iain morland

The Injured World:

Intersex and the Phenomenology of Feeling

he purpose of this essay is to reflect critically on the feelings

provoked by anatomies that are customarily regarded as sexually ambiguousin particular, those anatomies that have been surgically modified
in an objectionably paternalistic way. There might appear to be a gulf
between, on the one hand, the feelings of individuals born with what are
usually called intersex genitalia or disorders of sex development and,
on the other hand, the feelings of people born without such characteristics.
This presumed gulf is sometimes called lived experience, as if experiences were ultimately separable, and one has to live something in order
to experience it (see Karkazis 24647 for an example of this position). But
I want to examine how, in the words of the philosopher Rosalyn Diprose,
the borders of the body as it is lived do not coincide with the borders of
the body as it is observed (104). I will contest the notion that ones lived
experience ends at the surface of ones skin. To advance my argument,
I will draw in the course of this essay on relevant accounts from patient
advocacy, gender studies, philosophy, and neurosciencespecifically,

Volume 23, Number 2 doi 10.1215/10407391-1629803

2012 by Brown University andd i f f e r e n c e s:A Journal of Feminist Cultural Studies

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their phenomenologies of feeling. I will also discuss some of my own

experiences, where they shed light on issues not accessible by other means.
Those of us born with genitals of seemingly uncertain sex often
face a dilemma about whether and how to disclose to others the details
of ones intimate anatomy. When asked at a peer support group meeting
in 2006 to identify behaviors that make life easier with such an anatomy,
group members and I specified both talking about it and not talking
about it. This ambivalent response shows that living with an unusual
genital anatomy means feeling neither unproblematically included in, nor
straightforwardly excluded from, mainstream discourse about the sexed
and gendered body. The response expresses, moreover, the contradictory
felt experience of sharing a world with others whose anatomies differ
from ones own. We can think of this, following the philosopher Kathleen
Lennon in a related context, as the matter of how we find our feet with
each other (34); and empathy seems to be one way in which we might,
together, find our feet.
If we assume lived experience to end at the skins surface, then
empathyby doctors in the medical sphere and by individuals with identities other than intersex in the political sphereoffers a limited bridge
across an inevitable gulf. Empathy might minimize the perception of
unusual sex anatomies as jarring bodies, in the phrase of historian and
ethicist Alice Domurat Dreger, who has accordingly critiqued the impulse
to jar affected individuals as if specimens for examination rather than
people. We might, Dreger has suggested, dissolve all the glass that separates us (Jarring 171). But I am not convinced that the glass is there in
the first place. By this, I do not mean to appeal to a collective humanity,
which would remain a claim about identity. Rather, I argue that there is
less separation than we might suppose between the feelings of living with
atypical genitalia and of sharing a world in which others have such anatomies, even where the former includes the experience of surgery and the
latter does not. These feelings are different, but it is their difference from
one another that they have in common. Consequently, I shall argue in this
essay for an expanded understanding of feelings as the transindividual
condition of being sensible with others.
Feeling Bad about Surgery
In the course of researching intersex since 2000, I have accumulated a large number of photocopied medical articles about genital

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surgery. Several contain close-up photographs and diagrams of surgical

procedures that have traditionally been performed on intersex anatomies to alter genital appearancein some cases, procedures that were
also performed on my own body in childhood and adolescence. (I have
had fourteen such surgeries, the majority of which took place before I
was five years old, and which produced mostly functionally unsuccessful
outcomes.) Sorting through the articles one day in a house that I shared
with fellow students, I fell into conversation about my research. Although
good friends of mine, my housemates did not know at that time about my
medical history, nor did they have similar histories. They were struck, and
a little morbidly fascinated, by the details of surgery that they glimpsed in
the articles as I sorted them into boxes. Some phrases in the papers made
my housemates wince with dismay: clitoral resection, penile disassembly,
pubic skin flaps, urethral mobilization, glans separation. Illustrations of
these taking placethe normal currency of medical papers on the topic
elicited sharp intakes of breath. My housemates, none of whom had a background in medicine or intersex studies, even exclaimed in alarm at some
of the images: photographs taken during surgery showing swollen and
bloody genitalia, sometimes hooked open with metal equipment or freshly
stitched together after an incision. You, reader, may similarly be wincing
as I recount the incident. The detail is not gratuitous; your response to
the descriptionif you have not had such surgerylike the response of my
friends to the original medical material, is highly significant. It reveals
something about how intersex surgery feels, even to individuals untouched
by the surgeons scalpel. It feels uncomfortable.
Of course, the details of surgeries unrelated to intersex might
look comparably grisly to a layperson; I recognize that the articles in my
collection were addressed to a medical readership for whom the material would probably not be disquieting. Nonetheless, I think there is an
important difference between how my housemates might have reacted
to representations of other, elective surgeries with demonstrable health
benefits and their reaction to images and descriptions of surgical interventions upon intersex anatomies. These latter interventions not only
look and sound bad; they are bad. Over approximately the last twenty-five
years, the medical protocol of surgery for intersex has been forcefully critiqued. Such critiques began outside medicine, with the work of feminist
scholars like Anne Fausto-Sterling (Myths 13341) and Suzanne J. Kessler
(1232), and patient activists including Cheryl Chase (Hermaphrodites
193203) and Morgan Holmes (Queer), as well as ethicists such as Dreger

