construction of genders/sexes
In later sociological
studies on the social construction of genders/sexes (Kessler/McKenna 1978, West/Zimmerman
1987, Lindemann 1993, Hirschauer 1993) this cultural practice was called 'doing gender'.
In order to observe this practice it is not necessary to presume a gender identity, not
even to presume 'sex' as a corporeal basis. Both the gender identity of an individual and
the physical state of her body are in most interactions derived from how a person
communicates her sex membership. We always attribute to a person's presentation of herself
that he/she has certain anatomical features under her clothes and a certain identity under
her skin. But the most important space in which the distinction between two sexes is
actually brought about is its enactment in everyday interaction.
Members of our society are confronted with the sex distinction from the beginning of their
life: in the deciphering of the gray shadows of ultrasound pictures or - more important
for the legal fixing of gender - at birth. Knowing that the strange creature emerging
there must be either a 'boy' or a 'girl', a doctor or a midwife take certain anatomical
features as a 'good reason' to apply a sex category to the baby, uttering, for example,
"It's a girl".
There is nothing biologically necessary in this act - as the birth-classification of race
just abolished in South-Africa isn't biologically necessary. The midwife's utterance does
not simply 'describe nature' but it reestablishes the convention of treating certain
anatomical features as cultural signs, i.e. as insignia of a sex category. But there are
still more specialized places in modern societies where the sexes are distinguished
(Hirschaue, is not taken as a 'good reason' to call a baby a boy, but as 'good stuff' to
make a vagina from. Both acts give meaning to a piece of body which is indifferent to
whether and how it should be treated and classified.
When we look at the actual workings of these gender determination methods we find them all
rooted somehow in the everyday method of attributing and presenting gender in interaction.
In order to tell how much testosterone and estrogens males and females have you first have
to distinguish men and women. In order to tell which sex has which chromosome structure
you first have to distinguish men and women. So there are rather specialized methods to
differentiate men and women, but it is the everyday life method we all use routinely which
determines what the categories of man and woman mean. In the last 15 years several studies
were carried out in the sociology and history of science which showed in detail how the
practices and theories of sexual differentiation are embedded in specific historical
contexts and cultural interpretations (e.g. Laqueur 1990). On the background of this
research on scientific and everyday practices a distinction which is fundamental in the
medical treatment of transsexuals doesn't make sense in sociology: the distinction between
sex and gender.
Within a notion of gender as cultural practice there is no space and no need for a body as
a presocial biological entity. The body is an always implied 'something' in practices like
embodying sex categories orally and visually or taking blood samples and passing them
through test tubes and computer programs. As cultural anthropologist Mary Douglas (1970)
said: "there is no 'natural' perception and description of the human body which is
free from the dimension of the Social".
gender migration with falsified bodies
At this point one might ask how one can conceive of transsexuality in
such terms, if not describing it in terms of a contradiction between sex and gender. In
terms of a cultural practice one can begin to perceive transsexuality as a highly specific
case of gender mobility - to use a notion of David King (1993). Historical and
anthropological research (e.g. Amadiume 1987, Williams 1986, Bullough 1974, 1975, Perry
1987) revealed an enormous variety of this phenomenon: e.g. the ritual redefinition of
female newborns as male when there was no hereditary successor in native North American
tribes; or the reclassification of infertile women as fully acknowledged men in some
African societies. But these phenomena still have a completely different frame of meaning
from transsexuality. We become more specific looking at cases where since the European
Middle-Ages people have changed their public appearance in order to make sense of their
same sex sexual preference as a legitimate kind of relationship, sometimes oscillating
between the sexes. Another case more closely related to transsexuality in terms of a
practice is the juridical revocation of birth attribution which was granted to 18-year-old
hermaphrodites until the end of the 19th century in Europe (Hirschauer 1992b).
Both cases have a similar structure which I suggest calling 'gender migration'. They start
with a rather individualistic claim to the style of living granted to the other sex: its
appearances, occupations, sexual preferences, rights and duties. It is a membership claim
in the form of a delayed revocation of birth attribution: "No, I'm a boy". Such
leads to a conflict between, on the one hand, a person making a verbal claim to being one
gender and, on the other hand, people in her environment who believe her to be the other
gender because of the public appearance or their past knowledge of this person. Two
parties emerge here: a majority of people, embarrassed by a severe interruption of the
routine workings of their classificatory practices, and a tiny minority of people turned
into strangers in their own social environment.
Now the specific transsexual way of making sense of this situation consists of turning the
social conflict into a personal one, using the formula of "a female (or male) soul
within a wrong body". It is well documented that this formula was invented by a
sexual subculture of the 19th century calling itself 'homosexuals' - a genealogical
predecessor of transsexuals.
