a philosophical rethinking of gender, this aspect in particular is not spelled out by Butler. If she had conceded Money’s role in coining and circulating the concept of gender, trans and intersex issues might have been foregrounded and not, as in the second preface to Gender Trouble, acknowledged in retrospect, as an addendum to the text. By contrast, looking at the history of the concept of gender provides an opportunity to raise intersex concerns and to challenge transphobic claims within feminism. While taking a stance against transphobic feminism and politics – exemplified for instance in the works of Sheila Jeffreys and Janice Raymond 28 and contemporary trans-exclusionary radical feminists (TERFs) such as UK philosopher Kathleen Stock – it must be acknowledged that trans and intersex theory and activism are always already at the heart of the concept of gender that most feminists appeal to and, as such, are at the heart of feminism itself. Recalling the clinical origin of gender might therefore offer a productive and timely intervention in contemporary debates.

Money’s publications were singularly influential from the mid-1950s to the 1970s and, until recently, have been the main point of reference for medical theory and practice. 29 The concept of gender identity/role introduced psychological principles into the medical treatment of intersexuality, and in so doing provided a link between the fields of psychology, endocrinology and surgery in gender affirmation. 30 Establishing a point of convergence, gender, Repo argues, became the major sexual discourse of the mid-twentieth and early twenty-first centuries, just as sexuality had been the subject of scientific and biopolitical discourse in the nineteenth century. 31 Yet to fully understand this shift, we need to move beyond Money to attend to the historical context more broadly.

The medical interest in intersex people that gave birth to the notion of gender occurred at a time when the West was rebuilding the social, political and economic order after the Second World War. 32 While the management of sex was an integral part of post-War order, military technology in turn was a condition of possibility for new approaches to intersex treatment. Plastic and cosmetic surgery, which had advanced in the First World War, set out not only to reconstruct broken bodies but also shell-shocked minds by means of operations. 33 Surgeons emphasised the positive psychological impact of their operations, which came to justify surgical intervention more broadly. As Iain Morland notes, the symmetries between these interwar treatments and Money’s advocacy of gender reassignment surgery are striking. 34

Until Money’s publications in the mid-twentieth century, medical intervention in intersex conditions remained uncommon, partly due to a lack of technological capacity. 35 As Katrina Karkazis explains in Fixing Sex, rather than thinking about ways of intervening, the medical establishment had previously focused on how to understand and classify intersex bodies. 36 Advancement in surgical techniques, the discovery of sex hormones, new understandings of sex differentiation in embryology, and the ability to test for sex chromosomes, all shaped Money’s understanding of sex as a differential term and his proposed protocol and intervention. 37

However, there was another important if unexpected influence. Money was motivated in his work not only by surgical and psychological innovation but also by cybernetics, the study of communication and control that was first conceived in military research during the 1940s. 38 If understood as part of the general postwar US scientific context, this influence on his work will be less surprising. Cybernetics gave Money new theoretical tools and concepts with which to rethink sex and define gender.

As Morland demonstrates in ‘Cybernetic Sexology’, Money uses a cybernetic vocabulary of ‘variables’, ‘thresholds’, and ‘feedback systems’ to replace central psychological concepts such as those of motivation and drive. 39 The use of a cybernetic vocabulary was meant to offer a more up-to-date sexology and to provide an alternative to both psychoanalytic and biological explanations of sex, gender and sexuality. 40 Money had read and, in a 1949 paper, cited Norbert Wiener, who is considered the originator of cybernetics. In particular, Money referred to Wiener’s analysis of systems and it is noticeable that Money’s definition of sex as a list of five prenatally-determined variables follows the cybernetic definition of a system.

According to cybernetics, a system is not a thing but a list of variables chosen by an observer. As Morland outlines, ‘(t)he definition of systems as sets of observer-selected variables allowed cybernetics to recognise a world of boundless complexity, but also to constrain it, much like Money’s multivariate definition of sex’. 41 For Money, cybernetics offered a precedent in its creative use of language to define a new discipline and to set up a new research institute. 42

However, as Morland argues, ‘Money did not merely borrow cybernetic rhetoric in articulating gender. For Money, gender was cybernetic, directly.’ 43 What this means is that Money recognises sex difference as having a complexity that can nonetheless be contained by defining certain key variables by which sex can be understood and governed. If gender has cybernetic roots, then the discourse of gender must be understood as being shaped by contexts of communication, warfare and control. Even as Money deployed new surgical and hormonal technologies as well as cybernetic ideas of communication, feedback and control to modify intersex bodies, effectively questioning the fictitious unity of sex and acknowledging the malleability of sex difference and anatomy, his conception of gender did nothing to unsettle older nineteenth century Naturphilosophie ideas of sexual difference as being rooted in nature and structuring all of human life.

The philosophers Friedrich Schelling and G.W.F. Hegel, among others, as well as medical practitioners such as Carl Gustav Carus, proposed a theory of sexual complementarity according to which men and women are not physical and moral equals but complementary opposites whose complementarity underpins the notions of species, nature and reproduction as expressed in the concept of sexual difference. 44 It followed that if sexual difference, defined as complementary dualism, was the general principle of the species, then no individual existence could, according to Hegel, Schelling and Carus escape it.

Money’s theory of gender did not question the naturphilosophische conception of sexual difference as a complementary dualism that structures all of human life, but rather envisaged those clinical, medical and surgical procedures that would implement sexual duality. In other words, even though the possibility of a straightforward revelation of sex was no longer conceivable in Money’s framework, he did not conceive of a new understanding of sex/gender that escaped binarism.