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(Hermaphrodites 167202). Increasingly, clinicians like gynecological

surgeon Sarah Creighton and psychiatrist William Reiner, too, have criticized genital surgery. Although most commentators acknowledge that the
motivation for surgery has been benign, grounded in a disastrously naive
assumption that secretive genital surgery in infancy can eliminate visible sexual ambiguity and thereby foster an unquestioned female or male
gender identity for the patient, criticisms of surgery assert that these aims
are both unfeasible and objectionable.
The reasons why the surgical protocol is argued to be bad are
fourfold: first, it entails cosmetic procedures that neither cure organic
disease nor improve functionality; second, surgery is performed without
properly informed consent because patients are very young and their
parents are unaware that procedures are experimental and risky; third,
surgery can injure patients in ways that cause distress and lifelong inconvenience, such as genital pain and nerve damage; and fourth, even technically successful surgery is morally injurious in its attempt to determine,
through the construction of genitals and gender, the ways in which individuals find themselves in the worldit impairs ones authenticity, the
philosopher Herman Stark has suggested (28889). I think that the above
reasons are ample cause to feel bad about surgery for intersex, irrespective
of whether one has been subject to it. Further, I would expand this claim
and call these four reasons to feel bad simply about living in a world in
which intersex surgery takes place. I prefer the latter, broader formulation because it emphasizes that to feel bad about something that happens
in the world is to feel uncomfortable with being in the world in the first
place. (Another way of putting this is to call it an existential problema
concept to which I will return.)
It is customary, in critiques of clinical practice, to move
promptly from identifying the problems with traditional surgery-centered
treatment to exhorting medical change in favor of what one leading patient
advocacy group has called a patient-centered approach (Chase, What
240). Usually, from the above four reasons follow recommendations for
treatment reform such as the provision of psychological support as an
alternative to surgery, and attention to first-person narratives of life with
intersex, inspired by academic work in the medical humanities as well as
by predominantly American civil rights activism. Critics of early genital
surgery have drawn too on the work of biologist Milton Diamond, who
since the 1960s has argued against the theory that gender is a flexible
social construct amenable to medical manipulation in early childhood. It

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is worth noting, however, that surgery can be challenged on the alternate

basis that gender is wholly social and hence that surgical interventions
to modify genital appearance conflate a social attribute with a physical
one, as if genitals mean gender, as Kessler has complained (132). I intend
not to pursue such recommendations herealthough I support many of
themor to discuss their relation to debates about nature and nurture,
which I have addressed elsewhere (Plastic 8993). Instead, I shall reflect
on the overlooked interval between feeling bad about intersex surgery and
formulating proposals to make medical treatment feel better.
Beyond Identity Politics
I am sometimes asked not to intellectualize or abstract the
problem of genital surgery. In other words, I am prompted to dwell on the
ways in which surgery feels bad, rather than the reasons why it is so. By
itself, this reaction by others reveals little specifically about intersex; readers with physical impairments of various kinds will probably recognize
the difficulty of explaining, for example, the social model of disability to
well-meaning friends and colleagues who presume bodies to be disabled
when in fact it is environments that are disabling. What others sometimes
wish for, I find, is an account of personal experience separated impossibly
from an explanation of the world that structures that experience. To be
clear, I regard this as an oversight rather than an insult, one informed by
a pervasive discourse on gender and sex as apparently irreducible aspects
of the self, in which questions of gendered and sexed embodiment are
necessarily inquiries into a persons nature. After all, if the experience
of intersex is structured by the world, then asking a person about their
intersex experience is likewise structured by a discourse that exceeds the
individual asker. But when genital surgery in infancy has left one with a
sense that ones sexual anatomy, and perhaps ones gender identity too, is
inauthentic (to use Starks term), such questions are peculiarly discomfiting. For instance, individuals who have been subject to clitoral reduction in childhood can be unsure whether to call the outcome of surgery
female genitalia or injured intersex genitalia. The former description
can ascribe to surgeons the power to create a woman by removing body
parts, as Chase has cogently objected (Affronting 214). Her point is not
an intellectualization or abstraction, but an expression of what is wrong
with genital surgery in its complex totality. Therefore, far from evoking a
straightforward distinction between the feeling that surgery is bad and its

