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Washington Post Editorial
Japan's Future -- and Past
The new prime minister must be honest about history.
Monday, September 25, 2006; A20
IN ITS LONG march from military catastrophe to heavyweight status, postwar Japan has oscillated between two kinds of error. Its left wing has been honest about the past but irresponsible about the present: It has shown remorse for atrocities committed by Japanese troops in East Asia in the 1930s and 1940s but has been reluctant to see Japan emerge from its pacifist shell and contribute to international security. Meanwhile, the right has made the opposite mistake: It has pushed for Japan to take more responsibility for defense but has glossed over Japan's war guilt. Since becoming prime minister in 2001, Junichiro Koizumi has tended to make the right-wing mistake. His newly chosen successor, Shinzo Abe, threatens to do the same -- but more dramatically.
Mr. Koizumi came to power after a period in which demonstrators called for the removal of American troops from Japanese soil and the value of an alliance forged during the Cold War was widely questioned. He acted decisively to reinforce U.S.-Japanese ties, participating in the Bush administration's missile defense program, sending noncombat troops to Iraq despite Japan's pacifist constitution and taking a tougher line on North Korea than Japan had ventured previously. This pro-American instinct was Mr. Koizumi's good side. But the prime minister also insisted on visiting the Yasukuni shrine commemorating Japan's war dead, including its war criminals, and during his tenure some government-approved textbooks whitewashed Japan's war record. This unnecessarily inflamed anti-Japanese sentiment in China and other neighboring countries.
Mr. Abe promises an extreme version of this formula. He seems likely to dilute Japan's pacifism further: As he correctly says, it is wrong that a Japanese warship cannot come to the aid of a U.S. one attacked by a third country. He will be tougher on North Korea, too, having built his public career on denouncing Pyongyang's dictator. But Mr. Abe has also gone further than Mr. Koizumi in glossing over the past. He has questioned the legitimacy of the Tokyo trials that condemned Japan's wartime leaders. He has not endorsed the apology that Japan's government issued on the 50th anniversary of its surrender.
Mr. Abe sees political advantage in asserting Japan's pride. His grandfather was part of Japan's wartime leadership, so there may be a personal angle to his view of history. But he needs to recognize that forthright policies in the present must be underpinned by forthright honesty about the past. If Japan admits past errors, it will gain acceptance as the responsible democracy that it is, and its muscular foreign policy will be treated as legitimate. But if it professes to see nothing wrong in its own record -- including episodes such as the massacre of at least 100,000 Chinese in Nanjing -- its efforts to assert itself on security and diplomatic questions will raise tensions with neighbors, undermining regional security rather than contributing to it.
Evangelical voters more jaded in 2006
By ROSE FRENCH, Associated Press Writer
Fri Sep 22, 7:32 AM ET
Christian conservatives, traditionally a reliable Republican constituency, aren't necessarily a GOP gimme this time around. There is an undercurrent of concern that some evangelicals, unhappy that the GOP-led Congress and President Bush haven't paid more attention to gay marriage and other "values" issues, may stay home on Election Day or even vote Democratic.
"Conservative Christians are somewhat disenchanted with Republicans," said Kenyn Cureton, vice president for convention relations with the executive committee of the Southern Baptist Convention, the nation's largest Protestant denomination with nearly 16 million members.
Religious conservatives are unhappy the Republican-led Congress hasn't paid enough attention to "values issues," he said, noting that even a push this summer against same-sex marriage came too late.
"It has not escaped our notice that they waited until just a few months from the November elections to address our agenda," Cureton said.
Jonathan Gregory, 38, a deacon at Grace Baptist Church in Bethpage, Tenn., said he may not vote GOP this fall, even though he considers himself a Republican and has voted for President Bush.
"I will vote conservative across the board, depending on the candidates' stance on abortion, gay marriage and their support of the military," Gregory said.
Voters like Gregory were once considered the president's strongest supporters. Exit polls showed 78 percent of white evangelicals voted for him in 2004. But an Associated Press-Ipsos poll conducted Sept. 11-13 indicated 42 percent of white evangelicals disapprove of the job Bush has done as president.
His approval rating among evangelicals is still better than he gets among Americans generally, but the poll shows Democrats have made slight gains among moderate white evangelical voters.