Gender, accordingly, became the terrain on which Naturphilosophie met biotechnological medical care. Once sexual dimorphism was no longer tenable as a universal description of human nature and biology, it was gender that implemented the promise of nineteenth-century sexual difference and sex dimorphism through technological, surgical and psychological means. What emerged was a new sex/gender regime produced by the unexpected alliance between a nineteenth-century naturalist metaphysics of sexual dimorphism that focused on heterosexual reproduction and the rise of cybernetics and a medical biotech industry that acknowledged that gender roles and identities could be artificially redesigned. 45

Money’s work gained not only medical but also a wider public recognition. In the 1970s and 1980s, he was interviewed in mainstream magazines, appeared frequently on television and was often quoted in newspapers. 46 While feminists in this period seized on the concept of gender as a means to oppose biological determinism and its control over women’s bodies and capacities, and while this uptake has resulted in the radical rethinking of sex, gender and reproduction, Money’s influence on feminist theory has remained largely implicit.

It is in the works of second-wave feminists that the concept of gender is first rethought, most importantly as a sociological category. Ann Oakley’s influential book Sex, Gender and Society has often been credited with initiating a new use of the term gender and specifically with introducing this use into the lexicon of social science. 47 According to Oakley, who refers to the work of Money and Stoller as well as anthropologists like Margaret Mead, gender is ‘the cultural construction of femininity and masculinity’. 48 Splitting gender from sex, Oakley aligns herself with Stoller more than Money. For Oakley, the purpose of affirming a sex-gender distinction is, first, to argue that the physical effects of biological differences between men and women are exaggerated and employed to maintain a patriarchal system of power 49 and, second, to introduce gender as a new analytical category into the social sciences in order to illuminate how all fields of life are shaped by patriarchal relations.

Money, Oakley argues, ‘has done important research on the social-sexual identity of people, who are biologically intersexual.’ 50 While rethinking gender and claiming it as a feminist sociological concept that departs in important ways from Money’s as well as Stoller’s use of the term, Oakley does not problematise Money’s work. With the exception of her 2015 introduction to the new edition of Sex, Gender and Society, Oakley uncritically refers to Money’s research, using it as scientific proof to support her own claim that culture plays an important part in the shaping of male and female identity. 51 By not engaging rigorously with Money, using his work primarily as scientific confirmation and evidence of her own claims, trans and intersex considerations are marginalised in Oakley’s research. It is therefore not surprising that they do not find their way into mainstream feminism and into the majority of writings that come out of second-wave feminist scholarship. As a result, gender comes to be disassociated from intersex and trans concerns.

In the introduction to the 2011 volume Deviations that anthologises her work, Gayle Rubin remarks on the impact of Money’s analytic framework on her early work. 52 In her influential 1975 essay ‘The Traffic in Women’, Rubin introduced the concept sex/gender system, which she defined as ‘a set of arrangements by which a society transforms biological sexuality into products of human activity’. 53 In Deviations, Rubin acknowledges that while she did not cite Money in her early work, she was indeed influenced by him and had absorbed aspects of his analytic framework without grasping its novelty. 54 Rubin writes that Money’s ‘gender’ ‘was one of the resources at hand with which to build feminist frameworks’ that together with Karl Marx’s discussion of reproduction, Claude Lévi-Strauss’s analysis of kinship, and Sigmund Freud and Jacques Lacan’s discourse on femininity, contributed to her own choice of terminology. 55 Money’s concept of gender draws attention to the social production of sex and gender identity. But while for Money, this proposition establishes ‘gender’ as a clinical and behavioural term with implications for the medical ‘treatment’ and normalisation of intersex children, Rubin reads the social construction of gender through a Marxist psychoanalytic framework, concluding that the social and historical production of gender roles and norms is a site of political struggle. Contrary to Money who sees the reorganisation of sex/gender as a clinical issue, Rubin advocates the reorganisation of the sex/gender system through political action.

A similar pattern of Money’s unacknowledged influence can also be observed in Butler’s work. It is in Undoing Gender – Butler’s re-elaboration in 2004 of the question of gender performativity – rather than the earlier Gender Trouble or Bodies That Matter – that Butler first mentions and engages with Money’s work and acknowledges trans and intersex discourses as inherent to the question of gender performativity. Until Undoing Gender, Butler, in line with feminist theory more generally, ignored the medical and biotechnological dimensions of gender production. 56 In this book, moreover, the definition of gender performativity is elaborated as both a doing and an undoing. Accordingly, the work brings together the two separate but related discourses that are of interest here: namely, an analysis of gender that includes its historical origin as a term meant to answer questions regarding the status and medical treatment of intersex and trans persons, as well as a philosophical account of gender ontology.

Butler’s discussion of intersex and transgender activism and theory demonstrates her political and theoretical commitment to challenging mainstream feminist discourses. Intended, like Gender Trouble, as a critical intervention in contemporary feminism by highlighting how ‘its own practice sets up exclusionary gender norms’, 57 Undoing Gender shows Butler’s continued investment in opening up feminist theory and practice. As she states at the outset, it was intended to investigate ‘what it might mean to undo restrictively normative conceptions of sexual and gendered life’. 58 While also dependent on other social factors such as class, race and age, this normative pressure affects not only women but queer, trans and intersex people who may or may not identify as women but who have a shared interest in challenging the violence of gender norms.