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reasons for being so, the very act of talking about it with others generates
feelings that trouble such a divisionas the ambivalent desire of support
group members to talk and not talk indicated.
To reflect, then, on the gap between feeling bad about intersex
surgery and formulating proposals for medical reform is not to retreat
into solipsism. Rather, it is to explore how a history of surgery affects the
interpersonal process that Lennon calls finding our feet with each other.
To extend Lennons metaphor, a major consequence of surgery is that one
does not begin on an equal footing with others. In fact, when questions
are posed by people who do not have intersex anatomies and have not
received surgery, ones footing is doubly uncertain. In a sense, invoking a
natural continuum between intersex genitalia and conventionally male or
female genitalia could make ones anatomy at birth more comprehensible
to others. This can entail the assertion, traditionally favored by clinicians,
that sexually ambiguous genitalia are unfinished types of male or female
genitalia (Hendricks 10). More radically, it can involve identifying as a sex
other than the usual two, such as in Fausto-Sterlings waggish argument
that at least five sexes exist (Five 21). But in another sense, appealing to
continuawhether between finished and unfinished genitalia or two and
many sexesfails to express the fact that ones anatomy has been altered
irrevocably by surgery. Even if it were locatable at birth on a continuum
relative to unambiguous genitalia, after surgery ones genital anatomy is
situated radically elsewhere. An example of this displacement effect is the
scarring caused by childhood surgery; it is neither merely superimposed
upon, nor subsumed by, ones genital anatomy. Scars and genitals grow
together, shaping each other, registering a past intervention that remains
obdurately present. And as shown by Chases explanation of the politics
of naming postsurgical body parts, to express to another person how
ones body came to be is never simply to describe; it is always to endorse
a certain type of world in which the surgical protocol is either affirmed
or challenged.
Some weeks after I sorted through the medical articles that
produced such visceral reactions in my housemates, I decided to disclose
to them my history of surgery for intersex. They were supportive and
respectful, but the disclosure was inevitably not straightforward, for the
reasons Ive been discussing here. Aware of how the details of surgery
in the articles had stirred aversive feelings, I wondered whether evoking such imagery and descriptions when telling my own story would be
usefulnot to shock, but to help convey that surgery is bad. While infant

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genital surgery seems self-evidently wrong to many people with whom Ive
discussed intersex, I have found that some individualseven those who
know my historynevertheless perceive surgery to be a quick fix that can
avert social awkwardness, in particular childhood teasing. Some medical
professionals have similarly asserted that parents have an obligation to
choose surgery for children with ambiguous genitalia, on the grounds that
it would be neglectful not to bring ones child into line with normal expectations about female and male bodies (see Rossiter and Diehl 6061). These
views are incorrect; what is more, surgery can have the opposite outcome.
Many of us who received surgery in infancy find it not to be normalizing at
all and think that a postsurgical anatomy looks stranger than a presurgical
one, for example because of genital scarring. It feels stranger too, due not
only to an ineradicable sense of inauthenticity but also in some cases to
nerve damage. So the question I faced when choosing to disclose my history was whether it would be sufficient to state dryly and nonspecifically
that surgery had been bad for me or to bring my housemates onto equal
footing with me by making it feel bad for them too. Put another way, this is
the question of whose feelings about genital surgery matter in discerning
whether the surgical protocol is right or wrong.
One established way to communicate the objectionable sense of
uneasy difference that surgery can produce is to draw an analogy between
intersex and identity categories with which others are familiar, or indeed
that they occupy. A mordant example is the 1990s intersex activist adage
that it can be difficult for a child to grow up black, yet that is no reason for
parents of black children to bleach their babies (Chase, qtd. in Horowitz
12). It is a powerful formulation, to be sure, but currently I do not think
that intersex is an identity comparable to black or, for instance, gay. This
is because there is no social script for how one ought to think, behave, and
feel with an intersex anatomy, any more than there is for life with ginger
hair. Briefly put, my understanding of identities as social scripts regards
identities as personal commitments to ways of life, which can include the
elevation of physical attributes to matters of ongoing social importance
but does not have to (Appiah). Consequently, I see no compelling reason
for there to be such a script for intersex peoplewhich is not to say that
those of us with intersex anatomies are unentitled to rights like autonomy
and bodily integrity. However, such rights are by definition conferred
regardless of a persons identity. Hence, it is wrong to bleach black babies
not because they are black, but because they are babies; the analogy does
not pivot on identity, and I dont think infants have identities in any case.

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What the analogy does highlight, though, is that being bleached would
neither straightforwardly stop one from being black nor make one white.
In this respect, I think the analogy is informative in helping others to grasp
the unsettling effects of surgery without appealing to a coarse humanist
notion that we are all the same underneath our different identities (see,
for example, Dreger, Intersex 81).
In rejecting the humanist idea that we are all the same underneath, I am drawing on a long-standing argument about social justice
that conferring rights on the basis of attributes that individuals have
theoretically in common means sidestepping their divergent material
circumstances. Differing circumstances mean that rights that are fair and
beneficial for one person may not be for another. My point in the present
context is to suggest not that infant genital surgery is sometimes of benefit, but merely that we cannot determine surgerys moral caliber by the
extent to which it respects the presumed common humanity of patients.
However well intended that presumption may be, it signals a failure to
interrogate critically the ways in which humanism obscures individual differencesfor example, in the very theory of infantile gender flexibility that
has underpinned the protocol of surgery for intersex. That theory evoked
adaptability as a defining human attribute; its advocates saw medicines
role as the humanistic facilitation of whatever adaptation would enable
children with unusual anatomies to meet mainstream expectations about
gender and genitalia (Morland, Plastic). The theory suggested that,
underneath, we are all adaptable and so can be adapted with impunity.
It would not be progressive simply to flip the terms by suggesting that,
underneath, none of us are adaptable and so can never be adapted. What is
more, if humanism were redeployed as the starting point for a critique of
surgery, then such a critique could entail the peculiar claim that a persons
humanity is somehow susceptible to surgical damage and therefore that
individuals who have already received surgery are less than fully human.
I argue that talking with others about whether surgery is right or wrong
should not involve endorsing any particular definition of the human.
A History of Discomfort
It might seem that what I am advocating in this essay is nonetheless a humanism of feelings, an appeal to shared sentiment. Certainly,
like the medical articles at which my housemates winced, talking with
others about the idea of bleaching babies generates a corporeal response

