When boys will not be boys: American eugenics and the formation of gender nonconformity as psychopathology

ABSTRACT

Drawing from Michel Foucault’s theorization of disciplinary power and biopolitics, this paper advances and reconstructs earlier scholarly literature on American eugenics through an examination of nineteenth- and twentieth-century penological and psychiatric techniques that contributed to the birth of a discourse on gender nonconformity as psychopathology. In this paper, I ask: how do certain forms of embodiment, dress and expression come to be interpreted as ‘effeminate’ and ‘sissy’? Furthermore, how did various moral and penological techniques around gender nonconforming embodiment and subjectivity contribute to the development of psychiatric treatment methods for homosexuality and transsexuality? Drawing from early sexological studies on prisoners as well as psychiatric studies on institutionalized children, the paper argues that in the context of ‘boyhood effeminacy’, normalizing power operates not merely on the disciplinary level of the individual body, but also through a biopolitical governing of health, reproduction, family and citizenship. The paper concludes by addressing the contemporary European Trans sterilization legislation as a biopolitical offshoot of eugenic rationality.

KEYWORDS:

• Gender nonconformity
• biopolitics
• eugenics
• femininity
• sterilization
• GIDC

Introduction

In 1999, Sweden apologized for the 1935–1975 eugenic sterilization program and begun paying compensation to victims of coerced sterilization. Yet, since 1972, a law mandating the sterilization of persons requesting to change their legal gender remained effective until the Stockholm Administrative Court of Appeal ruled it unconstitutional. Until 2013, Trans persons had to prove their infertility, to repel their right to bank sperm or egg cells and if married, to renounce that marriage before obtaining legal recognition by the state. In accordance with the WHO’s ‘International Classification of Diseases’, which classifies ‘transsexuality’ as a mental and behavior disease, access to legal documents was also predicated on the person receiving a mental disorder diagnosis. In 2016, following a lawsuit, Sweden announced that it would begin to pay economic compensation also to transgender victims of state-enforced sterilization. As of July 2016, 23 European states (of which 13 are EU members) still maintain their Trans sterilization laws in effect (ILGA, 2016; TGEU, 2013, 2016).

Historical research on gender and race in the construction of European and American nationalism has revealed the significant role of eugenic ideology and consequent medico-political practices all over the Western world. According to archival government records and scholarly research, a high percentage of eugenic sterilizations were performed on women, immigrants, orphans, the poor, disabled persons as well as those conceived as mentally ill or sexually promiscuous. Both in Europe and in the US, eugenic sterilizations were conducted in public institutions, such as correctional facilities and state hospitals (Largent, 2011; Mattila, 1999; Stern, 2016).

Since eugenic sterilization is usually theorized in relation to reproductive heterosexuality, and seen as a historical practice that targeted the assumed hereditary degeneracy of certain heterosexual and normatively gendered bodies and populations in particular, the history of the eugenics movement has not caught enough scholarly attention in the field of critical transgender studies. Instead, research on the history of transgender subjectivity and embodiment has tended to draw from and build on German sexology, such as the works of Krafft-Ebing and Hirschfeld (e.g. Meyerowitz, 2009; Stryker, 2008). The American eugenic movement’s influence on the formation of gender nonconformity as psychopathology, and the influence of this history on the rationality behind European Trans sterilization laws remain unexamined.

As juvenile, male homosexual conduct and/or juvenile, male transgression of the gender binary was in the late nineteenth- and early twentieth-century American society often perceived as a sign of pre-criminal personality (‘sexual delinquency’) and ‘sexual psychopathology’, many children and adolescents who exhibited cross-gender behavior or mannerisms were ordered to the supervision and custody of corrective reformatories and mental institutions, leading to compulsory sterilization or lobotomy in some cases. Yet, studies on the history of racial and class bias in the early American juvenile justice system, for instance, have tended to not focus on data, statistics and documentation on youths who were sentenced and treated for homosexuality, cross-dressing or for otherwise violating the heteronormative gender binary (e.g. Chávez-García, 2012; Macallair, 2015; Rembis, 2011). In other studies, where existing documentation is taken into account, the focus has been primarily on adult, male homosexuals and ‘inverts’, but not on youths charged for various forms of male and female gender nonconformity¹ (e.g. Eskridge, 2008; Kunzel, 2008; Largent, 2011).

