This chapter outlines intersex embodiment as inherently pluralistic in its production through materiality, institutions and cultural knowledge that are contingent to particular times, places, contexts and regulatory frameworks. These different intersecting dimensions produce diverse understandings of intersex embodiment at different times and places. This chapter highlights that understanding these different approaches and how they, in turn, are understood by intersex people remains an important task for all researchers, legislators and policy makers. This chapter closes by articulating a conception of intersex embodiment that goes beyond traditional categories of disorder and identity in order to outline a more situated, contextful and considered account of intersex people.
This chapter focuses on Malta’s rights-based approach to intersex, which specifically prohibits unnecessary sex-assignment treatment and surgery on intersex minors. This approach has placed the framing of intersex outside simplistic medical and LGBT accounts. As a result, it offers the potential for significant new framings of what intersex is and what intersex can be. Unfortunately, the reality of the intersex experience in Malta has not lived up to the promise of the 2015 legislation. This is predominantly due to an implementation gap where law is yet to affect clinical practice and disrupt the disordered narrative. This serves as an important reminder of how resistant to change the medical framework is. We also note, however, the dynamism of social change and highlight its ongoing and continuous nature rather than being a shift between two static points. State buy-in after law reform takes place is as important as that needed to introduce new legislation to disrupt medical embodiment.
This chapter explores how psychosocial care within healthcare is an essential element of reframing intersex embodiment and care for intersex people away from paradigmatic medical narratives ‘fixing’ a ‘disorder’ and towards supporting a person. Many biomedical accounts of intersex as a ‘disorder’ remain prominent in psychosocial provision with care often been offered as an ‘afterthought’ or an ‘emotional repository’. Such approaches fail to consider the transformative effect that psychosocial care can have on the intersex experience. Such care can offer support to ensure that intersex people and their families are equipped to deal with the structural challenges that they will face as a result of their intersex variations. These transformative approaches construct intersex as a contextual, situated and dependent individual in need of support in order to overcome the structural issues that they will be faced with. These insights are read alongside shifts in legal theory towards notions of ‘embodied integrity’ in order to outline a thicker conception of legal embodiment.
This book examines the divergent medical, political and legal constructions of intersex. The authors use empirical data to explore how intersex people are embodied through these frameworks which in turn influence their lived experiences.
Through their analysis, the authors reveal the factors that motivate and influence the way in which policy makers and legislators approach the area of intersex rights. They reflect on the limitations of law as the primary vehicle in challenging healthcare’s framing of intersex as a ‘disorder’ in need of fixing. Finally, they offer a more holistic account of intersex justice which is underpinned by psychosocial support and bodily integrity.
This chapter outlines a working definition of intersex and highlights its multiple and contested nature with particular reference to a community retreat (The Darlington Statement, 2017), the European Parliament (Promoting the Human Rights of and Eliminating Discrimination against Intersex People (Resolution 2191) 2017) and a consensus statement of leading endocrinologists (Lee et al, 2006). From the outset the chapter highlights the plural approaches taken to defining and constructing intersex. The chapter then outlines the concept of legal embodiment highlighting its material, discursive and institutional nature. The chapter finally summarizes the methods used in the book describing the participants, recruitment method, interview approach and methods of analysis.
This chapter outlines the ways in which intersex embodiment has been framed through an LGBT approach. This results in two contrasting perspectives: a ‘queer’ approach that problematizes heteronormative and binary institutional accounts; and a homonormative approach that tends to replicate existing institutional structures. It is this latter account of LGBT that has seemingly influenced policy makers in their framing of intersex issues. This chapter traces these tensions through Australia’s Sex Discrimination Amendment (Sexual Orientation, Gender Identity and Intersex Status) Act (Cth) 2013. The chapter outlines how, despite myriad contributions, petitions and commentaries to the contrary, the Australian government failed to challenge the disorder narrative of intersex embodiment and subsequently was unable to change the behaviours and practices of medical practitioners in this area.
This chapter explores how, since the 19th century, in the West intersex bodies have become primarily constructed through a medical lens of ‘disorder’. The increasing pathologization throughout the 20th century and technological advancements gave medical professionals the ability to ‘correct’ intersex bodies in infancy. The result of such early ‘correction’ was to erase intersex at the cultural and institutional levels. This has meant that medicine has largely shaped understandings and responses to intersex, defining it as a ‘disorder of sex development’ and surrounding treatment with shame and secrecy. Paternalistic attitudes, the young ages of the intersex people involved and a lack of longitudinal data collection have further contributed to healthcare’s framing of intersex as a disorder in need of ‘fixing’. As a result, healthcare has routinely used non-therapeutic surgical interventions to physically shape the intersex child’s body to fit the gender binary. Medical responses to intersex have centred on attempts to erase intersex as a political space or an identity and instead focused on protecting the gender binary and heteronormative society.
This chapter problematizes the contemporary ways in which third markers have been used to recognize intersex embodiment as synonymous with non-binary identity by law, academia and policy makers. While historically intersex was depicted as a place-holder for binary sex, the use of third markers has become the most prevalent way in which intersex has become recognized in non-medical realms and ultimately frames intersex as located outside of binary conceptions of sex and gender. The chapter particularly focuses on Germany, which, in 2013, became the first European state to recognize third-gender markers on birth certificates. Ultimately, we problematize the depiction of intersex embodiment as non-binary identity when followed through into policy development and legislation as it struggles to challenge medical framings of intersex embodiment as ‘disordered’.
The Bournewood case posed a new question of vast numbers of people in hospitals, residential care and other ‘community’ settings: is this person deprived of their liberty? If so, the DoLS or some other formal authority was needed to regulate the situation. Yet this question did not come naturally to the inhabitants of the post-carceral landscape of care, its very meaning imbued with liberation from the legal and institutional structures of the carceral era. Suggestions that people might be ‘deprived of their liberty’ by community care arrangements were outliers, curios for legal enthusiasts (Brearley et al, 1980/2001: 68). For most, this was a ‘hitherto unknown question’ (Allen, 2009: 19), a new game without written rules or clear traditions of practice, to secure or repel the law of institutions in the community through persuasion and other tactics.
A week before the Supreme Court handed down its ruling in Cheshire West, the House of Lords Select Committee on the MCA (2014) reported on its post-legislative scrutiny of the Act. It concluded that while the MCA’s principles were ‘visionary’ for their time, its ‘empowering ethos has not been delivered’ owing to poor awareness and understanding, and cultures of paternalism and risk aversion in health and social care. The Committee concluded the DoLS were poorly drafted, overly complex, tens of thousands of people were unlawfully detained, and ‘far from being used to protect individuals and their rights, they are sometimes used to oppress individuals, and to force upon them decisions made by others without reference to the wishes and feelings of the person concerned’. The Committee recommended that the government ‘start again’ (pp6–7).