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comparable to that of medical descriptions such as penile disassembly

a response more immediate than the contemplation of analogies based
on identity or the meaning of humanity. But I shall now suggest that the
relation between vicarious discomfort and the moral character of surgery
is not referential. The reason for this caveat is that to posit a referential
relationwhereby surgery would feel bad to others directly because it is
badwould be to assume that feelings can tell us the truth. Moreover, it
would be to suppose a particular type of person whose interior feelings
can act as a mirror on the morality of the world. The account of feelings for
which I will argue is more expansive than this, and less individualized. In
a relevant essay, Lauren Berlant has dissected the position of the subject
of true feelinga culturally constructed standpoint from which it appears
possible to distinguish right from wrong on the basis of how things feel.
This is a problematic construct, Berlant argues, not least because it can
lead to political inaction when individuals misrecognize feeling good as
evidence for the arrival of justice (58). I agree with Berlant and have elsewhere extended her argument to critique what I call sentimental determinism in debates about intersex treatment (Morland, Between 208).
Sentimental determinism is the belief that a decision about the right way
to treat intersex (or indeed to demedicalize it altogether) could be reached
through attention to how accounts of intersex make us feel. Sentimental
determinism is not what I am proposing here.
The challenge, then, is to reconcile a refusal of Berlants subject of true feeling with my contention that genital surgery not only feels
bad, but is bad. Attending to the uncomfortable feelings generated in others
when they hear about surgery evidently risks ascribing to those feelings
the status of moral referent. However, even if the generation of uneasy
feelings about surgery prompts others to support patient-centered treatment, these feelings cannot reveal whether patient-centered treatment is
just; that is a separate debate, its outcome undetermined by sentiment.
Patient-centered treatment, as Chase has noted, means treating people
with atypical genitalia by conventional ethical and therapeutic standards
rather than as exceptional (What 242). Nonconsensual cosmetic surgery
is not normal in other areas of medicine. Therefore, querying the justness
of standards is distinct from feeling bad about failures to apply those standards to people born with intersex anatomies. I think that this distinction
addresses, to an extent, Berlants concern about mistaking feelings for
justice or injustice. It means continuing to hold open for critical reflection the interval between bad feelings about surgery and the formulation

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of proposals for medical improvement. To the same end, I caution against

eschewing feelings altogether; Berlants argument can be turned around to
indicate that if feelings are no measure of justice, then justice is no determinant of feelings. This is to say that the morality of medical treatment
for intersex does not exhaust peoples feelings about it.
Far from being merely an unreliable interior reflection of an
exterior morality, feelings have been central to the recent history of intersexboth its conventional medical treatment since approximately the late
1950s and treatments subsequent critiques. Together these phenomena
compose a veritable history of discomfort. This does not mean that clinicians and critics have been acting irrationally, but rather that treatment
and its criticisms have had in common the aim of reducing feelings of
discomfort about intersex. In other words, both have sought to make bodies less jarring. But traditionalists and reformists have diverged over how
best to achieve this, and for whom. In the traditional medical view, the
sight of an infants atypical genitalia has been held to cause discomfort
not only for parents, leading to a damaging lack of conviction about their
childs gender, but also for diaper-changing friends and relatives, leading
to exclamations of dismay and subsequent gossip (Hendricks 12; NihoulFkt 24). Genital surgery has been claimed to foreclose such reactions.
Critics have inverted this argument by suggesting that even if atypical
genitalia do cause discomfort to others, such feelings are matters of social
psychology and ought therefore to be tackled through dialogue rather
than body modification (Chase, Hermaphrodites 198; Kessler 36). As
one progressive physician stated in the late 1990s, Early surgery makes
parents and doctors more comfortable, but counseling makes people comfortable too, and is not irreversible (Schober 607). More recently, a key
reason for advocating a change in medical nomenclature from intersex
to disorders of sex development has been that the new nomenclature is
apparently more comfortable to affected individuals than the oldthat it
feels right in its medicalizing specificity (Dreger and Herndon 212). Here,
then, is another cause to reject sentimental determinism: feelings cannot
guide the treatment of intersex because the management of feelings about
intersex has itself been part of treatment, surgical or otherwise.
Coined at an important conference in 2005 between traditionalists and reformists, the term disorders of sex development was intended
in part to avoid the connotations of sexual and gender identity implied by
intersex (Dreger and Herndon 208). Yet in turn, critics of the new term
have responded that it makes them more uncomfortable, not less: It does