Drawing from Michel Foucault’s theorization of disciplinary power and biopolitics, this paper advances and reconstructs earlier scholarly literature on eugenics through an examination of nineteenth- and twentieth-century penological and psychiatric techniques that contributed to the birth of a discourse on gender nonconformity as psychopathology.

During the shift from the archeological to the genealogical period in his thinking, Foucault examined and lectured widely on institutions such as the prison, the clinic, the military and the school as sites of disciplinary power (2003a, 2006). In Discipline and punish (Surveiller et Punir: Naissance de la prison, 1975), Foucault claims that the ‘criminal’ and the ‘abnormal’ subject, for instance, are effects of power/knowledge mechanisms, such as cross-examination and psychiatric observation, through which the body of the detainee becomes differentiated and inscribed with social norms (1979). Furthermore, disciplinary power, through an ‘epistemological-juridical formation’, generates new regimes of truth about criminality, mental health and sexuality (1979, p. 23).

By the time of the publication of the first volume of The history of sexuality (La Volonté de Savoir, 1976), Foucault contrasted his notion of ‘disciplinary power’ with a new type of power, which he termed ‘biopower’. Rather than surveillance and normalization through specific institutional practices and techniques over the body, biopower operates at the level of life, intervening and regulating every vital aspect of a population, including sexuality, health, nutrition, hygiene, reproduction, immigration and death (Bargu, 2014; Foucault, 1990). Yet, disciplinary power over individual bodies (anatomo-politics) does not disappear with the birth of biopolitics. Rather, the two become coexistent, operating on different levels of society (Foucault, 2003b). A concrete example of this coexistence occurs in Foucault’s analysis of European eugenics and the invention of the biological notion of ‘human race’. According to Foucault, the eugenic discourse on race, sexuality and reproduction connects disciplinary power over the body (anatomo-politics) and regulatory power over populations (biopolitics) (2003b, p. 252).

Utilizing this framework of disciplinary power and biopolitics, I argue that disciplinary techniques contributing to the birth of truth-discourses on ‘boyhood effeminacy’ as psychopathology can be found already in the early, American eugenic matrix among criminology, sexology and psychiatry, that is, much earlier than the Post-World War II sexological literature on ‘transsexualism’. I further contend that since ‘effeminacy’ has historically been associated with ‘[…] lack of fitness for citizenship and the active involvement in state activities […]’ (Hennen, 2001, p. 129), my findings point out a significant link between effeminacy and second-class citizenship. In the context of ‘boyhood effeminacy’ in particular, normalizing power operates not merely on the disciplinary level of the individual body, but also through a biopolitical governing of health, reproduction, family and citizenship.

I construct my argument through a threefold genealogical analysis. In the first part of the paper, I examine the late nineteenth-century invention of eugenic castration and sterilization as both a disciplinary technique over the body and a biopolitical means of regulating degenerate populations. I then move on to analyze how early twentieth-century sexological studies on homosexual inmates of Alcatraz federal prison generated a discourse on ‘male effeminacy’ and ‘female masculinity’ as objectively measurable and statistically quantifiable objects of inquiry. I compare and contrast these studies with psychiatric attempts to redirect and reshape cross-gender behavior and identification in children institutionalized at psychiatric wards during the 1930s–1940s. Finally, the last part of the paper focuses on the cold war, academic studies on ‘effeminate boys’. I argue that in all of these studies, disciplinary power and biopower function conjointly in (1) the production of truths about the connection between gender and mental health and (2) the governing of reproduction. Hence, I view American eugenics, both in its negative and positive form, as an apparatus of normalization that contributed to the formation of gender nonconformity as psychopathology. Furthermore, elements of American eugenic rationality remain operative in contemporary, European biopolitics of Trans sterilization.