But how can one understand its usage in order to make sense of gender migration? On the
one hand, one can understand the rhetoric of the soul politically: a rather isolated
stranger who wants to deny that anatomical features are fundamental signs of her identity
is in a weak position. Instead of bluntly claiming to be the other gender and simply
living it, it is a more modest rhetoric of subjectively 'feeling' it inside and looking
for an affirmation of this feeling - whatever it should consist of.
On the other hand, the experience of being in the wrong body can be understood
historically: in the 19th century one first finds the expression of a moral sense that
homosexual deviants have the wrong body for their sexual preferences: "what we do is
not wrong, what is wrong is our body". At the end of the 19th century this wrongness
received a theoretical meaning when a biological etiology and symptomatology for so-called
'homosexuals' was developed. Finally, since the 1920s the wrongness took on a pragmatic
meaning with the development of genital surgery. Now a body can be experienced as 'wrong'
because it can be corrected. So, overaccentuating the kinship of homosexuality and
transsexuality, one could say that transsexuals claim the very body from medicine which it
formerly imputed to homosexuals: they execute the 'sexual inversion'.
shaping of gender migration
Establishing transsexuality, we have arrived at a form of gender
migration which denies and renews the symbolic value of genitals for personal identity.
The body becomes a part of gender migrants' claims. This specific cultural shape of gender
migration is inconceivable without modern medicine, i.e. without professionals who are
addressed by the way transsexuals formulate their claim and who are also approached by
society to decide its validity and to solve the arising conflicts.
We can therefore ask: what happened to gender migration when medicine became involved?
In which ways did the establishment of interdisciplinary treatment programs shape the
The medicalization of gender migration started with a translation of social conflicts into
conflicts between medical experts. There are three types of such expert controversies:
First the social conflict of whose gender definition must adapt itself to another gender
definition was transformed into a question of treatment: whether one should adapt
psychiatrically the soul to the body or surgically the body to the soul.
Secondly, the cultural conflicts as to the validity of gender migrants' claims were
transformed into theoretical controversies on nosological classification: when
transsexuality was labeled a psychotic condition, a neuroendocrinopathy, a borderline
syndrome or a creative defense mechanism, all these theoretical classifications implied a
political position on one of the sides of the social conflict.
Thirdly, gender migrants' duties to legitimize their claim were transformed into a problem
of legitimizing medical treatment: the disunity of people in families and at places of
work as to the gender of a member was transformed into heated medical debates on
professional ethics concerning the legitimacy of genital surgery.
These debates are largely settled now on the basis of shared responsibility and careful
controls of the treatment. One of the intellectual means of pacifying professional
controversies was the establishment of a professional demarcation line I already
mentioned: the distinction between sex and gender, neatly separating professional domains.
Now what have been the effects of these translations of conflict on the phenomenon of
gender migration? I think there are two: an individualizing effect and a differentiating
Firstly, the phenomenon is framed in individualistic terms. The medical profession on does
not primarily deal with social relations (like the law, e.g.) but with individual
pathologies. In psychoanalytical terms, for instance, the gender migrants' acts of
self-definition are transformed into a symptom which is not true or false but significant.
The statement "I am a woman" is not regarded as a sentence a speaker uses to
designate an object in the world but as a sign that reveals something interesting about
the speaker. The social conflict is transformed into an 'inner conflict'. But in genetic
terms, too, the phenomenon is located inside the gender migrant. It isn't framed in terms
of claims or style of living, but in terms of a condition which a person is forced to
suffer from. Gender migration under medical direction have become a property of
individuals, incorporated in them as a transsexual substance - be it a gender identity or
a hormonal defect.
From the perspective of society this location of the phenomenon within gender migrants is
a location outside society. So the first medical offer to society is to theoretically
'heal' the 'traumatization' of a taken for granted world of two sexes. A universe of
meaning is maintained by 'explaining' gender migrants' claims to a style of living from
The differentiating effect has its most obvious side in the standard diagnostic procedures
of selecting candidates for surgery. The psychiatric gatekeepers have to care for patients
who are good co-workers of the medical enterprise. This has two reasons: Firstly, medical
authority and reputation has been invested into gender migration and has to be regained
from a successful treatment. 'Relapses' of transsexuals would endanger the legitimacy of
medicine's involvement. Secondly, patients have to be protected from false treatment.