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feel like a slap in the face, one patient activist has asserted (Long). Objections to the revised nomenclature have coalesced around the not entirely
reconcilable claims that disorders of sex development casts unusual bodies
as inherently defective and that it pathologizes the identities of individuals
who have such bodies. Those in favor of the term argue that it was never
intended to describe an identity, but was, rather, to enable the formulation
of clear standards of care where medical interventions would be genuinely
useful, as opposed to traditional cosmetic surgeries of no demonstrable
use (Feder 24041). However, the extent to which surgical procedures
can and will be firmly distinguished by this criterion is a topic of ongoing
debate. Further, some online critiques of the new nomenclature have taken
the form of vituperative screeds against the integrity and motives of the
nomenclatures authors, as if an appropriate response to the bad feelings
generated by disorders of sex development would be to make its authors
feel bad too (see, for example, Organisation Intersex International). At
the time of writing in 2011, I think it is unclear whether the nomenclature
change has accomplished all its stated aims but acknowledge that it has
facilitated improvement in decision making about treatment. For instance,
new guidelines for uk clinicians emphasize psychological support far more
strongly than genital surgery, including the frank provision of information
about the controversy over surgery, converse to the traditional view that
surgery can bypass psychological concerns (Ahmed et al. 1314). Whatever
happens, the dispute over nomenclature shows that responses to atypical
genital anatomies continue to be polarized between feelings of comfort
and discomfort, with everyone arguing that their approach is the most
comfortable to the people who matterunderstood variously to be patients,
their families, prospective sexual partners, doctors, and so on.
But despite attempts from diverse standpoints to make intersex
feel comfortable, it seems to me that just as feelings about treatment are
not a mirror of treatments morality, so too do feelings exceed the poles of
comfort and discomfort. This is to suggest that feelings cannot fully and
finally be managed by anyone, whether traditionalists or reformists. I
make this suggestion not because emotions are ungraspable or capricious,
but for two reasons of increasing specificity. The first reason is that if
approaches to intersex are judged wholly by their felt location between the
poles of comfort and discomfort, then the body is treated as something akin
to a couchwhereby the feeling of comfort would be good and inversely
proportional to the feeling of discomfort. But living well in ones body does
not mean feeling comfortable in the same way that one might relax on a

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couch. I understand the body to be ones inescapable point of view on the

world, a phenomenological claim that means the world appears to oneself
through bodily perception. Consequently, in order that there is a world for
oneself at all, ones perceiving body must be constitutively open to impressions as various as the world. For example, because my visual perception
is both located within the world and open to it, the content of my visual
field changes when I move my eyes (Merleau-Ponty 134). Now, it might be
very comfortable to rest my eyes in darkness, but then the world would
be lost to me because my visual field would become monotonous. (This is
not to imply that individuals with visual impairments are cut off from the
world; I am selecting one sense, in hypothetical isolation, as an example.)
What this understanding of the body means for feelings about intersex
treatment is that unalloyed comfort would be both unusual and undesirable. A perceiving body is not a comfortable body; it is less narcissistic and
more open than that.
The Body as Object
If the bodys perceptual mutability must correspond to the
mutability of the world in order to perceive the world at all, then the
second reason why feelings about intersex treatment exceed the poles of
comfort and discomfort is more specific. It is also more personal. Like
several others who have received surgery for intersex, I have experienced genital desensitization due to nerve damage during surgery. In my
case, it occurred during an operation at age sixteenitself a follow-up
to surgeries in infancyand caused a complete lack of tactile perception
in most of my genitalia for nearly a year. Genital tactility was severely
diminished for a further three and a half years, such that sexual pleasure
was extremely difficult, even tedious, to obtain. More than sixteen years
after the surgery, tactility remains patchy and weak; I suspect that it will
never return fully. I mention this experience in some detail because I have
found genital desensitization to be a singularly difficult phenomenon to
communicate to otherswhether in the context of giving a medical history or during sexual relations. Within the latter, its communication is
not comparable to a conventional explanation of which sex acts one does
and does not enjoy, because sexual likes and dislikes require body parts
capable of feeling comfortable (I like this) and discomfortable (I dont like
that). Indeed, one reason why desensitization is so inconvenient is that,
like genital surgery for intersex generally, it can turn sexual relations

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themselves into a gauche process of giving ones medical history. This