Conservative Christian groups have started trying to mobilize evangelical voters this fall by focusing on issues such as gay marriage and abortion. A "Values Voters" summit that has attracted several potential 2008 presidential candidates gets under way Friday in Washington.
The Colorado-based Focus on the Family has started voter registration drives in eight states, according to the group's Web site. The Southern Baptist Convention is helping promote a Focus on the Family DVD about gay marriage.
The DVD and booklet about gay marriage entitled "Why Not Gay Marriage?" aims to "equip Christians with answers to some of the most often asked questions in the gay marriage debate."
Neither group is endorsing candidates, which they're not allowed to do because of their tax-exempt status, but they are encouraging Christians to vote on "values issues," Cureton said.
The nearly 70-minute Focus on the Family DVD gives answers to 10 questions, such as "How will my same-sex marriage hurt your marriage?" and "Is it healthy to subject children to experimental families?"
David Masci, senior research fellow at the Pew Forum on Religion and Public Life, said gay marriage is approaching abortion in terms of the weight it's given among conservative Christians.
"This issue (gay marriage) has become important enough for them that they want people to be conversant in it," he said. "It's a battle being fought on so many fronts."
In November, eight states will have referendums on state constitutional amendments banning same-sex marriage: Arizona, Colorado, Idaho, South Carolina, South Dakota, Tennessee, Virginia and Wisconsin.
Focus on the Family, founded by Christian radio host James Dobson, is seeking church and county coordinators in at least one of those states — Tennessee.
Other states the group is targeting include Maryland, Michigan, Minnesota, Montana, New Jersey, Pennsylvania and Ohio, according to a news release posted on the group's Web site last month.
Church coordinator duties include "encouraging pastors to speak about Christian citizenship, conducting a voter registration drive, distributing voter guides and get-out-the-vote efforts." County coordinators recruit "key evangelical churches, friends and family and supporting church coordinators with periodic phone calls."
Southern Baptists created the iVoteValues initiative in 2004 to increase evangelical Christian voter registration, education and mobilization, Cureton said. Several groups participated in the movement, including Focus on the Family and the Family Research Council.
Those efforts are continuing this year, with churches holding nonpartisan voter registration drives and pastors encouraged to preach on "values issues," particularly since conservative Christians may be disillusioned this time around, Cureton said.
Harry Knox, director of the religion and faith program at the Human Rights Campaign, the nation's largest gay rights group, said religious progressives are beginning to speak out on gay marriage and other issues.
He said, for example, that the Human Rights Campaign recently launched its "Out In Scripture," a free weekly online resource to help clergy in planning their sermons and spiritual discussion groups.
"People on our side of the conversation, who have been silent for a long time, are tired of being silent," Knox said.
On the Net:
Focus on the Family: http://www.family.org/
Southern Baptist Convention: http://www.sbc.net/
Human Rights Campaign: http://www.hrc.org/
The New York Times Magazine
WHAT IF IT'S (SORT OT) A BOY AND (SORT OF) A GIRL?
Written by ELIZABETH WEIL
Sunday, 24 September 2006
When Brian Sullivan — the baby who would before age 2 become Bonnie Sullivan and 36 years later become Cheryl Chase — was born in New Jersey on Aug. 14, 1956, doctors kept his mother, a Catholic housewife, sedated for three days until they could decide what to tell her. Sullivan was born with ambiguous genitals, or as Chase now describes them, with genitals that looked “like a little parkerhouse roll with a cleft in the middle and a little nubbin forward.”
Sullivan lived as a boy for 18 months, until doctors at olumbia-Presbyterian Medical Center in Manhattan performed exploratory surgery, found a uterus and ovotestes (gonads containing both ovarian and testicular tissue) and told the Sullivans they’d made a mistake: Brian, a true hermaphrodite in the medical terminology of the day, was actually a girl. Brian was renamed Bonnie, her “nubbin” (which was either a small penis or a large clitoris) was entirely removed and doctors counseled the family to throw away all pictures of Brian, move to a new town and get on with their lives. The Sullivans did that as best they could. They eventually relocated, had three more children and didn’t speak of the circumstances around their eldest child’s birth for many years. As Chase told me recently, “The doctors promised my parents if they did that” — shielded her from her medical history — “that I’d grow up normal, happy, heterosexual and give them grandchildren.”