Although Butler emphasises that she wants to understand gender historically and biopolitically, there are limits to her approach. She writes that ‘[t]o understand gender as a historical category […] is to accept that gender, understood as one way of culturally configuring the body, is open to a continual remaking, and that “anatomy” and “sex” are not without cultural framing.’ 59 Butler argues that the concept of gender, if understood through the concept of performativity, contains a reference to history by definition, both historicising ontology and presenting this as an historical account of gender. Her project, in other words, is to construct a concept of being that is open to change and that in its definition includes an understanding of social temporality and of the cultural shaping of what ‘is’. Defined as such, the concept of gender stands in tension with some versions of sexual difference as defined in French psychoanalytic theory, for instance in the works of Lacan, Luce Irigaray and Julia Kristeva, but also as taken up by Slavoj Žižek and Joan Copjec among others. In Undoing Gender, Butler argues that the sexual difference framework is unable to respond to the following questions: ‘What is the history of this category? Where are we in its history at this time?’ 60 Yet when it comes to the concept of gender, she does not seem to have an answer to these questions either.

When Butler emphasises that gender as a concept is inherently historical, she makes a convincing philosophical claim regarding the nature of conceptual form and its ontological instantiation. However, this does not translate into a retelling of the particular history of gender. While this does not invalidate her critique of the sexual difference paradigm of French psychoanalytic thought, I would like to suggest that Butler needs to specify what kind of history she is talking about. There are at least two histories of gender at stake: one at the level of conceptual form and ontology, which is about the nature of ontology itself; and one that traces the history and politics of gender as a social category and notes its changing meanings over time. While both accounts are necessary, Butler largely addresses only the former.

Repo criticises Butler’s emphasis on rethinking ontology, which, she argues, comes at the expense of a Foucauldian analysis of the operations of power that are necessary to understand the historical origin and workings of the concept of gender. According to Repo, ‘Butler’s gender theory evades these questions of biopolitical strategies and tactics that are central to Foucault’s analysis of the apparatus of sexuality/sex’. 61 Repo argues that instead of a Foucauldian analysis of power, there is in Butler’s work an overemphasis on ‘the rules of the dialectical production of meaning that serves to satisfy the subject’s laborious desire for recognition’. 62 Here Butler is critiqued for being too Hegelian in her analysis. While Repo is justified in arguing that Butler does not sufficiently engage with Money and the clinical protocols out of which the discourse of gender emerges as well as with the sociology of gender, Butler’s interventions into ontology are nonetheless vital and should not be underestimated. Moreover, they do not preclude an analysis of power and do not imply that her findings are politically irrelevant.

In Gender Trouble, Butler describes her project as not simply a genealogy of gender but as ‘a genealogy of gender ontology’. 63 Butler’s enquiry seeks to demonstrate that there is no pre-established ontology of gender because ontology in general does not constitute a foundation. Rather, Butler argues, ontology should be understood in terms of a series of normative injunctions that operate by installing themselves into political discourse as its necessary ground. 64 Among these normative injunctions are, for instance, ideal dimorphism, heterosexual complementarity of bodies, and ideals and rules of proper and improper masculinity and femininity, all of which are also underwritten by racial codes. 65 Political discourse, according to Butler, establishes an ‘ontological field’ in which bodies can be given legitimate expression. 66 Ontology, thus understood, will always ask questions about power, violence, resistance and freedom. Inherently political, ontology is open to transformation. For feminist philosophy this means, on the one hand the possibility of change, but on the other, that no pre-established and stable category of ‘woman’ exists on which to build a politics. What these conclusions mean for philosophy more broadly remains to be investigated, but in Butler’s work the understanding of ontology is elaborated through her conception of performativity. While there has been a lot of work in recent years on linguistics and performativity and the relation between performance studies and philosophy, the question of performativity as social ontology, already hinted at in Butler’s work, has not been widely addressed.

While Butler’s notion of performativity explains a very specific doing, namely that of gender, a more general notion, even if not explicitly addressed, is still at work in Butler and allows her to transpose her concept of performativity onto other contexts, for instance in Excitable Speech: A Politics of the Performative and Notes Toward a Performative Theory of Assembly. 67 What is thought through in all these instances is a concept of activity that does not start from or rely upon an already-given idea of subjectivity. Although sceptical of traditional ontology, Butler’s work nonetheless interrogates the conditions of possibility for ontological claims, since these are decisive for subjectivity and agency and thus for any feminist and emancipatory project. Thus, despite her thoroughgoing critique of ontology, it is becoming increasingly clear, as Stephen K. White points out, that Butler is herself affirming an alternative ontology. 68 Unmasking the essentialism at work in various conceptualisations of masculinity and femininity, and thus of subjectivity, gender and the body, 69 Butler also develops alongside this critique a concept of ‘performativity’ that is mobilised to describe not only linguistic acts and theatrical performances but more generally the processes through which ontological claims come to manifest on or in the body or even as body.

Though Butler does not propose it explicitly in these terms, I want to suggest that her concept of performativity is better understood as performative ontology. Gender, according to Butler, is performative in that it is a doing that constitutes the identity it is purported to be. 70 It follows that the gendered body ‘has no ontological status apart from the various acts which constitute its reality.’ 71 In other words, by means of her concept of performativity, Butler develops a new language of ontology, a new discourse describing how selves come to body forth – what Gerhard Thonhauser has recently characterised as ‘a theory that could be called a social ontology.’ 72 This is an attempt to move away from ontological essentialism towards a speculative ontology that is neither voluntaristic nor entirely structurally constrained. What might such an ontology look like?