occasioning of discourse about the body causes one to lose ones footing
with others rather than to find it, as one struggles to express how it feels
not to feelto communicate not wince-inducing pain, but the diminution
or absence of perceptual content.
Confounding the alignment of good treatment with feelings of
comfort and bad treatment with discomfort, the desensitized feeling of no
feeling is a moral injury of a strange order. Because it takes place not over
the whole body, but in only one area, I think that it can be understood as
an injury of differentiation. This is to say that the body is experienced as
partitioned between areas with and without tactility. Previous critiques
have also asserted that medicine has a differentiating effect, but not in
the manner that I am suggesting here. For instance, it is true that genital
surgery functions to differentiate individuals born with intersex anatomies
from those born without; in the ways I have been discussing in this essay,
surgery stigmatizes rather than normalizes, and thereby marks recipients
of surgery as different from those unaltered. It is true, too, that surgery
endeavors to differentiate individuals in terms of bodily sex between those
who are visibly male and those who are visibly female. These are longstanding objections to the medicalization of intersex. A more recent criticism is that the term disorders of sex development differentiates between
people who have a disorder and those who do not.
The various objections have a shared interest in debunking the
medical project of differentiating people from one another, whether along
the lines of surgically modified or not surgically modified, male or female,
disordered or nondisordered. However, in addressing desensitization, I
am interested in the establishment of differences upon individual bodies,
not between them. The experience of lost tactility is neither a matter of
contrasting oneself to others for whom sensitivity is intact nor a matter
of comparing ones state of desensitization with a prior, uninjured state.
For individuals who received desensitizing surgery in infancy, the latter
comparison is impossible anyway. Rather, loss of tactility is the ongoing experience of a contrast on ones own body between sensitive and
insensitive areas.
At this point, it might be objected that desensitizing surgery,
unfortunate though it may be, is nevertheless discontinuous with intersex
surgeries that leave nerves undamagedin other words, that the consequences of desensitizing surgery cannot be generalized. This would
mean that the remainder of my essay could have only a very specific

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scope. Similarly, it might be objected that surgeries on atypical genitalia

performed in infancy, whether destructive or preservative of tactility,
are discontinuous with elective surgical procedures on adult intersex
genitalia; one might argue that whatever undesirable effects surgery has,
such effects are not morally injurious if surgery is chosen by a consenting
adult. I think these objections would be misplaced. Consider that when
genitalia are insensate, it is as if one part of the body remains anesthetized
for surgery, after the rest of the body has awoken. The difference is one of
degree, rather than kind, between this and surgeries that preserve tactility.
Phenomenologically, desensitizing surgery just goes on for longer: in one
place on the body, the anesthetic never wears off. To put it another way,
desensitized genitalia linger in a belated time zone all of their owna kind
of inverted erogenous zone. The significance of this phenomenological
account can be amplified by drawing on a seminal essay by the philosopher
Iris Marion Young. In her essay, Young interrogates the claim that there is
a particular way of throwing like a girlnot to dismiss it as a sexist fiction, but to explain how in a sexist world certain styles of bodily movement
are at once gendered and naturalized. Her argument will help explain in
more detail the crucial continuity among intersex surgeries of all kinds.
Young argues convincingly that a style of embodiment characterized by mistrust of ones body is customarily gendered feminine. The
kind of mistrust to which Young refers is not an intellectual judgment
about bodily appearance but a felt sense that ones body is an unreliable
conduit for ones intentionshence, to throw like a girl is to throw
badly because one feels that ones body cannot be trusted to throw at all.
Understood phenomenologically, the body needs to disappear from ones
attention when throwing an object, such that one is occupied entirely with
the will to throw rather than the act of throwing. Some recent commentators on intersex treatment have explained in similar terms the experience
of parents in choosing surgery for their children. A newborns atypical
anatomy can appear to its parents attention as an obtrusive object, the
disappearance of which seems to be promised by surgerynot literally
(although clitoral reduction may have that aim too), but in the sense of
allowing a childs genitals to pass without notice (Zeiler and Wickstrm
370). However, that process concerns the purported surgical differentiation of children along the lines of male and female, which is distinct from
the experience of tactile partition. I think Youngs essay illuminates a different point relevant to tactility. She suggests that if one feels pervasively
unsure about the bodys capacity to execute a desired action, then the act

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of throwing itself becomes ones object of attention. The resultant faltering

movement, simultaneously willful and distracted, is critiqued by Young as
typically feminine. Put differently, it is the contradictory feeling of acting
on an object in the world (the thing being thrown), while feeling that one
is an object in the world, an obstacle to overcome in order to act. I argue
that when genitalia are insensate, they are similarly experienced as part
of ones body and, at the same time, as an object in the world.
Like the feminine embodiment described by Young, the experience of desensitization is irreducibly and distractingly contradictory. Just
as the act of throwing like a girl is characterized by uncertainty over the
parameters of ones body in relation to the world, so too is the phenomenology of genital desensitization typified by ambiguity over where one is
and where one is not. This makes clearer why desensitization cannot be
conveyed in terms of comfort or discomfort: what needs to be expressed
is not I exist in that body part, and it feels comfortable or uncomfortable, but rather I am not sure whether I exist in that body part, because
it does not feel at all. Discourses of sexual relations and medical history
alike cannot easily accommodate body parts that belong seemingly to no
one. As one former patient has put it, [F]unctional damage can give rise
to feelings of loss of body ownership (Cull 341). Hence, lived experience
and the surface of ones skin fail to line up; the former contracts from
the latter. If Young is correct that this mode of embodiment is feminine,
then it is another way in which surgery genders individuals. I suggest
more broadly that all surgery for intersex is objectifying, not simply in
the everyday sense of measuring the body against aesthetic norms, but
in the phenomenological sense of turning a part of the body into a part of
the world (Zeiler and Wickstrm 371). In this respect, there is no essential
difference between whether genitalia are experienced as an obstacle to
overcome by surgery (where surgery is experienced as successful) or an
obstacle to overcome because of surgery (where surgery is experienced
as injurious). In both cases, living in a world in which genital surgery is
thinkable as a way of modifying the body leads to the objectification of
genitalia. This is what Young would call the existential phenomenology
of intersex (143). Such is the continuity between intersex surgeries, even
those that are elective and minor: they all involve a loss of body ownership,
whether fleetingly in anesthesia or persistently in nerve damage. But that
is still only part of the issue.