Sullivan spent most of her childhood and young-adult life extremely unhappy, feeling different from her peers though unsure how. Around age 10, her parents told her that she had had an operation to remove a very large clitoris. They didn’t tell her what a clitoris was but said that now things were fine. At 19, filled with rage and feeling suicidal, she started trying to access her medical records and finally succeeded when she was 22. As a means of recovery, she threw herself into her work. She graduated from M.I.T. with a degree in math and then went on to study Japanese at Harvard. Soon after, she moved to Japan and helped found a successful tech company, assuming she’d work really hard for now and be happy later. At 35, realizing that being happy later was not going to happen, she flew to Florida with a list of questions to ask her mother, to whom she was never close. According to Chase’s notes from that conversation (both of her parents have since died), her mother maintained that the clitoridectomy had not impacted her daughter’s life. “When you came home,” Cathleen Sullivan told Chase about her return from the hospital after surgery, “there seemed to be no effect at all. Oh, yes, wait a minute. Yes, there was one thing. You stopped speaking. I guess you didn’t speak for about six months. Then one day you started talking again. You had known quite a lot of words at 17 months, but you forgot them all.”
After that conversation, Chase, an extremely ambitious, focused and analytical individual, decided it was time to heal herself, and she gave herself a year. As part of that project, she moved to San Francisco and started calling and writing to doctors, academics and gender activists — anybody who might have something concrete to say about the predicament of being born part male, part female, or who might be able to tell her why it had been necessary to have her clitoris removed and if she’d be able to get any sexual function back. Along the way, in 1993, Sullivan called Anne Fausto-Sterling, a professor of biology and gender studies at Brown, who had published several papers on intersex (the term that has come to replace “hermaphrodite”) and who was about to publish an article in a magazine called The Sciences. Sullivan wrote a letter that was published in the next issue calling for people with intersex conditions to get in touch with her, and she signed it Cheryl Chase, the Intersex Society of North America, though neither a person named Cheryl Chase nor an organization called the Intersex Society of North America yet existed.
Thirteen years later, Chase, as Sullivan began calling herself, is now known throughout the urology and endocrinology establishment as a passionate advocate for the rights of those born with ambiguous genitals, and she has succeeded in stirring a contentious debate among those doctors over how intersex babies should be treated. At the heart of the controversy is the question of whether intersex children should have surgery to make their genitals look more normal. Chase has talked to thousands of doctors and others in the medical profession, making the case that being born intersex should not be treated as shameful and require early surgery. In doing so, she has assembled an impressive intellectual arsenal, drawing on everything from the Nuremberg Code and its prohibition against experimental medical procedures without patient consent to the concept of “monster ethics” — the idea that we perform questionable medical procedures on certain patients, like intersex people and conjoined twins, when we consider those patients to be less than human. Reports on the frequency of intersex births vary widely: Chase claims 1 in 2,000; more conservative estimates from experts put it at 1 in 4,500. Whatever the case, intersex is roughly as common as cystic fibrosis, and while the outcome of the debate Chase has stirred is directly pertinent to a limited number of families, her arguments force all of us to confront some basic issues about sexual identity, birth anomalies and what rights parents have in physically shaping their kids. Will a child grow up to enjoy a better life if he or she is saved from the trials of maturing in a funny-looking body? Or will that child be better off if he or she is loved and accepted, at least at home, exactly as he or she is?
The old protocol for dealing with an intersex birth, the protocol Chase was subjected to as a child, was based on the belief that children should be saved from the anguish of looking weird, or of even knowing they were born looking weird. This would come to be known as the “optimal gender of rearing” protocol and was put forth by John Money, a psychologist who in 1965 founded the Johns Hopkins Gender Identity Clinic, which specializes in transgender surgery. Money’s protocol guided doctors to perform genital surgery on intersex babies and then discourage families from discussing the child’s ambiguity, for fear that the child would grow up questioning his or her sexual identity.
This protocol held for 40 years, until Chase began agitating against it in the mid-1990’s. For a dozen years, she chipped away at its logical underpinnings, and last month Money’s protocol officially fell. The journal Pediatrics published a paper signed by 50 international experts, primarily doctors but including Chase, titled “Consensus Statement on the Management of Intersex Disorders.” The consensus promotes the traditional idea that every child should be assigned a gender as soon as possible after birth, and that this should be done by doctors examining the baby’s genes, hormones, genitalia, internal organs (via ultrasound), electrolytes, gonads and urine. These doctors then make their best guess as to whether that child will want to live his or her adult life as a man or a woman. Where the consensus departs from tradition is that it also instructs doctors to discourage families from rushing into surgery. The paper is a bit vague on this point; it doesn’t directly tell doctors not to operate but does state that no good scientific studies prove infant cosmetic genital surgery improves quality of life.