Reading Butler as a thinker of ontology means understanding her project not only as discourse analysis, as a discussion of Derridean iterability or a Foucauldian analysis of power, but as an attempt to construct a speculative social ontology. Given that for Butler, ontology is inherently unstable and works through a series of normative injunctions and within a field of constraint, this is not to break with either Derrida or Foucault. Nor is the question of ontology superimposed onto them, since iterability and the discursive production of meaning are always, as Butler also shows, linked to their bodily instantiation as ritual and habit. Moreover, thinking about or in terms of ontology does not mean that all other questions are bracketed. Rather, the question of being is dispersed and is shown to be often as much a question of language, power, identity and discourse.

The question of ontology comes to the fore at different moments in Butler’s work. It is implied in the conceptualisation of gender performativity through statements such as the following: ‘There is no gender identity behind the expressions of gender; that identity is performatively constituted by the very “expressions” that are said to be its result.’ 73 Statements such as these could be interpreted as saying that gender is constructed and therefore is completely individually produced. Recognising that performativity is to be understood as social ontology, however, complicates this claim. Norms, institutions, history and culture performatively create the context out of which individuals’ genders are produced. Butler’s performativity is a doing and undoing that is not the wilful act of an already-determined subject. Reframing performativity as a form of speculative social ontology offers an avenue out of the oft-repeated criticism that Butler’s account of gender performativity is overly voluntaristic.

Gender ideals ‘work’, according to Butler, because ‘performativity is not a singular act, but a repetition and a ritual, which achieves its effects through its naturalisation in the context of a body’. 74 In other words, through their performative repetition, gender norms come to be experienced and lived as a second nature. What seems to be instinctive, such as masculine and feminine gender norms, is a habitual production. In this sense, gender is produced ‘on the surface of the body’ and comes to have ‘the effect of an internal core or substance.’ 75 Gender, then, has an ontological ‘effect’, but, since performative, ‘it has no ontological status apart from the various acts which constitute its reality.’ 76 Gender, in other words, is produced habitually. However, this is not just a personal habit but institutional, and the result is that rather than being produced, gender becomes enforced. Is gender then a ‘bad habit’? According to Butler, the question is ‘not whether to repeat, but how to repeat’ 77 – that is, not how to break out of habit as such but how to break out of a bad habit. In this way, Money’s intervention in sexual difference by way of gender is pursued further by Butler, though under radically different premises. While Money wants to fix trouble, Butler asks ‘how best to make it, what best way to be in it.’ 78 It is therefore telling that in the preface to the second edition of Gender Trouble, Butler remarks that if she were to rewrite the book under present circumstances she ‘would include a discussion of transgender and intersexuality, the way that ideal gender dimorphism works in both sorts of discourses, the different relations to surgical intervention that these related concerns sustain.’ 79 The discussion of gender would, thereby, come full circle.

The ‘John/Joan’ case, as it was first referred to for reasons of anonymity, 80 details the childhood and adolescence of David Reimer, an identical twin, who in 1965 had his penis burned off in a circumcision accident and who was subsequently raised as a girl under Money’s medical care. 81 While this case was central to changing beliefs about the relationship between the social construction of gender and biological sex, Money failed to mention that Reimer rejected his female gender assignment as an adult and lived the rest of his life, until his suicide in 2004, as a man. 82 In 2000, John Colapinto published a book on the case that was critical of Money’s intervention, eliciting a number of responses raising concerns about the ethics of Money’s practice but also vindicating biological explanations of gender. 83 According to the latter critiques, Money’s writing and experiments had done violence to the unassailable nature of man and woman. 84

Butler’s retelling of the Reimer case is commendable for the way that she enables his story to be heard while questioning Money’s clinical framework for its enforcement of gender stereotypes and sexual dimorphism, without however using Reimer’s story for her own theoretical and political purposes. What Butler shows is that Reimer’s experiences at home, in school and in the medical establishment shed light on the experiences of non-binary and trans people more broadly. Reimer’s experience and double ‘transition’ is presented in its complexity by Butler, who makes no final judgement on whether Reimer is trans or not.

Reimer functions, for Money, as an exemplar of his own theoretical beliefs. Butler rightly observes that in Money’s work, Reimer’s body becomes a point of reference for a narrative that is not about this body, but seizes upon the body, as it were, in order to inaugurate a particular narrative about what it means to be human. 85 For Money, gender describes the social dimension of sexed bodily life as noncausal and yet as utterly predictable and controllable. By means of the concept of gender, bodies are ‘normalised’ and governed under Money’s care. But why could Reimer not be a man without a penis? Or decide for himself, as he later did, whether and how to identify in gender terms? Money’s emphasis on ‘looking normal’ not only reinforced gender norms, it also encouraged early infancy surgery, which risked permanently depriving a person of sexual function and pleasure. 86 The surgery, ostensibly for the patient’s sake, is in fact performed for society’s sake, a society which, as Butler observes, demands a ‘normal-looking’ body. 87

For Butler, the better imperative is ‘to imagine a world in which individuals with mixed genital attributes might be accepted and loved without having to transform them into a more socially coherent or normative version of gender.’ 88 In Lessons from the Intersexed, Suzanne J. Kessler makes a similar point: ‘Why are unusually sized and shaped genitals not accepted as reasonable markers of gender – gender either as we know it in the two-option scheme or as we could know it in a new gender system?’ 89 Kessler, moreover, points to the heteronormative bias that underlies Money’s clinical protocol. When Money argues that Reimer, because of the loss of his penis, should not be raised as a boy but be assigned the female gender, one of the justifications for this decision is that Reimer will not be able to have heterosexual intercourse. This supports Butler’s claim that gender dimorphism is inherently linked to heterosexism in what she refers to as a heterosexual matrix or hegemony.