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d i f f e r e n c e s

The Injured World

In this concluding part of my essay, my analysis will diverge
from Youngs argument because her interest is primarily in the inhibited
capacity to affect the world; I will explore instead the inhibited capacity
to be affected by others. So far I have made claims about, on the one hand,
the interpersonal experience of sharing a world in which genital surgery
takes place; and on the other hand, the highly personal, even isolating,
experience of genital injury following surgery. I think that these divergent claims can nonetheless be synthesized to reveal something about the
existential phenomenology of intersexhow the shared world in which one
finds oneself determines the means by which one perceives the world. I
shall show that even though an objectifying loss of body ownership is a
contraction of lived experience away from the skins surface, the perception of that loss by others is an experience that exceeds the surface of any
individuals skin.
A critic might respond to the preceding section of this essay by
arguing that surgery of any kind, unrelated to intersex, necessarily turns
into an object the part of the body on which it operates. To clarify, such an
argument would refer not to a body parts physiological state after surgery,
but to its distracting presence in ones awareness. I acknowledge that such
objectification is unavoidable, even in demonstrably therapeutic interventions (Diprose 110). But there is a difference. When surgery is performed on
a body part such as an arm, ones capacity to affect the world is impaired
by the arms objectification: for instance, it becomes difficult to throw
things. When surgery is performed on the genitalia, ones own capacity to
be affected is acutely impaired. It is impaired because usually the disappearance from ones awareness of ones genitalia permits an experience
of genitalia as transparently receptive. More precisely, it is the capacity
to be affected by others that is disrupted by the genital objectification
entailed by surgery. Desensitization of the genitals limits this capacity in
an especially persistent and irreversible way. What is at stake, then, is the
objectification of a body part through which others can usually act on the
self, by virtue of that parts tactile receptivity.
It is important to clarify that what I am describing is not the
impaired capacity to touch and be touched, which some authors in gender and sexuality studies have valorized as exemplary of the bodys constitutive openness to others. Touching and tactility are different, as I
have discussed elsewhere (What 29598); touching can be valued for

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its dissolution of the bodys perceived limits only if it coincides with the
interpersonal reciprocity of tactility. The diminution of such reciprocity
is my concern in the present context. Hence, I agree with gender studies
scholar Margrit Shildrick that bodies are existentially leaky in their
capacity to be affected by others (Leaky) but disagree that such openness
is exemplified by the capacity to touch and be touched, as Shildrick has
suggested (Unreformed 329). Rather, I think that leakiness is exemplified by the capacity to feel. By this, I mean neither emotions nor sensationsnot because I think emotions are really sensations or vice versa, but
because I think both terms misleadingly evoke a state located within an
individual body. I argue more expansively that the capacity to feel is the
transindividual condition of being sensible with others. In other words,
it is a kind of leakiness that cannot, as Dreger put it, be jarred (see also
Morland, Intimate 429).
In the light of this claim about feelings, three of my earlier
formulations can be revisited and unified. First, the correspondence that
I posited between the bodys perceptual mutability and the mutability of
the world is exactly the leakiness under discussion here. As a perceiving
entity, the body needs to be capable of being affected by the world. Because
the world is inescapably shared, to perceive the world at all is to be affected
by othersto be sensible with and among them. Accordingly, I am using
the word transindividual now instead of interpersonal to emphasize
that leakiness is not reducible to any given interaction between specific
individuals. Second, when genitalia are objectified, they are experienced
as an obstacle to overcome, but not in order to act in the same way that
one might throw something. Rather, objectified genitalia are an obstruction to feeling, in the transindividual sense. Specifically, the curtailment
of ones capacity to be affected by others is nothing less than a dwindling
of the world. The world recedes from me when I am touched without tactility. Third, because ones body comprises both sensate and insensate
zones alongside each other, to live with desensitization is nevertheless not
a monadic existence; some body parts remain sensible to the touches of
others. Therefore, in experiencing the contrast between such zones, one
is experiencing a difference in the extent to which one can be affected by
others. In existential phenomenological terms, I would call that an injury
of differentiation.
To lose tactility, to lose others, to lose the worldthese are the
same. In this regard, my argument is fundamentally unlike critiques of
intersex treatment that focus on the loss of autonomy (see, for example,