Chase says she believes that every child should be assigned a gender at birth but that the assignment should not be “surgically reinforced” and that parents and doctors should remain open to the idea that they may have assigned the wrong sex. She contends that the most important thing is for a child to feel loved by her parents, despite her difference. An operation, she says, should not be done to assuage parental embarrassment or anxiety; it should be chosen, if it is chosen at all, by an intersex individual who is old enough to make her own decision and give proper consent.
The consensus is a major victory for Chase. Yet making progress from here may prove extremely difficult. Chase now must take her arguments not just to medical professionals but also to parents of intersex children, almost all of whom will be feeling intensely stressed and almost none of whom will have considered the complexity of raising an intersex child. One doctor, who didn’t want to be named, put her chances of persuading parents not to choose surgery for their intersex children at “honestly, zero.” From the parents’ perspective, the argument for surgery is almost impervious to reason. As one mother of an intersex girl wrote on a message board: “How can anyone possibly think that a child can grow up and feel confident of her sexuality looking down at her genitals that look like a penis? Come on.”
One day last spring, Chase traveled from her home in Sonoma County, Calif., to Chicago to tell her story to a group of genetic counselors and to distribute the Intersex Society’s latest handbooks, one for medical professionals and one for parents. On this morning, Chase, who is 50, has short white hair, fashionable glasses, intelligent eyes and a strong build, was wearing a wide-necked sweater meant to fall off her shoulders, exposing a black bra. She lives as a woman and as a lesbian, and while she imagines she doesn’t look or feel exactly as other women do — for instance, she can’t find any gloves made for women that fit — she has no desire to be a man.
Chase had been invited to speak by Rebecca Burr, a genetic counselor who several years ago found herself dealing with a 26-year-old woman who’d never menstruated, knew she’d had multiple operations as a child but didn’t know that she was intersex. Burr felt ill prepared to handle the case and tracked down the Intersex Society. In Chicago, Chase stood in front of 30 members of the Genetic Task Force of Illinois, telling them about the parkerhouse roll, the trashing of her baby pictures, the hospital stay at age 8, when she was told doctors would be helping her stomachaches but when she really had the testicular part of her gonads removed.
When Chase began her activism, more than a decade ago, few doctors were open to her ideas about the way intersex babies should be treated. “When I first started doing this, it took some extreme kinds of conversation to get people to listen up,” she told me. She also organized a picket of a pediatric convention; she sneaked into medical conferences and buttonholed attendees. In 2000, however, the esteemed Lawson Wilkins Pediatric Endocrine Society finally invited her to speak, and since then Chase’s technique has evolved. She now receives and solicits speaking engagements from groups of all kinds. She addresses nurses’ associations, doctors, medical students, anybody who will listen.
Among the Intersex Society’s primary goals is ending the shame and secrecy surrounding being intersex, and toward that end, upon founding the society in 1996, Chase organized an intersex retreat. She wanted to help people, herself included, become more comfortable speaking openly about their condition. So she invited the 62 intersex people she had made contact with for a weekend at her farm in Sonoma. Eleven came. Chase made a raw and moving documentary of their time together, titled “Hermaphrodites Speak!” Ten people directly address the camera. Nine tell stories of surgery and lives nearly wrecked. One man refers to himself as a monster. Another says she’s “damaged goods.” One person, however, did not have an operation, and she alone looks fit and confident, sitting with great posture and seeming at home in her body. She grew up in a Catholic family, and when she first saw another naked woman up close, at age 12, her initial thought was, What’s wrong with her? She modeled her sexuality on Grace Jones and David Bowie. Her story, though just one account, is consistent with the findings of Sarah Creighton and Catherine Minto, two London gynecologists. The two have reported, albeit with small samples, that genital surgery is likely to have a negative impact on sexual function and quality of life.
