Since 2013, genital surgery performed


on intersex babies has been described as a human rights violation, and the utilisation of psychosocial justifi cations for normalising surgery is now contested. In the UK, there are no laws to protect infants diagnosed with disorder of sex development (intersex conditions) from undergoing surgery, which seeks to assign a sex category. A fact sheet about intersex persons produced by the UN states: “Intersex persons are often subjected to discrimination and abuse if it becomes known that they are intersex, or if they are perceived not to conform to gender norms”. They are often subjected to discrimination because those working in public and private health care provision frequently lack the training or knowledge to give appropriate care and to respect the autonomy and rights of intersex persons to physical integrity and health. These occurrences of discrimination are not helped by existing anti-discrimination laws, which do not protect them.


Statistics Current statistics suggest there is a


signifi cant UK population of approximately 358,100 people with intersex variations. This is not refl ected in the therapeutic landscape, with few therapists acknowledging or knowledgeable about this client group, nor explicitly identifying as intersex. Furthermore, this client group is not visible in therapeutic literature or included on counselling and psychotherapy training curricula. According to intersex-rights campaigners,


annually around one in 2000 live births have intersex characteristics, and one in 200 of these babies are born with visibly variant genitalia that don’t fi t typical binary defi nitions of male or female. The true fi gure is hard to ascertain since most people born with intersex characteristics do not have variant external anatomies. Of those born with intersex characteristics, some infants will be identifi ed at birth; some may be identifi ed in childhood; some in adolescence; and some much later in life, although some never are. The reason this client group has until


relatively recently remained hidden is largely the result of the medical protocol developed by psychologist John Money in the 1950s, whose theories about ‘hermaphrodites’ (a term used by clinicians at the time, but now no longer used) are still used as the basis for current treatment-practices. Roen explains, “Money and colleagues proposed


Context 155, February 2018


Photo: Katy Davies, © Fashion Space Gallery


that the sexual reassignment of atypically sexed children would be possible if carried out before a critical age, and if the child was raised unambiguously within the gender role consistent with their new sex” (2004, p. 127). Referring to ‘female hermaphrodites’, Money also insisted on life-long post-surgical secrecy. This protocol was followed in mainstream western nations where those who fall outside of ‘male’ or ‘female’ are not recognised as valid and, instead, undergo treatments which “render[s] intersexuality invisible and maintains it as shameful: something that needs to be hidden or erased” (Roen, 2004, p. 127). These historical contexts produce the currently accepted conditions for intersex erasure.


Why intersex people may seek therapy


My research data showed that three out of


fi ve participants initially sought therapy for issues arising from the knowledge they had intersex characteristics. The remaining two accessed therapy for reasons connected to, but not initially arising from, their intersex variation. This suggests that counselling support sought by intersex clients is both implicitly and explicitly connected with the trauma of being intersex in a world that fails to recognise their existence, and simultaneously pathologises their very being. A key fi nding in the research data further


confi rms the failure of the standard medical protocol: no participant fully identifi ed with the sex category assigned to them at birth. What’s more, because surgeries are conducted without the child’s consent, they cause “severe mental suff ering” (Mendez, 2013, p. 18-9). The “heteronormative assumptions”, that is, the privileging of cisgender and heterosexual presentations,


“underpinning a number of intersex-related medical interventions” (Liao & Roen, 2014) have also been called into question. In a pilot study of psychological distress


caused by both the medical management received and the stigma that is projected onto intersex bodies, Schuetzman et al. note that, “Adults with DSD are markedly psychologically distressed, with rates of suicidal tendencies and self-harming behaviour on a level comparable to non-DSD women with a history of physical or sexual abuse” (2009, p. 1). The impact of cumulative harmful surgical experiences, as detailed by participants, is likely to impinge upon intersex people’s sense of their right to exist and their embodiment. A corollary of this non- consensual surgical intervention is noted by Leidolf (2006, p. 90) who observes that without informed knowledge and consent, the potential for further abuse is greatly increased, with intersex children made more vulnerable to being victimised by sexual predators.


Gender identity in therapy with intersex clients


In psychoanalytic work with this client


group, the focus in the literature is on gender identity. Indeed, psychotherapists in this fi eld and I suspect across a wider range of therapeutic modalities, have attempted to establish a ‘true sex’ and a ‘stable’ normative gender identity and sexuality with their intersex clients. Practitioners who are not intersex themselves are advised to be refl exive about their own relationship with their gendered physiologies before intervening in the lives of others. Whilst there is certainly a place for


exploration of gender identity when working with some in this client group,


35


What therapists need to know when working with intersex clients: A primer


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