On Cohen-Kettenis: “Psychosocial and psychosexual aspects of disorders of sex development”

Intersex biological diversity was subsumed into the world of psychological theory as a result of John Money’s observations and beliefs, developed from the mid-1950s onward. Psychologists, psychiatrists and other “mental health professionals” have maintained a vice-like grip on intersex issues and the private lives of intersex people since that time.

Money’s duplicity in the David Reimer case has been swept aside by psychological theorists such as Peggy Cohen-Kettenis and Heino Meyer Bahlburg – recently implicated in the fetal dex controversy as an adviser to Patricia New.

Both of these individuals are also members of the DSM-V review panel tasked with rewriting the section on gender identity disorders. Meyer Bahlburg, in particular, was mentored by John Money and has arguably inherited Money’s mantle as a leading proponent of upbringing – environmental determinism – as the most important influence on psychosexual formation. Cohen-Kettenis is the chairperson and team leader.

The dominance of psychologists has resulted in an extraordinarily tunnel-visioned and one-dimensional understanding of intersex issues.

That should not be surprising. The profession brings a view of the subject predominately perceived through the ethnocentric prism of middle class European values and beliefs that have intermittently denied the very existence of intersex bodies for centuries. The desire to “convert” biological diversity into a psychosocial issue and deal with it on that basis is an almost inexorable by-product of that denial.

Cohen-Kettenis gives an almost perfect demonstration of this “conversion” when she claims that…

… a variety of medical and psychosocial factors may jeopardise the psychological development of children with DSDs. This sometimes results in the desire to change gender later in life.

Cohen-Kettenis is well aware of the difference between sex and gender. The issue she side-steps is that gender change is often the easiest problem misassigned intersex have to deal with. It is loss of physical and genital integrity, coupled with the theft of personal autonomy, opportunity and genital sensation, the physiological “sex” issues, that can cause the greatest distress.

From its outset psychological “gender” theory has been the device favoured by psychologists and medical practitioners in their endeavor to tame and manage the wayward bodies and potentially unacceptable sexualities of intersex lives.

See: http://igitur-archive.library.uu.nl/dissertations/2010-0517-200233/eckert.pdf

It was in psychological research at the Johns Hopkins University in Baltimore, USA, that the gender-concept was invented… experts construed “intersexuality” as a psychopathology in need of treatment during infancy, even though their samples demonstrated that.. there was no problem before the researchers intervened.

Now the apparent decision to doubly pathologize intersex adolescents and adults who reject the pediatric gender assignment imposed on them as babies by including them in the DSM-V under the new diagnosis of “gender incongruence” takes the situation from the sublime to the ridiculous.

If this remarkable act of illogic were carried to its inevitable conclusion then David Reimer would have been served up with this diagnosis for rejecting Money’s attempt to impose a female identity on him.

See: http://www.hawaii.edu/PCSS/biblio/articles/1961to1999/1997-sex-reassignment.html

But in this a one-sided discourse. Reimer was as biologically male as it is humanly possible to be.

In the same vein the manipulated identities imposed on some intersex babies are not perceived as disordered, despite their being predominately biologically male or female – all that is required for psychological legitimacy is total acceptance of the identity imposed externally by others.

So… “disordered” is only applicable when and if the identity acceptable to the psychological gender theorists is not realized.

Finally it should go without saying that Reimer’s rejection of an imposed female identity would not have occurred were it not for the concerted attempt to impose it in the first place. But that same argument applies every time an intersex adolescent or adult rejects the attempt to impose a controlled identity – be it male, female, or for that matter religious or political.

The attempt at imposition must always come before the rejection. Any proposition to the contrary merely demonstrates both the intensely disordered nature of psychological theory and the lack of any willingness to accept responsibility when those theories fail to materialize in a desired result.
Clinical Endocrinology & Metabolism: Psychosocial and psychosexual aspects of disorders of sex development


Clinical Endocrinology & Metabolism


P.T. Cohen-Kettenis


Department of Medical Psychology, VU University, PO Box 7057, 1007 MB Amsterdam, The Netherlands


Psychosocial aspects of the treatment of disorders of sex development (DSDs) concern gender assignment, information management and communication, timing of medical interventions, consequences of surgery, and sexuality. Although outcome is often satisfactory, a variety of medical and psychosocial factors may jeopardise the psychological development of children with DSDs. This sometimes results in the desire to change gender later in life. The clinical management of gender dysphoria in individuals with DSD may profit from methods and insights that have been developed for gender dysphoric individuals without DSD. In DSD care, clinical decisions are often made with long-lasting effects on quality of life and should be based on empirical evidence. Yet, such evidence (e.g., regarding gender assignment, information management and timing of surgery) is largely non-existent. DSD-specific protocols and educational materials need to be developed to standardise and evaluate interventions in order to facilitate decision making of professionals and individuals with DSD and enhance psychosocial care in this area.

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