What if it's (sort of) a boy and (sort of) a girl? 1/2
In the last several years, the Intersex Society has formed an active speakers’ bureau, and at Cook County Hospital in Chicago, after Chase addressed the genetic counselors, a young woman stood up to speak. A 20-year-old DePaul student, she was very pretty, in a chunky necklace, floral shirt and hiphugger jeans. “I found out last year I was intersex; I was in my freshman women’s studies class,” the young woman, who asked not to be identified in this article, said. Her professor was lecturing about various intersex conditions and started describing the symptoms — “No periods, can’t have children, ambiguous genitals. I called my mom, and I said: ‘What’s it called? What do I have?’ ” It turned out she has partial-androgen-insensitivity syndrome, a phenomenon in which fetuses with male chromosomes (XY) can’t properly metabolize male hormones and are born looking mostly like girls. “When she said the name I threw the phone across the room and started crying. I cried for like a week.”
A few weeks after hearing this news, at the urging of Lynnell Stephani Long, a member of society’s speakers’ bureau who happened to be giving a talk around that time to the women’s studies class, the young woman retrieved her medical records from Chicago Children’s Hospital. “They photocopied them for me and I got them hot,” she told the group of counselors. “The first page said ‘pseudo male hermaphrodite.’ Just the words ‘male’ and ‘hermaphrodite’ made me want to throw up.” Chase has since lobbied doctors to stop using the word “hermaphrodite.” Intersex, she contends, is a medical condition, not an identity, and the consensus suggests using the term “disorders of sex development.”
The young woman continued speaking, her story raw and captivating. “I grew up a girl. I was always a tomboy, I wrestled, I played softball. I had bladder problems when I was a kid, and when I went in to have my urethra fixed” — at age 3 — “they decided to give me a vaginoplasty and also a clitoridectomy,” that is, surgically reshape the vagina and reduce the size of her clitoris. “When I finally learned all this, I spent a lot of time staring in the mirror” — she pressed her hands flat against her cheeks and stretched her skin of her face back toward her ears — “going: ‘Do I look like a boy? Do I look like a boy?’ Now I think being intersex is pretty weird but kind of sweet. I just wish someone had given me the tools to be able to talk about it.”
Chase’s position — that cosmetic genital operations on intersex children should be stopped and that children should be made to feel loved and accepted in their unusual bodies — is still considered radical. Most people believe, reflexively, that irregular-looking genitals would be extremely difficult to live with — for a child on a sports team, for an adult seeking love and sex — so why not try to make them look more normal? Katrina Karkazis, a medical anthropologist at the Center for Biomedical Ethics at Stanford, interviewed 19 clinicians and researchers of various specialties who treat intersex individuals, 15 intersex adults and 15 parents of intersex children, and she found that a majority of the doctors and parents felt surgery was a good idea. “We chose surgery for my daughter mainly because we did not want her to grow up questioning her sexual identity,” one mother explained about her baby, who was born with congenital adrenal hyperplasia, a genetic defect of the adrenal glands that causes girls’ genitals to appear masculinized at birth. “We felt that she should look like a female, so we chose the clitoroplasty and the vaginoplasty. We felt that she would have a better self-image if she did not have a ‘phallic structure’ and ‘scrotum.’ ”
Within the medical community, Chase has been successful in tempering the explicitness with which people publicly make this argument. As Chase has explained innumerable times, intersex babies are not having difficulty with sexual identity or self-image. The parents are, and parental anxiety about the appearance of a child’s genitals should be treated with counseling, not with surgery to the child. When I met Melvin Grumbach, one of the doctors who cared for Chase as an infant and who went on to become one of the most respected pediatric endocrinologists in the country, he’d clearly heard Chase’s line of reasoning many times. He participated in forming the consensus, and he also signed it. He knew what he was supposed to say. “We say, ‘Don’t do surgery unless it’s necessary, unless it’s important,’ ” he told me in early summer in his office at the University of California in San Francisco, where he’s now an emeritus professor. “But I think if the external genitals are really masculinized, you work it out with the family. I mean, good grief. What about the parents? The parents are raising the child. Don’t they have some say?”
A debate has emerged in recent years concerning if and when parents and doctors should medically shape children. Should very short children be treated with growth hormone and surgery? Should children have multiple cosmetic operations to try to erase all traces of a cleft lip? In these instances, no studies have shown that these medical interventions improve children’s quality of life. The same is true for operations on intersex children, though in truth, few well-controlled studies exist that prove much of anything, in part because the success of these treatments cannot be meaningfully assessed for at least 20 years, and by then most patients are lost to follow-up.
