Intersex Genital Surgery as Torture, from a Perspective of the Imperative of Normality
“When we fall outside the norm, we fall outside the set of categories and concepts by which we can be understood and be made intelligible to others…[T]o the extent that we come to be identified with the anomaly, we simply are identified as someone who lacks value and even intelligibility.”
“Normality, then, is the backdrop against which our individuality…becomes foregrounded.”
“This is discrimination on the basis of social stigma. The unavoidable pain of surgery and the high risk of severe lifelong physical and mental suffering – from loss of sexual sensation and function, pain caused by scarring, infertility, castration, violation of bodily integrity, and irreversible surgical assignment to the wrong sex – would never be acceptable by doctors or parents if the child did not have an intersex body.”
To what extent can a discussion of the imperative of normality inform our classification of particular acts as torture? On Feb. 1st, 2013, Juan E. Méndez filed a report entitled “Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment” to the United Nations which focused on certain forms of abuses in health-care settings. This report, which included a brief discussion of medical practices of genital surgery on intersex infants, drew from a report to the UN Special Rapporteur by Anne Tamar-Mattis, which extensively documented human rights abuses and harm against intersex individuals, which Tamar-Mattis claimed to be severe enough to be considered torture. What conclusions or implications from an analysis of the imperative of normality can be brought to bear on this characterization of genital surgery as torture?
At first glance it appears as if consideration of normality allows us to draw no conclusions whatsoever; indeed, it is a fact of a reality that genital surgery for intersex infants is the norm in most parts of the Western world, and certainly in the United States. And if torture is the classification in question, then we have normative definitions of torture, like the ones provided in both reports (which draw from various legal precedents, both national and international, regarding the legal definition of torture) which have been applied to intersex individuals (putting aside for the moment of their correct or incorrect application). Thus, it would appear that an analysis of normativity does little to inform this debate, as the question is simply a matter of whether or not the one norm properly confronts the other.
However, here we must distinguish between normative and prescriptive. Usually we think of “normative” with regard to claims that purport to be prescriptive, that demand obedience. However, in the context of social norms, normativity, and the imperatives of the normal, the normative is that which actually comes to bear on the freedom of action of individuals who operate within it. Thus, the UN definitions of torture (and the corresponding demands of cessation) would be merely prescriptive if in fact they did apply in this context, and have failed to be normative insofar as they continue to be ignored. Indeed, many other prescriptive norms which usually apply in medical or surgical contexts (the demand for consent, the demand for full disclosure of information, the demand that surgical operations follow a coherent and rational cost-benefit analysis, that follow up treatment be available, that we avoid actions on children that have similar psychological effects to child abuse, the principle of non-harming, that permanently life changing operations be approached cautiously and after much deliberation) are blatantly ignored in the event of an intersex birth. The question is, then, why are such prescriptives ignored, and what does this tell us?
In fact, analysis of the imperative of normality can aid us in identifying populations who are the subject of torturous practices insofar as those populations fall outside of the norm. The reason for this is found in the above quotations: normality grounds the possibility for intelligibility. Those who fall outside the normal fall outside of our normal ways of perceiving the human person. Insofar as they lie outside the text of normality, they are seen as an exception, not only to the norms that they violate, but indeed the rules of behavior which normally govern our relationship and behavior towards them. The permissibility of non-normative actions is greatly increased when applied to non-normative subjects. If individuality is foregrounded in normality, as Kittay claims above, then individuals who fall outside of norms are not seen as individuals who are subject to normative values (such as human rights) at all, but are seen instead as a social emergency that needs to be eradicated. And since intersex infants are seen as a medical emergency, the medical apparatus that (re)produces their abnormality brings its full strength to correct it. A whole slew of norms, not just gender or sex, but heteronormative, patriarchal, and embodied norms (being able to urinate standing up for males, having an adequate sized penis that is capable of penetrative heterosexual intercourse for males, having a vagina that is receptive to penetration for females, discourses of masculinity and femininity, and having genitals that match gender assignment are frequently cited justifications for surgery by medical professionals) are brought up in discussions of how to normalize. The willingness to bring intersex individuals within normative classifications no matter what the cost (mental, physical, spiritual, social, relational) should raise great suspicion about the legitimacy of normalization procedures. It could be argued that all populations which lie outside of normative frameworks which, nonetheless, have power over and come to bear on them ought to be considered at-risk populations for human rights abuses. Since falling outside of norms, and therefore outside of conceivability, elicits a visceral, emotional response and is considered an exception to normal regulations of behavior, the possibility and permissibility, and indeed the impunity of violence and abuse is magnified. This analysis of the imperative of the norm, and what falls outside it, informs our discussion of genital surgery on intersex infants and torture insofar as it forces us to consider intersex infants an at-risk group, and to take these claims of abuse extremely seriously.
 Kittay, Eva Feder, “Thoughts on the Desire for Normality,” Surgically Shaping Children: Technology, Ethics, and the Pursuit of Normality, p. 106
 Ibid., 108
 Tamar-Mattis, Anne, “Report to the UN Special Rapporteur on Torture: Medical Treatment of People with Intersex Conditions as Torture and Cruel, Inhuman, or Degrading Treatment or Punishment,” Dec. 10, 2012, p. 9
 Méndez, Juan E., United Nations General Assembly, Human Rights Council, Twenty-second session, Agenda item 3: “Promotion and protection of all human rights, civil, political, economic, social, and cultural rights, including the right to development.” 1 February 2013
 The ignoring of all of these is well-documented in Tamar-Mattis’ report
 Tamar-Mattis’ report documents these concerns, but see also Kessler, Lessons from the Intersexed, Ch. 2-3
Complications of Mycobacterium leprae
The above condition is probably what you think of when you hear ‘leprosy’; disfigurement and limbs falling off. These are not actually symptoms caused directly by M. leprae, but are complications of long exposure to it. Prior to the effective forms of modern medicine some of us enjoy today, once an individual was infected with M. leprae, life long exposure and disfigurement was a guarantee. Today, leprosy is very treatable.
The reason digits and extremities decay in extreme cases is because of the damage M. leprae reaps on the peripheral nerves (which your hands have a high density of). Without feeling in your extremities, you become prone to damaging them without realizing, cutting off their blood flow, wrist/foot-drop, absorption of digits, clawing of toes and hands, and possibly contracture.