d i f f e r e n c e s

Holmes, Distracted 133). I think that treatment makes individuals too

autonomous. As the philosopher Matthew Ratcliffe has written insightfully
regarding some psychiatric conditions, [W]hat distinguishes a predicament as existentially pathological is a particular kind of loss, a loss of the
sense of other people or a loss of possibilities involving access to other
people (287). Consequently, there would seem to remain an absolute division between those of us whose intersex genitalia have been desensitized
by surgery, and others whose anatomies are sexually unambiguous and
who have not received genital surgery. This point returns my essay to its
central story. It would appear that no amount of talking with housemates
about my medical history could have expressed to them the peculiar
character of the injury I incurredirrespective of how gorily graphic I
made my account. To some patient advocates, the division between my
housemates and me would be a rallying point for intersex identity politics, on the grounds that my housemates could have winced all they like
but would never have known how injurious surgery actually feels. In that
view, my only hope for expressing my predicament would have been with
an audience of individuals in the very same situation. I reject that alternative, not least because it would be really no expression at all, but merely
a confirmation of a common experience assumed to be the foundation of
identity. Identity politics would thereby invoke the literary critic Elaine
Scarrys maxim that one cannot know anothers pain (34). However, as
I have argued, perceptual content (such as pain) is not the predicament
here; its absence is.
So, in view of the analysis I have developed in this essay, what
if it is not a feeling that the wincers lack, but a lack of feeling? To pose this
question is to bring to light a surprising symmetry between my housemates
and me. It is a reciprocal lack, distinct from the inexpressibility of physical
pain discussed by Scarry (3). Just as I lack feeling, the wincers lack that
lack of feeling. This means that their perception of discomfort is clearly
not an absence of feeling comparable to my own, but something is missing
from it nevertheless, precisely because it differentiates them from me. I do
not feel what they feel; they feel what I do not feelthis is what separates
us. Yet strikingly, it is also something that we share, a knot of lack. Insofar
as the loss of others is an existential problem, it is transindividual: I cannot lose others without their losing me.
If my account sounds abstruse, consider that the wincing of others can be understood as the activation of what neuroscientists have called
mirror neuronsareas of the brain implicated in the perception of ones

37

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The Injured World

movements and emotions, which are also activated to a lesser extent during
the perception of movement and emotion in others. Some scientists have
suggested that such a process is a neural basis for empathy (see Bastiaansen, Thioux, and Keysers). Although simply having the right neurons does
not make one empathetic (as the behavior of some paternalistic clinicians
shows), and obviously one need not know anything about neurons in order
to empathize, I find the neuroscientific account nonetheless interesting.
I suspect that the discomfiting effect of phrases like penile disassembly
and clitoral resection, and their accompanying illustrations, coincides
with the activation of mirror neurons in individuals who have not undergone genital surgery. So when I claim that others feel what I do not feel,
I mean it materially. Their nervous systems react where mine does not.
A helpful term for this materiality is flesh, which the philosopher Maurice Merleau-Ponty once used to describe the inseparability of the
perceiving body and the world perceived. He asked, Where are we to put
the limit between the body and the world, since the world is flesh? (138). In
Merleau-Pontys writings, flesh is a foundational quality of reversibility
whereby bodies exist in a shared world that they perceive and in which
they are perceived. By his definition, objectified body parts would not be
flesh because they are only perceived; they do not perceive. Reversibility
is diminished. Intersex surgery, then, is an injury to flesh; and when flesh
is injured, our capacity to find our feet with each other is impaired. This
is another way in which surgical effects are irreversible. Accordingly,
my argument about the existential phenomenology of intersex has been
informed throughout by Merleau-Pontys definition of flesh. What I have
called feelings and what Merleau-Ponty calls flesh are ultimately indistinguishable; I introduce his term here because it usefully draws attention
to materiality without reducing materiality to that which can be known
through science, such as the behavior of neurons. I regard knowledge of
the latter as valuable because it adds texture to our understanding of the
phenomenal world, not because it replaces it.
With Merleau-Pontys work in mind, reflection on the role of
mirror neurons in sharing a world makes apparent something startling,
even redemptive. It is conventional in neurology to think of the referred
sensations that sometimes follow an injury as sensations transferred only
from one part of an individual body to another partfor example, from
the upper part of an arm to its lower part, following a stroke (Turton and
Butler). Phantom perceptions beyond the end of an amputated arm can also
be understood as referred sensations (Ramachandran and Hirstein). They

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d i f f e r e n c e s

extend lived experience beyond the skins surface, rather than contracting
from itan expansion of body ownership, converse to its loss in the case of
desensitization. I argue that mirror neuron effects are referred sensations
too. They exceed the boundaries of individual bodies, referring sensations
across flesh (in Merleau-Pontys sense) that has been surgically injured.
This undoes any notion that the lived experience of intersex is purely
personal. The ensuing reciprocal lack, whereby one individuals wince
at surgery lacks the very lack of feeling that surgery has brought about,
might be rethought not as a deficiency but as potentially redemptive: the
other feels for me, is affected on my behalf. Finally, then, one cannot avoid
being affected by anothers loss of the capacity to be affected, because we
are of one flesh, as expansive as the world.

I thank Lauren Berlant, Matthew Ratcliffe, Margaret Simmonds, and Alessandra Tanesini
for helpful conversations and information; and the editors and anonymous readers at
differences for their feedback.
iain morland is the author of a dozen scholarly articles on the ethics, psychology, and
politics of intersex. He edited Intersex and After, a special issue of glq , and Queer Theory
(with Annabelle Willox) in the Palgrave Readers in Cultural Criticism series.

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