Among the arguments against genital surgery is the fact that sexual identity does not derive solely, or perhaps even primarily, from a person’s genitals. As Eric Vilain, professor of human genetics, pediatrics and urology at U.C.L.A., has shown, many genetic markers go into making a person male or female, and those markers affect many parts of the body. In studies of mice, he has found 54 genes that work differently in male and female brains just 10 days after conception. In humans, we’ve all been taught, and we’d like to believe, that being male or female is as a simple as having XY or XX chromosomes, but it is not. Even the International Olympic Committee acknowledged this when it suspended its practice of mandatory chromosomal testing for female athletes in 2000, reflecting current medical understanding that a female who tests positive for a Y chromosome can still be a woman. (Chase is XX, and the reason for her intersex condition has never been fully understood.)
Vilain has a clinic devoted to treating disorders of sex development, where he sees 40 to 50 new intersex patients a year. When he first left the lab and started seeing patients, he said he couldn’t believe that surgeons were performing genital reconstructions with so little data. “To me it was shocking, because where I come from, molecular genetics, we’re under extreme scrutiny,” Vilain told me on the phone in July. “If you want to show that a molecule causes something, you have to show it with a bunch of excruciatingly painful controls. And here I was looking at a lot of surgeons who were saying, ‘We think it’s good to do genital surgery early on because the children are doing better.’ So each time I would ask, ‘What’s the evidence that they’re doing better?’ And in fact the answer is there’s no real evidence. Then I’d ask: ‘What does it mean doing better? How do you measure it? Are you talking quality of life, or quality of sex life?’ And there was never any convincing answer.”
Other surgeons contend that not intervening presents its own risks. “There haven’t been any studies that would support doing nothing,” says Larry Baskin, Grumbach’s protégé and current chief of pediatric urology at the University of California, San Francisco. “That would be an experiment: don’t do anything and see what happens when the kid’s a teenager. That could be good, and that could also be worse than trying some intervention.” In Baskin’s view, being intersex is a congenital anomaly that deserves to be corrected like any other. “If you have a child born with a cleft lip or cleft palate or an extra digit or a webbed neck, I don’t know any family that wouldn’t want that repaired,” he told me. “Who would say, ‘You know what, let’s wait until Johnny is 20 years old and let him decide’? You probably get those fund-raising postcards from the Smile Train all the time. I can’t send those out, because you can’t put pictures of penises on postcards. But if you could, I think I’d be able to raise a lot of money.”
Still, Baskin acknowledges that intersex is different: genital surgery has the potential to diminish sexual function, and how do parents weigh that risk? Doubtless, surgical techniques have improved since Chase’s clitoridectomy — Baskin describes the old operations as being “like bloodletting,” when doctors were only able to excise the clitoris, not try and reduce it. Now, he says, “We have a pretty good handle on where all the nerves are.” But whom are these operations serving? Do parents have a right to take chances with a child’s future sexual function? And are we more willing to risk the sexual futures of intersex kids? The vast majority of adults — parents and doctors included — find intersex bodies, especially sexualized intersex bodies, unsettling. Karkazis, the medical anthropologist, heard from clinicians she interviewed of numerous cases of parents who initially decided against surgery but changed their minds when their children started to explore their own sex organs, often around the age of 2. “Masturbation in little girls with clitoromegaly” — abnormal enlargement of the clitoris — “is a situation I’ve encountered quite a few times, and that’s actually pushed many parents toward surgical intervention,” one doctor told Karkazis. “The little girl was masturbating, and the parents just fell apart and were back in the office the next week for surgery.”
Chase says that her own mother’s discomfort with and ignorance about sexuality contributed to the decision to have Chase’s clitoris amputated. When Chase flew from Japan to Florida to discuss her childhood with her mother, she also quizzed her mother about sex. “No, I don’t know what human genitals look like, exactly,” Chase’s mother told her. “I have never looked at myself, and I never looked closely at my children. The doctor said your clitoris had to go. Mine never meant anything to me, so I didn’t think it was wrong to remove yours.”