From vasectomy experiments to sterilization laws: negative eugenics

In the US, particularly the prison has for the past two centuries been perceived as a site of deviant sexuality and perversion, and hence American penologists, doctors and sexologists have benefitted from working conjointly in their efforts to create methods for quantifying sexual behavior, gender transgression, personality, intelligence and hereditary degeneracy (Hegarty, 2013; Kunzel, 2008; Largent, 2011).

In the late 1890s for instance, Albert J. Oschner, then chief surgeon at St. Mary’s Hospital, Chicago and Harry C. Sharp, a doctor at the Indiana Reformatory, began performing vasectomies on male criminals. Although it is debated whether Oschner and Sharp were, in fact, the first doctors to conduct vasectomies, they are nevertheless the first ones to have explored the eugenic value of vasectomy (Largent, 2011). Sharp’s experiments on ‘masturbators’, for instance, led him to expand his practice to the sterilization of degenerates in general and during his position as a prison doctor, he performed vasectomies on nearly 500 men. Also Oschner argued that sterilization could be used as a cure to treat all types of degenerate populations.

[…] if it were possible to eliminate all habitual criminals from the possibility of having children, there would soon be a very remarked decrease in this class, and naturally, also a decrease in the number of criminals in contact. […] the same treatment could reasonably be suggested for chronic inebriates, imbeciles, perverts and paupers. (Oschner, 1899, pp. 867–868, my emphasis)

Based on his experiments, Sharp urged the State of Indiana to legislate the world’s first compulsory sterilization laws, which became effective in 1907. California, Connecticut and Washington followed Indiana two years later (Largent, 2011). By 1930, over 30 states had enacted sterilization laws. Also anti-miscegenation laws were adopted by nearly all states.

During the early twentieth century, eugenic societies and research institutes such as the British Eugenics Education Society (1905), the German Internationale Gesellschaft für Rassenhygiene (1907) and the Swedish Statens Institut för Rasbiologi (1922) were established (Largent, 2011; Mattila, 1999). All over the Western world, eugenics was held to be a highly respectable science that produced working solutions for combatting the threat of crime and the hereditary degeneration of the human race.

Unlike the popular perception of eugenic sterilization as a practice invented in Nazi Germany’s human experiment laboratories, early eugenic movement supporters included hereditary biologists, scientists, penologists, social workers, educators and even first wave feminists (Rembis, 2011). Due to the fact that criminality was now seen as a biological, hereditary problem, advocates of eugenic sterilization often proposed that it was more humane to prevent degenerates, such as ‘paupers’, ‘prostitutes’, ‘alcoholics’, ‘hysterics’, ‘epileptics’ and the ‘feeble minded’, from reproducing than to have their children incarcerated for inevitable crimes at a later stage in life (Largent, 2011). Here, the connection between American penology and psychiatry is evident also in the fact that even the first references to child psychiatry as a distinct discipline were formulated in conjunction with the establishing of America’s first juvenile court in 1899, and the attempts to prevent juvenile criminality. Whereas juvenile criminality had previously been considered a moral problem, and defined through the same juridical system as adult criminality, it now became a problem related to biological, hereditary factors and personality traits (Chávez-García, 2012; Macallair, 2015; Rembis, 2011).

The earlier century criminological conception of castration as punishment hence evolved in the beginning of the twentieth century into a medical notion of sterilization as a cure. Oschner, for instance, did not view castration or sterilization as a criminal punishment, but as a necessary, medical treatment (1899). Furthermore, Oschner’s and Sharp’s advocacy for state-wide sterilization legislation exemplifies a move from disciplinary power over the body to a regulatory biopower over populations.

