Every Book Leads Me Down a Rabbit Hole

[Note: The author assumes a detailed knowledge of the central topic of the chapter, Herculine Barbin. To contextualize the material, here is some background, based largely on Wikipedia. Barbin was classified as female at birth and was educated at a convent school. There she fell in love with a fellow female student, then later with a fellow female teacher. Severe abdominal pain led her to a series of medical examinations, which identified anomalies in her anatomy.]

The literary style of the memoirs of Herculine Barbin is compared to fictional representations of hermaphrodites. Barbin offers what may be the only firsthand account from a 19th century intersex person. Indeed their memoirs were sometimes treated as fictional, plagiarized for other authors fictions, and appropriated for inclusion in medical reports.

This chapter looks at the purposes and conclusions of medical investigations of intersex people, and how those conclusions relate to the idea that all people have a “true sex.” Doctors came down on both sides of the question, as well as disagreeing about methods of sex determination.

Barbin was born in 1838 and recorded (as required by law) as female. In Barbin’s own writings both female and male gendered forms are used, predominantly female before the medical examinations that resulted in a change of legal sex, and mixed male and female afterward. This distinction is largely erased in English translations, and even the original French must be treated with caution as it survives only in excerpted form, as the original manuscript was lost.

Barbin’s legal sex change was done in 1860 (so when they were about 22). But having been required to change legal sex and start a new life, Barbin struggled to rebuild their life, fell into poverty, and committed suicide in 1868. All of which was recorded in their memoirs.

Barbin predicted that their death would renew medical interest in their case. The excerpted version of their memoirs was published in 1872 by Ambroise Tardieu as part of a study of sexual variation. A century later, Foucault would claim to “rediscover” the memoirs, and assert that they had not previously received much interest. (Not true.) Discussions of Barbin’s life generally pointed to their suicide as a consequence of their erroneous sex assignment at birth (rather than a consequence of the disruption of their life by the imposed sex reassignment in adulthood which Barbin alludes to).

Central to Barbin’s life was the importance of story to understanding and shaping identity. Barbin was well read, and one can’t find various literary influences in the memoirs.

The excerpts in Tardieu’s edition were edited and appropriated for an erotic novel L’hermaphrodite au couvent in 1905 written under a transparent pseudonym by a man who also wrote a medical study of hermaphrodism. The novel also draws on the tradition of convent-set erotica, offering sexual encounters that appear nowhere in the memoirs. Appended to the novel were various case studies, with the purpose of validating the believability of the events in the story. Both the novel and Tardieu’s commentary on the memoirs justify Barbin’s (or the fictional character’s) erotic desire for women as being due to an essential male nature.

Barbin had sought medical treatment due to abdominal pain, thought to be menstrual cramps, but the initial doctor, having observed Barbin’s ambiguous anatomy, made no direct diagnosis, only vague cautions about socializing with young girls. It was Tardieu who diagnosed the pain as due to “strangulation of the seminal gland” internally. Much of the anxiety expressed around “incorrect” sex assignment involved the possibility of a covertly male person having access to young women, with the assumed result of sexual activity.

Medical reports investigating cases of “doubtful sex” were often written in dramatic style: opening with a mystery, maintaining suspense, dropping hints, then finally offering a conclusion. The initial “mystery” could include failure to conform to gender stereotypes, as well as more concrete medical issues. The failure to perform perfect femininity was considered a symptom of inner maleness, and vice versa (although the former seems more common). The belief in this underlying “true sex,” combined with heteronormativity shaped pre-formed conclusions about the proper fate of intersex patients. It’s worth noting that Barbin’s memoirs came to no such conclusion about the underlying cause of their attraction to women.

One school of medical thought held that “true sex” depended entirely on the nature of the gonads present. Superficial anatomy, secondary sex characteristics, socialization, and self identity were irrelevant. In Foucault’s study of the subject he claims that, before this “true sex” approach in the 19th century, intersex people were free to choose their gender category—a claim that’s easily contradicted. Further, even once gonadal “true sex” became the dominant approach, doctors disagreed over individual cases, sometimes modifying their conclusions to achieve the happiest situation for the patient. An example is given of two different scholarly analysis of the same historic case. One held that the diagnosis supported a “gonad-based true sex” approach, while the other showed that the tests used by the doctors produced variable conclusions as to what that “true sex” was.

When standard approaches produced contradictions (or pointed to the necessity of recognizing same-sex desire) then literary techniques might be brought to bear to achieve the desired harmonious result. The desire for identifying a “true sex” and it’s intersection with sexuality contributed to the medicalization of sexuality in the 19th century. It was one more factor that must be brought into alignment to support a complete separation of sex categories.

Louise-Julie-Anna—a patient with conflicting attributes—was told that “her very existence was criminal.” This was based in part on a diagnosis of masculinity due to her failure to perform acceptable femaleness, despite having been categorized as female and living as a woman. Whereupon she sought a second opinion. The first doctor had diagnosed her as a deceptive man. The second doctor, noting both male and female anatomy, while concluding she was a man, noted the evidence for her female self-identification and used feminine language for her. He noted that she had had sexual relations with men (and only men) and exhibited feminine “modesty.” Thus both doctors brought heteronormative gender stereotypes to bear on the question, with opposing conclusions, despite agreeing on the question of gonadal sex.

The original trigger for her examination was a combination of excess facial hair, an organ intermediate in size between a clitoris and penis, and a hernia resulting in a strangulated organ, identified by the original two doctors as an undescended testicle. The pain from this condition had not been addressed by the initial examinations, but she convinced a third doctor to surgically remove the organ, at which point it was declared to be an ovary, not a testicle, though the surgeon later walked this back. In the meantime, the patient reframed her story to seek support for removing the corresponding organ. This evidently raised some concerns as castration was illegal (presumably removing the strangulated organ was a special case), whereas presumably removing an ovary raised no similar concerns. (It isn’t clear from the text what the eventual outcome was.)

Medical debates over “true sex” also addressed the question of whether a “true hermaphrodite”—that is, a person with both functional ovaries and functional testes—was possible. The debate was largely conducted on the basis of theory and of supporting the integrity of previous diagnoses. (There’s an extensive discussion of the details of this debate.) The debate also challenged the French legal requirement for sex categorization within three days of birth, noting that diagnostic features such as menstruation and secondary sex characteristics might not be apparent until puberty.

(There is an extensive discussion of the timeline for theories about “true sex” versus “two hermaphroditism.” The two approaches are found to coexist throughout most of the 19th century.)