Chase claims she wasn’t even a social human being before age 35, when she started trying to recover from being “extremely pathologically shy and withdrawn.” She has built her personality alongside her activism, both growing steadily more refined over the years. As we traveled from Chicago to New Jersey, where Chase was to address the New Jersey Psychological Association, she told me she was working very hard on presenting herself as “extremely moderate.”
To do this, Chase has been honing her arguments about who has the right to do what to other people’s bodies. Those arguments first took shape in 1998, when Chase wrote an amicus brief to the constitutional court of the country of Colombia. At the time, Colombia was considering the ethical and human rights implications of genital surgery, as it pertained to a case of a 6-year-old boy with a micropenis and the question of whether his penis should be reduced to the size of a clitoris, his testes removed and a vagina constructed out of a piece of his ileum. Medical convention has traditionally held that the phallic structure must be at least 2.5 centimeters long on baby boys and shorter than 1 centimeter for girls. And since it’s easier to surgically construct a vagina than to make a penis, children with anatomies that fell in the middle were almost always raised as girls.
Building on work on the Colombia case, in 2004, Chase and the Intersex Society were involved in persuading the San Francisco Human Rights Commission to hold a hearing and address the question of medical procedures on intersex infants in the United States. Over the course of three hours, dozens of intersex people and parents of intersex people testified. When it came time to ratify the report, Chase addressed the commission. “What the Human Rights Commission has done. . .is to recognize me as a human being,” she said. “You’ve stated. . .that just because I was born looking in a way that bothered other people doesn’t mean that I should be excluded from human rights protections that are afforded to other people.”
This is the one time Chase was seen crying in public. “She lost it crying, and I thought, What a perfect time to lose it,” Chase’s friend Alice Dreger, a bioethicist and medical historian at Northwestern University who writes about intersex and conjoined twins, told me. “I’ve never seen her cry in public since. She’s damaged in a way that she doesn’t get very emotional.”
One of Chase’s closest allies is William Reiner, a University of Oklahoma urologist who retrained as a child psychiatrist to better understand his intersex patients. Reiner, like Chase, says he thinks that a child transitioning from his or her initially assigned gender to the opposite gender should not necessarily be viewed as a medical failure. A baby who was born with a penis-size clitoris who had that penis removed and a vagina constructed out of a piece of her intestine but who ended up wanting to live as a man — that’s a failure. Yet transitioning from one sex to another, says Reiner, is something a child can often handle. Transitioning, Reiner maintains, is much more difficult for parents than for children, because parents have large and complex psychological and social landscapes, while children have relatively small and simple ones. Reiner told me about a family he worked with in which a mother told her 7-year-old daughter that she was actually born a boy. “And within an hour the child had chosen a boy name and announced he was a boy.” Reiner continued: “The youngest child that I’ve had that spontaneously changed sexes was 4ð. This was one of the most assertive human beings I’ve met in my life. She cut off all of her hair one afternoon while Mom was at work.” When asked to explain, the child said proudly, “Mom, I’ve been telling you: I’m a boy, and boys have short hair, so I cut off my hair.”
Over the same period that the Intersex Society became effective, Chase’s personal life bloomed. Chase married Robin Mathias, her partner of five years, in 2004, when gay marriage was legal in San Francisco, and the two live on a hobby farm in Sonoma. In recent years, Chase has also made some important professional connections, like David Sandberg, a psychologist at the University of Michigan whose work has been instrumental in raising questions about treating children with very short stature with growth hormone and who has now turned his attention to intersex. Sandberg joined Chase for her presentation to the New Jersey Psychological Association, and afterward they talked late into the night. Both Chase and Sandberg say that the first few days of an intersex child’s life can set a tone within a family that persists for many years. Both say that medical professionals, right from the start, should behave as they would with any healthy baby and encourage parents to do the same — name the child, fall in love and bond. “If we don’t care for the parents early on,” Sandberg said as we all sat around Chase’s hotel room, “we might lose the battles in terms of creating circumstances for a happy life for this child, and perhaps sacrifice the quality of life for siblings too.”
The next morning, Chase came down to breakfast reading “On Becoming a Person,” a book by the psychologist Carl Rogers. Her goal of appearing mainstream while publicly discussing fused labia and unusual gonads seems, at times, unattainable. Few would argue that her current message — that doctors and families should not rush into surgery — is nothing if not prudent. Nonetheless, her long-term goal remains the eradication of infant genital surgery for the sole purpose of altering appearance, and this continues to sound outlandish to many medical professionals and to most of the general public as well.