How then was violation of the gender binary perceived in the context of the early eugenic movement? In conjunction with the birth of American eugenics in the late nineteenth century, a new conception of manhood emerged in the rising, capitalist, urban culture. Whereas American ‘manhood’ had in the pre-industrial, colonial states been distinguished from ‘boyhood’, by appeal to property rights and the inheritance of land (from fathers to sons), this new, urban ‘masculinity’ was instead defined in opposition to ‘femininity’. Kimmel (1994), for instance, argues that:

Fears of cultural degeneration were fueled by the entry of supposedly weaker and less virile races and ethnicities into the growing northern industrial city […] Many believed that feminization of American culture was synonymous with the feminization of American boyhood, the result of the predominance of women in the lives of young boys – as mothers were left alone in the homes with their young sons, and as teachers in both elementary and Sunday schools. (p. 23, my emphasis)

The masculinity crisis of the late nineteenth-century American society thus fed on a perceived racialized and gendered threat of degeneration. These fears gave rise to the emergence of the figure of the ‘effeminate boy’, or ‘sissy boy’. Physical markers of a ‘sissy’ (from the word ‘sister’) were conceived to be a high-pitched voice, youthful manners, softness, weak muscular structure and unathletic posture. Psychological attributes of a sissy consisted in cowardliness, emotionality, instability, chatter and nervousness (Kimmel, 1994). Femininity in boys hence became a physical and mental sign of pathology.

Kimmel’s historical account sheds light on the impact of industrialization on American conceptions of manhood and boyhood (see also Parsons, 1942). Yet, this account does not explain what kinds of disciplinary and normalizing techniques of power gave room to a discourse that enabled the gendering of these particular forms of behavior and expression as feminine in the first place? Why were American boys in the late nineteenth century perceived as sisterly, instead of simply weak or unfit for instance? How is it that precisely femininity became a primary figure of abjection in early industrial and urban American culture?

I argue that some elements of the already widely accepted nineteenth-century symptomatology of the ‘hysteric woman’ and ‘neurotic woman’ were carried over to the stereotype of ‘the sissy’. Overt emotionality, weak morality and sexual repression were the most important symptoms of hysteria (Foucault, 2006; Schowalter, 1987; Ussher, 1991). As a great amount of women sterilized during the American eugenic movement were diagnosed as hysterics, perceiving these same symptoms in young boys established ‘sissyism’ as a sign of mental degeneracy. The patriarchal ‘hysterization of women’ (Foucault, 1990, p. 146) then contributed to the birth of a discourse on gender in which masculinity was no longer viewed with respect to age, but instead as hierarchically opposed to femininity. As ‘masculine’ and ‘feminine’ became characteristics overlapping both women and men, the eugenic movement’s interest in better breeding soon produced a need to discover, study, discipline and regulate cross-gender behavior and identification. This project of positive eugenics culminated in various attempts to cultivate the heterosexual institution of marriage.

Scientific measurement of masculinity and femininity: a biopolitics of positive eugenics

In the early 1930s, when the American eugenic movement was at its peak, Lewis Terman and Catherine Miles began developing a scientific test (the Terman–Miles M–F test) for measuring masculine and feminine personality. Terman, who was a psychologist at Stanford University, and best known for his invention of the I.Q. intelligence test, believed that earlier sexology was not based on rigorous, quantitative data and mathematical methods of statistics. One of the aims of Terman’s sexological studies was to trace the etiology of homosexuality and sex-role transgression to a hereditary, degenerate condition of low I.Q. (Hegarty, 2013; Stern, 2016). Terman had a number of reasons for studying inmates of corrective institutions, such as reform schools and prisons. Firstly, these were sites where official reports on a person’s (assumed or rumoured) homosexuality and non-normative gender expression were already available, since judges and doctors had to submit reports before the incarceration or institutionalization of such persons. Secondly, Terman knew from previous prison studies that in prisons, men organized themselves according to a social ranking based on stereotypic gender roles. Masculine men held the highest rank, whereas those regarded as feminine, ‘fairy’ or ‘sissy’ held the lowest rank (Kunzel, 2008). This aspect of prison culture made it possible for Terman and Miles to study both masculinity and femininity in men.