A critique of idealised gender dimorphism, as put forward by Butler and Kessler among others, does not, however, lead to the conclusion that transgender people should not be allowed the right to surgery. The difference between intersex and transsexual surgery is that in the first case, physicians typically practice gender upon others – often, as in the case of intersex surgery, without the explicit knowledge and permission of the patient because it tends to be done in early infancy. In contrast, in claiming gender-affirming surgery, trans persons practice gender on themselves – they ‘do’ their own gender. 90 This is not an attempt to violently implement a norm, although this practice does not take place outside of a normative framework. Transness can illustrate the malleability of anatomy, gender identity and role but, as Butler points out, unlike in the Reimer case, malleability is not imposed here. 91

When considering the history of ‘gender’, it is imperative to reflect on the race and class of the intersex bodies that were of concern to the medical establishment. We must ask whose children the medical establishment was invested in when defining the category of intersex. As Repo outlines, gender was primarily ‘an apparatus designed to tame, normalise, and regulate White, middle-class children and parents into harmonious, reproductive, and productive nuclear units.’ 92 But who goes without health insurance and never enters the hospital in the first place? Who is from the start not meant to ever form a part of the harmonious, reproductive nuclear family unit? If the medical category of gender was in the 1950s predominantly concerned with white, middle-class families, is this concern maintained by feminists who take up the category for use as a feminist analytical tool? According to Repo, the answer is yes. This, however, is not because gender could be a better and more critical term but because the entanglement of feminist thought with the biopolitical practices of the postwar US medical establishment have never been sufficiently interrogated.

The unacknowledged origin of the concept of gender in medical, psychological and anthropological scholarship and in post-World War II nation building in the US continues also to trouble Butler’s work. Moreover, while Butler explains that gender and sexuality are not immediately self-explanatory, by and large race and class remain abstract terms in her work, truths taken to be self-evident. Butler states that all social markers are inherently related, but the nature of their relation is never explicitly explored. This is surprising given that performativity is a term that – like the prefix ‘trans’, in which Butler seems especially invested in her more recent work – implies a movement across or beyond given states of affairs. 93 However, even though ‘performativity’, ‘trans’ and ‘queer’ are terms that speak to each other as they try to address a processual, anti-essentialist notion of being and being-with, they can also at times end up obscuring the specific and complicated histories of social and political categories.

The ontological status of gender, as defined by Butler, is brought into question in Hortense Spillers’s and Saidiya Hartman’s accounts of how race operates to undo gender. Looking at the transatlantic slave trade and its legacy, Spillers introduces the notion of the ungendering of the Black body. What is at stake in this concept is the exact status of an ontology of gender in relation to both its historicity and to its performative and normative character. This analysis forms part of Spillers’s broader theoretical work on the distinction between captive and liberated subject positions. In her landmark essay ‘Mama’s Baby, Papa’s Maybe: An American Grammar Book’ (1987), Spillers proposes a distinction between ‘body’ and ‘flesh’. According to Spillers, before the ‘body’ there is ‘flesh’, a zero degree of social conceptualisation. 94 Spillers argues that the transatlantic slave trade

marked a theft of the body – a wilful and violent (and unimaginable from this distance) severing of the captive body from its motive will, its active desire. Under these conditions, we lose at least gender difference in the outcome, and the female body and the male body become a territory of cultural and political maneuver, not at all gender-related, gender-specific. But this body, at least from the point of view of the captive community, focuses a private and particular space, at which point of convergence biological, sexual, social, cultural, linguistic, ritualistic, and psychological fortunes join’. 95

As Alexander Weheliye explains, Spillers’s notion of the flesh does not demarcate an abject zone of exclusion that culminates in death but a zone in which kinship and social structures that are determining of Western society are suspended. 96 Most notable is the suspension of gender and sex-role assignation, which, with the exception of the reproductive labour of birthing, do not emerge for enslaved African-Americans in this historic instance. 97 Because Black women’s sexual and reproductive capacities were used to reinforce the existing relations of production and the continuation of slavery, it might be argued that slavery in this way bears a gendered aspect. But despite Black women’s sexual and reproductive capacities being essential to slavery, Hartman and Spillers argue that gender and sexual differentiation are unimportant, or matter only indirectly, as categories in this historical context. In her essay ‘The Belly of the World: A Note on Black Women’s Labors’ (2016), Hartman explains that this is because these categories are absent whenever the productive labour of the enslaved comes into view. 98 Kinship and gender relations lose meaning because they can be obliterated by property relations at any given moment. 99 For this reason, reproductive labour, including birthing, and not gender, is the central category for understanding slavery and its afterlife in global capitalism.