Over coffee, Sandberg told Chase that he, too, could not yet join her in taking the position that cosmetic genital surgery on infants is always wrong, and Chase was trying hard to understand why.
“But is there ever a good reason for reducing the size of a clitoris?” Chase pressed Sandberg.
“If the parent cannot tolerate it,” Sandberg replied.
Chase paused, struggling to empathize with a mother unable to raise a child because of the size of that child’s clitoris. Chase has spent her adult life explaining why such a position is unethical. The logic she has constructed is nearly unassailable. Yet for most of us, Chase’s thinking is emotionally difficult to embrace. For starters, we tend not to be very rational when it comes to our children and to our genitals. Complicating matters, in treating intersex, as opposed to, say, a heart condition, what feels best for the parent in the short term may not turn out to be what is best for the child over time. Finally, parents feel entitled to make decisions based on the (sometimes false) sense that they know what’s right for their families, and the reality is that in the case of intersex children, the right treatment for one child, or even the majority of children, will not be the right treatment for all. Even Sarah Creighton, one of the London gynecologists who reported that intersex patients who have not had surgical procedures tend to fare better, has noted that no treatment is guaranteed or even likely to make the lives of those babies born intersex pain-free. “These are not all happy people, either,” she has said. “Some of them have isolated, difficult lives. Some of the surgery patients are fine, and some of them are not, and it’s very hard to separate all the things out.”
Over time, the public may grow to accept Chase’s idea that we, as families and neighbors, have an obligation to shed our own biases and accept bodies that are neither neatly male nor neatly female. Or maybe we will not get there, and our discomfort with ambiguity will never fade.
Elizabeth Weil is a contributing writer for the magazine. Her last article was about a “wrongful birth” lawsuit.
都城市議会：男女共同参画条例案を可決 性的少数者配慮の文言削除 (毎日・宮崎版 2006/09/23)
「Dr.北村 ただ今診察中」～安倍晋三さんへの期待と不安 (毎日 2006/09/21)
Japanese city amends pro-gay law
By Linda Sieg TOKYO, Reuters
A Japanese city amended a rare local law protecting homosexuals from discrimination Friday, despite protests from activists who said the law was being watered down.
The step coincides with efforts by conservative lawmakers, including the next prime minister, Shinzo Abe, to revive respect for traditional family values they fear are being eroded in modern society.
The local legislature in Miyakonojo, a city of 171,000 on Japan's southernmost main island of Kyushu, voted in favor of a revision to a 2003 law that explicitly banned discrimination based on gender or sexual orientation, a city official said.
The "Law for a Gender Equal Society" includes the sentence: "In a gender-equal society, human rights should be respected for all people regardless of gender or sexual orientation".
The new version deletes the reference to gender or sexual orientation.
A city official said the revision would not change the way the law is implemented. Officials said previously the amendment was intended to make the law easier to understand.
"The spirit of the law, its intention, remains although the phrase has been changed," said Meiko Kawasaki, in charge of gender equality affairs at city hall.
"There is no change in our policy," she said.
The international organization Human Rights Watch had written to Miyakonojo Mayor Makoto Nagamine, who introduced the amendment, protesting the change and urging the city to reconsider.
On Friday, Japan's first openly lesbian politician, Kanako Otsuji, expressed disappointment and anger.
"I really want to ask those who made this decision why they made it," said Otsuji, a local legislator in the western Japanese city of Osaka who had campaigned against the change.
"If this doesn't change anything, why did they have to amend it?" she said.
"We can only see this as homophobia," she said.
Saturday, Sept. 23, 2006
Reference to gays cut from rights ordinance
MIYAZAKI (Kyodo) The municipal assembly of Miyakonojo, Miyazaki Prefecture, decided Friday to exclude sexual minorities, including homosexuals, from its ordinance on human rights protection.
The 2004 ordinance stipulated that the city respects the human rights of every person "regardless of gender or sexual orientation," but the assembly approved the new ordinance after deleting the passage on sexual minorities.
It is rare to see a passage referring to homosexuals in local government ordinances on human rights protection.
A city official said removing the passage does not change the overall meaning of the ordinance.
Some assembly members and human rights activists said it would lead to ignoring the human rights of minorities and their existence.