American prison officials had high hopes in the M–F test, since they believed that it would help detect homosexuals and prevent sex between prisoners. In their study conducted at the Alcatraz prison in San Francisco, Terman and Miles claimed that ‘passive’, male homosexuals received a higher ‘femininity score’ than female college athletes. Yet, what the M–F test and the 1936 publication of Sex and personality failed to disclose was the homosexuality of ‘active’, ‘masculine’, homosexual men. As these men expressed their gender in ways that conformed to the stereotype and ideal of the butch heterosexual man at the time, they could not as easily be detected, unless caught for homosexual conduct. Hence, in some prisons, the test was regarded as partly useless (Kunzel, 2008).

In order to obtain data on ‘feminine’ and ‘masculine personality’, Terman and Miles also studied girls and women. In one study, the authors conducted interviews and gave a questionnaire to seven 15–20-year-old inmates of the Ventura Home for Girls, a correction institute in California. According to Terman and Miles (1936), girls who received ‘high masculinity scores’ preferred sports, such as basketball, baseball and horseback riding, outdoor activities, mathematics, adventure and the company of boys. They were characterized as highly intelligent, ‘self-controlled […] self-assertive’, good in leadership skills and in conducting manual labor, ‘aggressive, independent in spirit […] self-confident, well poised, and lacking in feminine emotionality’. Furthermore, ‘[…] not one was particularly fond of cooking, sewing or fancywork. Three have always wanted to be boys […] one at least […] is more or less psychopathic’ (Terman & Miles, 1936, pp. 321–333; cf. DSM-V, p. 453). In this study, nearly all activities except for cooking and domestic work were scored as ‘masculine’. Likewise, lack of obedience, emotionality and physical attractiveness resulted in a low ‘femininity score’.

In the numerous studies of Terman and Miles, the disciplinary techniques of observation, measurement, interviews, questionnaires and scoring produce scientific data for the M–F scale, contributing to the birth of the new power/knowledge category of gendered personality. So-called ‘masculine’ and ‘feminine’ expression, behavior, manners, pitch, tone of voice and preference of activities now become intimately linked to personhood, the psyche and intelligence. At the same time, masculinity and femininity become objects of scientific inquiry.

As Terman and Miles regarded low I.Q. as an irreversible hereditary condition, they did not display much interest in developing therapeutic or medical techniques for intervening, repairing or redirecting masculine behavior in adolescent girls. Although they were interested in the question of the relationship between age and M–F status, the Ventura Home population was simply used as data in a more general, biopolitical project for the regulation of sexual reproduction, marriage and the family. Terman and Miles’ attitude was different towards such heterosexual, married women, who exhibited ‘masculine personality’ characteristics. During the 1940s, The eugenicist American Institution of Family Relations (AIFR) began to use the Terman–Miles M–F test and similar psychometric gender personality tests in their attempts to keep women in marriages, even when their husbands were abusive and violent. ‘From 1941 to 1962, at least seventy thousand people were administered’ the AIFR’s gender temperament test (Hegarty, 2013; Stern, 2016, pp. 199–200). Women who complained about their situation were studied and diagnosed by the AIFR as suffering from shame and rejection of their femininity, in other words of a psychiatric condition termed ‘masculine protest’ (Friedan, 1963; Stern, 2016, p. 174, 191). Women who failed to conform with the Postwar ideal of the wife’s function in the white, middle class, heterosexual marriage institution were enrolled in a psychological ‘marital counseling’ program which enforced an obedient and passive ‘gender temperament’ and a biological function of motherhood. Stern (2016), for instance, contends that during the Postwar era, sterilization was no longer considered as an effective tool to breed out hereditary defects and so American eugenics targeted sex, gender and heterosexual reproduction in particular. As this ‘positive eugenics’ focused on a biopolitics of eugenic selection through the marriage institution of the white, middle-class family, the degree to which a person’s gender conformed to their sex became criteria for biological normality. Vice versa, ‘distance and deviation indicated conditions stretching from minor and fixable gender distortion to nearly fatal gender pathology’ (Stern, 2016, p. 189).