The reproductive labour of birthing is also a driving force for nineteenth century gynaecological innovation in the US South. It is not surprising that one of the first specialised US medical journals is an obstetrical journal. 100 As Deleso Alford Washington outlines, ‘[s]lavery, medicine, and medical publishing formed a synergistic partnership in which Southern medicine could emerge as regionally distinctive, at least through its representation in medical literature, and especially with regard to gynaecology.’ 101 Since gynaecology and women’s health contribute to the maintenance of slavery, the concern for women’s health is here primarily driven by a desire to maintain and reproduce existing property relations. Moreover, these innovations illustrate that conceptions of sex, gender and sexual difference are inseparable from race. The experimental surgical treatment of Black enslaved women, as conducted for instance by James Marion Sims – once considered to be the ‘father’ of American gynaecology – ‘othered’ the women he experimented on based upon a construction of race but also ‘samed’ their bodies for purposes of extracting reproductive knowledge and surgical innovations that could benefit all women. 102 In other words, while Black female bodies are othered for the duration of surgical experimentation, once a cure is found it applies not only to all women but, as Sims once remarked, to the entirety of humanity. 103

Spillers argues that the marking of the Black body as flesh is passed on from one generation to another. According to her, the naming, valuation and relegation of Black bodies to the status of dispensable commodities is effective today through various symbolic substitutes, such as skin colour and ethnicity. In Spillers’s words, ‘the flesh is the concentration of “ethnicity”’. 104 It follows that with racism and structural discrimination, ungendering of Black and ethnic bodies continues too. This in turn raises questions about the types of histories and range of performances that are deemed normative in the constitution of gender categories today. What is at stake in Spillers’s and Hartman’s writings is the status of an ontology of gender.

According to Spillers, ‘gendering’ takes place within the confines of the domestic only to spread over a wider ground of human and social purposes. By contrast, the human cargo of a slave vessel offers a counternarrative to notions of the domestic. 105 The effacement of African family and proper names under conditions of enslavement leads to the creation of an alternate domestic sphere. Spillers writes:

It seems clear, however, that ‘Family’, as we practice and understand it ‘in the West’ – the vertical transfer of a bloodline, of a patronymic, of titles and entitlements, of real estate and the prerogatives of ‘cold cash’, from fathers to sons and in the supposedly free exchange of affectional ties between a male and a female of his choice – becomes the mythically revered privilege of a free and freed community. 106

Spillers demonstrates that the kinship models of Black communities are unintelligible within the terms of a white American grammar of gender and family relations. The loss of gender differentiation becomes a critical part of Blackness in the US, while the notion of the ungendering of the Black body demonstrates that gender and sex differences are also racial arrangements. 107

Hartman makes a similar point when she argues that the suspension of gender norms under slavery has led to the emergence of gender nonconforming Black communities in the US and to forms of domesticity distinct from those that obtain in the majority of white households. 108 Spillers and Hartman accordingly identify a queerness within Black gender and kinship relations, which creates a social subject position that is ungendered. Spillers urges us ‘to make a place for this different social subject’, ungendered and insurgent. 109

While Butler understands gender to be both performative and normative and intrinsically linked to heteronormative kinship ideals, she does not question its historical origins in the imperial slave-holding nation state. Spillers and Hartman, by contrast, explain that race and ethnicity, not only heterosexuality, are defining normative elements that determine whether a person can establish normative gender relations and whether their recognition by others might be foreclosed. It is in this sense that they question Butler’s notion of the normativity and performativity of gender.

Butler rightly claims that gender performativity is a practice of improvisation within a scene of constraint. But while she identifies heteronormativity and cisgender as normatively constraining, she does not address racial capitalism as a scene of constraint for gender relations. Gender, according to Butler, is a social law that ‘subsumes’ everyone; yet as Spillers and Hartman argue, only certain populations are subsumed into a realm of domesticity supported by state institutions, in which gender relations are formed. The normativity of whiteness as integral to gender performativity remains unanalysed in Butler’s work.

In this article, I have attempted to further Butler’s emphasis on the role and power of state institutions by looking, first, at the deployment of gender as a tool of medicalisation and enforcement of sex dimorphism and, second, albeit more briefly, at the white middle class nuclear family as the dominant form of domesticity which enforces a specific ideal of civil society. What remains to be addressed beyond this article, is how to think the relation between Blackness, transness and intersex in relation to the undoing of gender. In his book Black on Both Sides: A Racial History of Trans Identity, C. Riley Snorton gives an insightful account of this question. Snorton proposes that the notion of captive flesh, as defined by Spillers, figures a critical genealogy for modern transness. 110 This, Snorton writes, is because Blackness like transness articulates the paradox of nonbeing that is expressed in Spillers’s notion of the flesh. 111 In this sense, the ungendering of the Black body gives rise to an understanding of gender as mutable and as an amendable form of being, a context for imagining gender as subject to rearrangement. 112 If therefore the notion of female flesh ungendered ‘offers a praxis and a theory, a text for living and dying’, 113 could this be a transfeminist theory and praxis?

Emphasising the importance of being precise in recounting the connections between and within Blackness and transness, Snorton remarks on the difficulty of giving an exhaustive account or a full explanation of their relation. One reason for this is that some of these connections are a question of the future, of not yet known but possible alliances against a very violent history. Thinking these connections, as Snorton suggests, is an exercise in ‘seeking to understand the conditions of emergence of things and beings that may not yet exist’. 114 What this means for the conception of gender is that though gender has a history which forms the conditions of possibility for normative gender identities and relations, interrogating gender is at the same time a theorising of what might be possible, an attempt at thinking and living gender otherwise. As Spillers emphasises, the aim is not to join the ranks of gendered femaleness but to gain an insurgent ground for a different social subject position, which might be female, nonbinary or other. 115 By illuminating the violence and exclusion in the birth of gender as a concept, alternative futures and trajectories may be forged.