Doctors' responsibility and worries introduce another dichotomy into a change between the
sexes: the distinction between right and wrong treatment. Professionals' doubts about the
adequacy of treatment are translated into diagnostic distinctions between true and false
transsexuals. But there are also preclinical selection processes which turn gender
migrants into candidates for surgery. The public representation of genital surgery as a
'sex change' - propagated by journalists and, unfortunately, some surgeons as well - did
not simply stimulate a high quantitative demand for surgery. It had more of a qualitative
effect on the subtle processes of self-definition of gender migrants:
The so-called sex change operation devalued earlier forms of gender migration, which had
been labeled transvestitism, and which now appear as a mere change of clothes instead of
the 'radical' change of skin. Furthermore, the operations appeared to be upgraded by the
diagnostic controls of access to it: they look like prizes at the end of a long road of
tests. So the surgical transformation of genitals is like a challenge which differentiates
gender migrants into two camps: it either transforms the longings it claims to satisfy
into a demand for medical services - or it devalues them to a mere wish without
authenticity because it lacks medical consequence. So lot of the strong motivation doctors
encounter in their patients is mobilized by the medical treatment itself.
A second step in this involvement of medicine in the motivation for an operation happens
in psychotherapy. Again, the question of the authenticity of the claim on sex membership
is being questioned when professionals are interested in the subjective meaning of a
gender migrant's 'inner conflicts'. The psychological interest in the transsexual subject
further stimulates gender migrants to objectify their claim and to look for physical proof
in order to get rid of the question "what are the reasons for your claim".
change' as an implantation of gender identity
In terms of the social conflict gender migration starts with the
treatment of transsexuals offers a settlement to the two parties: the genital operations
on transsexuals confirm 'them' in their assertion that they really are the other sex now,
but by establishing it by a so-called 'sex change' they also prove to 'us' that they were
not the other sex before. For transsexuals, the new pieces of body are objective proof of
their gender not only because they are visibly 'there' but because anyone who denied their
objectivity would have to bear the costs of their removal, i.e. would have to argue for a
repetition of the medical interventions. So the burden of reasoning has shifted. On the
other hand, the medical treatment has tied transsexuals to staying in their new gender: in
the beginning, they were urged to 'feel' a gendered soul only as a rhetoric, suggested by
their small chances in a social conflict. At the end of a treatment, which constantly made
them feel being the other gender they are forced to have a gendered soul by the necessity
of living with the effects of medical treatment: with the stories and convictions once
uttered in psychiatry, with the habitus gained in the everyday test, and with the sexual
features produced by endocrinology and surgery. The treatment of transsexuals somehow
'buries' their claim very deeply in them, because after the irreversible alteration of
their bodies 'regret' is nothing to be confessed easily, let alone an option that could be
lived. In other words: the treatment materially constructs a gender identity as part of a
person's sex. Both, sex and gender identity, belong to the deep structure of the practices
The fact that the treatment of transsexuals is so successful to make 'relapses' a rare
public occurrence has another effect on the cultural shape of gender migration: it is
reduced to single events. The prevention of constant shifting between genders is the most
influential factor precluding a strong transsexual subculture: most gender migrants only
pass through small communities which would grow enormously without the medically organized
fluctuation (as they immediately do when gender migration is framed as 'transgenderism'
and grows up from the medical 'kindergarten').
The medicalization of gender migration framed this phenomenon into a highly contradictory
picture: Surgery, which seemed to radically surmount the anatomic boundary between the
sexes, on the other hand confirms with its genital transformations that anatomy remains
crucial. And psychiatric theories of transsexuality developed a notion of a constant,
never-changing gender identity determined early in life precisely from those persons who
actually change their gender during their life.
So in transsexuality the very axioms of our cultural assumptions about the sexes are
proved and denied: that sex membership is rooted in the body and that it is of lifelong
continuity. This picture puzzle mirrors all contradictions and irritations our culture
externalizes through its transsexual freaks. They are medical personifications of cultural
troubles. So transsexuality has cast a soft shadow on the fact that large parts of the
population of Western culture have themselves become gender migrating: in claiming
occupations, political positions, behavioral styles and sexual partners formerly reserved
for the other sex.
In political terms one can call this process 'emancipation'. In sociological terms one
better conceives of it as a continuous loss of social functions of the sexual distinction.
This has its emancipatory side, but it also has the side of lost orientations and
insecurity. In this cultural condition the medicalization of gender migration offers us
'normals' an opportunity to distinguish ourselves from those strangers. Medicine presents
us a phenomenon which characterizes our whole century as a peculiar condition, far away
from what we are. So if we feel unsure of what we mean by being a 'man' or a 'woman', we
can at least look at transsexuals and their doctors: they seem to know...
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Correspondence and requests for materials to:
University of Bielefeld
Faculty of Sociology