The gendered mind of the child in medical studies from the 1930s and 1940s

As late nineteenth- and early twentieth-century American psychiatric research on homosexuality was mainly based on studies conducted on sexually active adult prisoners, not much data existed yet on childhood homosexual behavior. Although experiences in early childhood could be perceived as contributing to the adult’s later behavior, data on childhood experiences were collected through adult recollections and by mapping the history of crime and mental illness in the patient’s family history (Foucault, 2006).

In one of the first clinical studies on the potential relationship among juvenile delinquency, ‘passive effeminate behavior’ and homosexuality in children, Dr Martha Wilson MacDonald, a pioneer in the rising field of psychoanalytically oriented child psychiatry, observed eight criminally charged, aggressively behaving feminine boys between the ages 8.5 and 15 at Michael Reese Hospital, Chicago (1938). All ‘boys’ had a previous history of placement in foster homes or care homes with many having experienced physical and sexual abuse as well as physical and psychological neglect. In her study, MacDonald characterizes the ‘boys’ as ‘seriously neurotic’, violent, aggressive and antisocial, with severe behavioral problems. MacDonald pays attention to a peculiar fact reported by family members, neighbors and teachers, namely, that when allowed in the company of girls and women, the behavior of these ‘boys’ changed dramatically.

At home when permitted to assist mother and grandmother with such household activities as cleaning, dusting, washing, sewing, embroidering and cooking, they are happy […] In play with girls, coloring, drawing, making cutouts, dressing dolls, dramatizing women’s roles, wearing girls’ dresses and hair ribbons, they have been the model playmates. (MacDonald, 1938, p. 71)

MacDonald observes that in addition to their desire to engage in feminine activities, some of the ‘boys’ either seemed to think that they are girls or then express a strong desire to be a girl. After describing each case, MacDonald argues that the explanation for the ‘boys’’ effeminate behavior can be traced to dysfunctional attachment and identification processes, the lack of proper father figures, and finally, because the ‘boys’ ‘had been in complete charge of women’ (1983, p. 71). Drawing from the Austrian psychoanalyst, Paul F. Schilder, MacDonald argues that violent and aggressive behavior is the result of an ‘attempt to overcome strong passive, homosexual drives’ (1938, p. 78). In her study, gender nonconformity is hence understood as a symptom of latent homosexuality. As the subjects of her study exhibited severe forms of aggressive and violent behavior, MacDonald suggested that the subjects be committed to hospital schools. As inmates of hospitals, they would constitute ‘a rich field of research […] about prevention of crime and mental disease’ (1938, my emphasis).

MacDonald’s suggestion to use delinquent, institutionalized children for scientific research reflects a general attitude of the eugenic era. Whereas in the late nineteenth century, mainly adult prison populations were used for medical experiments, from the 1920s up until the end of the cold war, particularly state run orphanages and mental institutions provided test subjects for the growing fields of experimental behavioral psychology and psychoactive drugs (Hornblum Newman, & Dober, 2014). State institutions were ideal because they provided a research setting with a controlled environment and repeated access to human test subjects. Children in particular were sought for neurological studies on development as well as for studying responses to psychotherapeutic, drug and shock treatment.