Gender without history is a generic concept that has become an emancipatory tool as much as a core category of governmentality, where it is often used against those whom it should help by impeding access to resources and services such as healthcare, housing, employment and refuge from violence. This article aims to revive gender as a critical feminist tool by offering an account of how trans, intersex and Black feminist concerns, although foundational to its history, slipped out of its early conceptualisation in feminist theory. If gender is to remain a critical and useful concept for feminist analysis, then its problematic past and present need to be addressed. Butler’s intervention is still helpful in this regard as it outlines a speculative social ontology of how the markers of sex and sexuality gain meaning and come to be embodied. Nonetheless, the omission of intersex, trans and Blackness from her initial conceptualisation of gender ontology necessitates a recuperation of these histories with a view to grasping how they might transform our understanding of gender ontology.

Notes

1. Judith Butler, Undoing Gender (New York: Routledge, 2004); Cristan Williams ‘Gender Performance: The TransAdvocate interviews Judith Butler’, The TransAdvocate, 1 May 2014; Sara Ahmed, ‘Interview with Judith Butler’, Sexualities 19:4 (2016). ^

2. Jemima Repo, The Biopolitics of Gender (New York: Oxford University Press), 75. ^

3. Paul B. Preciado, Testo Junkie: Sex, Drugs, and Biopolitics in the Pharmacopornographic Era (New York: The Feminist Press, 2013), 99. ^

4. John Money, Gendermaps: Social Constructionism, Feminism and Sexosophical History (London: Bloomsbury 2016), 11. ^

5. Ibid., 11. ^

6. Ibid., 18–19. ^

7. Ibid., 18–19. ^

8. Repo, The Biopolitics of Gender, 4. ^

9. Money, Gendermaps, 21. ^

10. Ines Orobio de Castro, Made to Order: Sex/Gender in a Transsexual Perspective (Amsterdam: Spinhuis, 1993), 24. ^

11. Money, Gendermaps, 18–19. ^

12. Ibid., 18–19. ^

13. Terry Goldie, The Man Who Invented Gender: Engaging the Ideas of John Money (Vancouver: UBC Press, 2014), 39. ^

14. Money, Gendermaps, 21. ^

15. Ibid., 21. ^

16. Robert Stoller, Sex and Gender (Volume 1): The Development of Masculinity and Femininity (London: Maresfield, 1984), vi: ‘… the word sexuality usually does not communicate much, for it covers so much. Trying to be more precise, we have split off “gender” as a distinguishable part of “sexuality”’. ^

17. Preciado, Testo Junkie, 111. ^

18. Repo, The Biopolitics of Gender, 4. ^

19. John Money and Anke A. Erhardt, Man and Woman, Boy and Girl (Baltimore: The Johns Hopkins University Press, 1972). ^

20. Ibid., 244. ^

21. Goldie, The Man Who Invented Gender, 207. ^

22. Talia Mae Bettcher, ‘Intersexuality, Transgender, and Transsexuality’ in The Oxford Handbook of Feminist Theory, eds. Lisa Disch and Mary Hawkesworth (Oxford: Oxford University Press, 2016), 409. Johns Hopkins halted gender affirming surgeries in 1979 and only formally reopened its transgender health service, including a surgical program, in 2017. ^

23. Ibid., 408. ^

24. Ibid., 420. ^

25. Emi Koyama, ‘Interrogating the Politics of Commonality: Building a Bisexual, Trans and Intersex Alliance’, in Introduction to Intersex Activism: A Guide for Allies (Portland, Oregon: Intersex Initiative Portland, 2003), 18. ^

26. Viviane Namaste, Sex Change, Social Change: Reflections on Identity, Institutions, and Imperialism (Toronto: Women’s Press Toronto, 2005), 13. ^

27. Ibid., 11. ^

28. Janice G. Raymond, The Transsexual Empire (London: Women’s Press, 1980) and critical response by Sandy Stone, ‘The Empire Strikes Back: A Posttranssexual Manifesto’, Camera Obscura 29 (1992), who was personally attacked by Raymond. ^

29. Iain Morland, ‘Gender, Genitals, and the Meaning of Being Human’, in Fuckology: Critical Essays on John Money’s Diagnostic Concepts, eds. Lisa Downing, Iain Morland and Nikki Sullivan (Chicago, IL: The University of Chicago Press, 2015), 69. ^

30. Katrina Karkazis, Fixing Sex: Intersex, Medical Authority and Lived Experience (Durham, NC: Duke University Press, 2008), 48. ^

31. Repo, The Biopolitics of Gender, 1. ^

32. Ibid., 47. ^

33. Morland, ‘Gender, Genitals, and the Meaning of Being Human’, 83. ^

34. Ibid., 83. ^

35. Karkazis, Fixing Sex, 31. ^

36. Ibid. ^

37. Ibid., 31–32. ^

38. Iain Morland, ‘Cybernetic Sexology’, in Fuckology: Critical Essays on John Money’s Diagnostic Concepts, 101. ^

39. Ibid., 101. Morland’s essay is to this day the only text on this subject. ^

40. Ibid., 101. ^

41. Ibid., 111. ^

42. Ibid., 105. ^

43. Ibid., 105. ^

44. Susanne Lettow, ‘Population, Race and Gender: On the Genealogy of the Modern Politics of Reproduction’, Distinktion: Scandinavian Journal of Social Theory 16:3 (2015), 2. ^