In a series of clinical studies from 1935 to 1940, 1951 and 1956 to 1963, Dr Lauretta Bender, the inventor of the Bender-Gestalt test, and senior psychiatrist of Bellevue Hospital’s Children’s Services in New York, examined altogether 38 prepubescent children, who had ‘atypical sexual experiences’ and of whom some were ‘preoccupied with problems of masculinity and femininity’ (Bender, 1965; Bender & Grugett, 1952; Bender & Paster, 1941). The children had been committed to the care of psychiatric wards after a history of custody in foster homes, school homes or other institutions from which they had escaped or been removed after involvement with law enforcement. Some were regarded as sex offenders. As in the studies conducted by MacDonald (1938), the majority of the children came from poor or working-class backgrounds and had experienced sexual abuse as well as physical and emotional neglect. There was no control group of ‘effeminate’ or ‘homosexual’ children from middle- and upper-class families. Hence, early research on feminine boys targeted a particularly vulnerable population.

Bender draws from European, psychodynamic and psychoanalytic theorizations on the relationship among personality, sexuality and early childhood experiences for understanding later adult behavior, but criticizes this research paradigm for its exclusive focus on adults (Bender & Paster, 1941). She is instead interested in studying what the development of gender and sexuality in a child reveals about gender and sexuality in adulthood. Rather than studying the already constituted, adult personality, Bender investigates personality in its early stages of development. As a new layer to the previous discourse on adults, disciplinary power in these early studies carves out the child as a gendered and sexual creature. At the same time, age becomes an important mechanism of power/knowledge. The adult, medical and psychiatric ‘expert’ now has epistemic hegemony of the child’s own experience of gender and their contents of the mind (Hornblum et al., 2014). When adult ‘expert knowledge’ contradicts the child’s perception and understanding of their own mental and physical health, the hegemonic power mechanism of age comes into play, directing the young patients to doubt their sense of sanity and to internalize social norms regarding their gender.

Although Bender’s studies attempt to isolate and define the etiology, ontogenesis and symptomatology of childhood homosexual behavior, childhood sex-role confusion and their possible connection to childhood schizophrenia, psychosis and aggression, she hesitates whether sex-role confusion is an early manifestation of homosexuality or schizophrenia and whether or not childhood homosexual activities are in some instances part of ‘normal psychosexual adjustment’ (Bender & Paster, 1941, p. 731). Like MacDonald (1938), Bender also observes effeminacy in boys as the desire to engage in play with dolls, domestic work, dressing up in women’s and girls’ clothes as well as the avoidance of rough, physical play with other boys (cf. DSM-V, p. 453). However, unlike earlier prison, reform school and hospital studies on ‘masculine girls’ and ‘effeminate boys’, Bender distinguished those children whose ‘transvetism’ and ‘homosexuality’ can be treated, possibly cured, through modification and ‘resocialization’, from cases she regarded as ‘psychopathic personalities in need of institutionalization’. The dividing line between these two groups of children was whether or not they could establish an attachment to the therapist or not (Bender & Paster, 1941, p. 742). Hence, the idea of a cure to homosexuality and gender nonconformity as dependable on expert knowledge constitutes an additional mechanism of power/knowledge in the study of children’s sexuality and gender.

Trained as a neuropsychiatrist, but deeply influenced by the work of her husband, the Viennese psychoanalyst Paul F. Schilder, Bender balances between psychodynamic therapy, Gestalt psychology, positivist behavior modification and medicinal therapy. She understands not only the child’s psyche but also the child’s brain in developmental terms, as a compound that can potentially be reshaped through therapeutic, medicinal and shock treatment by professionals. During her career as a child psychiatrist, Bender, for instance, experimented with the previously untested use of amphetamine (Benzedrine) in treating ‘sexually stimulated children’ as well as child victims of sexual abuse and incest (Bender, 1965, p. 700, 1970, p. 266). She also actively promoted electroshock and insulin shock therapy on children (Bender, 1970; Kneeland & Warren, 2002).