45. Preciado, Testo Junkie, 103. ^

46. Goldie, The Man Who Invented Gender, 3. ^

47. Ann Oakley, The Ann Oakley Reader: Gender, Women, and Social Science (Bristol: Policy Press, 2005), 2. ^

48. Ann Oakley, Experiments in Knowing: Gender and Method in the Social Sciences (Cambridge: Polity Press, 2000), 3. ^

49. Jane Pilcher and Imelda Whelehan, 50 Key Concepts in Gender Studies (London: Sage Publications, 2004), 56. ^

50. Ann Oakley, Sex, Gender and Society (Farnham, Surrey: Ashgate, 2015), 61. ^

51. See especially Oakley, Sex, Gender and Society, chapter 6. ^

52. Gayle Rubin, Deviations: A Gayle Rubin Reader (Durham, NC and London: Duke University Press, 2011), 14. ^

53. Ibid., 178. ^

54. Ibid., 14. ^

55. Ibid., 15. ^

56. Preciado, Testo Junkie, 106. ^

57. Judith Butler, Gender Trouble: Feminism and the Subversion of Identity (New York: Routledge, 1999), viii. ^

58. Butler, Undoing Gender, 1. ^

59. Ibid., 10. ^

60. Ibid., 38. ^

61. Repo, The Biopolitics of Gender, 6. ^

62. Ibid., 6. ^

63. Butler, Gender Trouble, 43, my emphasis. ^

64. Ibid., 189. ^

65. Ibid., xxiii. ^

66. Ibid., xxiii. ^

67. Judith Butler, Excitable Speech: A Politics of the Performative (New York and London: Routledge, 1997); Judith Butler, Notes Toward a Performative Theory of Assembly (Cambridge, MA: Harvard University Press, 2015). ^

68. Stephen K. White, ‘As the World Turns: Ontology and Politics in Judith Butler’, Polity 32:2 (1999), 156. ^

69. Ibid., 158. ^

70. Butler, Gender Trouble, 34. ^

71. Ibid., 185. ^

72. Gerhard Thonhauser, ‘Butler’s Social Ontology of the Subject and its Agency’, in Frei sein, frei handeln: Freiheit zwischen theoretischer und praktischer Philosophie, eds. Diego D’Angelo et al. (Freiburg: Alber Karl, 2013), 144. ^

73. Butler, Gender Trouble, 34. ^

74. Ibid., xv. ^

75. Ibid., 185, emphasis in original. ^

76. Ibid., 185. ^

77. Ibid., 202. ^

78. Ibid., xxvii. ^

79. Ibid., xxvi. ^

80. The case was initially discussed anonymously to protect Reimer’s privacy and that of his family. Reimer’s identity only became known when he went public with his story to help discuss Money’s medical practices. ^

81. Goldie, The Man who Invented Gender, 4. ^

82. Ibid., 4. ^

83. Lisa Downing, Iain Morland, and Nikki Sullivan, ‘Introduction: On the “Duke of Dysfunction”’, in Fuckology: Critical Essays on John Money’s Diagnostic Concepts, 6. ^

84. Ibid., 6. ^

85. Butler, Undoing Gender, 65. ^

86. Ibid., 63. ^

87. Ibid., 64. ^

88. Ibid., 65–66. ^

89. Suzanne J. Kessler, Lessons from the Intersexed (New Brunswick, NJ: Rutgers University Press, 1998), 105. ^

90. Ibid., 121. ^

91. Butler, Undoing Gender, 66. ^

92. Repo, The Biopolitics of Gender, 74. ^

93. Tawny Andersen, ‘An Object that Belongs to No One’, Performance Research 21:5 (2016), 12. ^

94. Hortense Spillers, ‘Mama’s Baby, Papa’s Maybe: An American Grammar Book’, Diacritics 17:2 (1987), 67. ^

95. Ibid. ^

96. Alexander G. Weheliye, Habeas Viscus: Racializing Assemblages, Biopolitics and Black Feminist Theories of the Human (Durham, NC: Duke University Press, 2014), 43. ^

97. Spillers, ‘Mama’s Baby’, 79. ^

98. Saidiya Hartman, ‘The Belly of the World: A Note on Black Women’s Labors’, Souls: A Critical Journal on Black Politics, Culture and Society 18:1 (2016), 166. ^

99. Spillers, ‘Mama’s Baby’, 74. ^

100. G. J. Barker-Benfield, The Horrors of the Half-Known Life: Male Attitudes Toward Women and Sexuality in Nineteenth-Century America (New York: Routledge, 2000), 82. ^

101. Deirdre Cooper Owens, Medical Bondage: Race, Gender, and the Origins of American Gynecology (Athens: The University of Georgia Press, 2017), 18. ^

102. Deleso Alford Washington, ‘Critical Race Feminist Bioethics: Telling Stories in Law School and Medical School in Pursuit of “Cultural Competency”’, Albany Law Review 72:4 (2009), 964–65. ^

103. When Sims finally discovered a cure to treat vesicovaginal fistulas, he remarked that he had made ‘perhaps, one of the most important discoveries of the age for the relief of suffering humanity.’ James Marion Sims, The Story of My Life (New York: D. Appleton and Company, 1885). ^

104. Spillers, ‘Mama’s Baby’, 68. ^

105. Ibid., 72. ^

106. Ibid., 74. ^

107. C. Riley Snorton, Black on Both Sides: A Racial History of Trans Identity (Minneapolis and London: University of Minnesota Press, 2017), 12. ^

108. Hartman, ‘The Belly of the World’, 169. ^

109. Spillers, ‘Mama’s Baby’, 80. ^

110. Snorton, Black on Both Sides, 57. ^

111. Ibid., 5. ^

112. Ibid., 56. ^

113. Spillers, ‘Mama’s Baby’, 68. ^

114. Snorton, Black on Both Sides, xiv. ^

115. Spillers, ‘Mama’s Baby’, 80. ^