In contrast to Terman and Miles’ Sex and personality, Bender was a pioneer in arguing that homosexuality in childhood was not a hereditary and degenerate condition related to low intelligence. She saw it instead as a result of disturbed childhood attachment processes, a view promoted much later by the American psychiatrist Robert Stoller (1968). It is my contention that Bender’s studies from the 1930s to the 1950s clearly constitute a discourse on gender nonconformity and deviant sexuality that precedes Alfred Kinsey’s and Harry Benjamin’s studies on ‘transsexuality’. Yet, her work on children’s sexuality and gender identification has not previously been theorized as part of a larger, disciplinary and biopolitical apparatus of positive eugenics that eventually gave room for the formation of gender identity disorder of childhood (GIDC) as a DSM-classified mental illness.

Behavioral modification experiments and the birth of GIDC

A few decades after Miles and Terman’s Sex and personality, and MacDonald’s and Bender’s first clinical studies on gender nonconforming children, a number of American psychiatrists and sexologist began studies on young patients referred to their practice by parents concerned about their child’s a-typical gender expression. In contrast to earlier sexological studies conducted on orphan, neglected and runaway children, who were involuntarily committed to correction institutions and mental hospitals, the new population of research subjects consisted of children referred to clinics by their own parents.

Nearly, all subjects of the studies from the 1950s to the 1980s were so-called ‘effeminate boys’, whereas studies on ‘masculine girls’ were minimal. Much of the research attempted to identify, quantify and redirect the child’s cross-gender behavior into a more socially acceptable and heterosexual behavior (e.g. Drummond, Bradley, Peterson-Badali & Zucker, 2008; Green, 1987; Green & Money, 1960, 1966; Rekers, 1982; Rekers & Oram, 2009; Zucker, 1985; Zucker, Wood, Singh & Bradley, 2012). Although some of the studies included ‘boys’ from non-white families, none of the studies examined possible variations in gender expression with regard to class and race. Once again, not only heteronormativity, but also class and race operated as normative frames for measuring ‘sex-typed behavior’ (Feder, 2007; Hegarty, 2009).

A majority of the research on ‘effeminate boys’ consisted in conducting diagnostic interviews and behaviorist observations of the children at the clinics’ playrooms, in the children’s homes, and at school. Psychiatrists and sexologists attempted to classify the children’s gestures, posture, pitch and tone of voice, manners as well as play style and toy preference as fitting objectively to either the ‘masculine’ or the ‘feminine’ spectrums of behavior, with control groups consisting of ‘normal’ boys. In contrast to Terman and Miles, MacDonald and Bender, the new generation of psychiatrist operated with a novel ‘taxonomic framework’ of terms, such as ‘gender identity’ and ‘gender role’ (as opposed to ‘sex role’), that John Money had launched (Germon, 2009; Zucker & Bradley, 1995, p. 8). Through longitudinal studies, taxonomy and measurement of ‘gender atypical’ and ‘gender typical’ behavioral frequency, the young patients were then diagnosed as suffering from ‘extreme effeminacy’, with a prognosis of possible development into full-blown homosexuality or transsexuality in adulthood (Green, 1987).

According to Bradley and Zucker (1990), therapeutic treatment approaches included ‘[…] behavior therapy, psychotherapy, family therapy, parental counseling, group therapy, and eclectic combinations of these approaches’ (Bradley & Zucker, 1990, p. 482). In the cold war era of positive eugenics, sterilization and castration were no longer regarded as efficient treatment methods, although sterilizations still occurred in adult prisons and mental institutions. Stoller (1968), for instance, regarded the existing Californian and Scandinavian castration legislation as beneficial only to dangerous types of ‘sex psychopaths’ (p. 246).

In 1987, Richard Green, a student of John Money, published The ‘sissy boy syndrome’ and the development of homosexuality. This study, which followed 66 ‘effeminate boys’ over a period of 15 years, became the pioneer work for establishing 2 new mental illness classifications in the DSM-III (1980), namely, GIDC and adult transsexuality (Bryant, 2006). The 2013 redefinition of ‘gender dysphoria’ in the DSM-V was also based on the GIDC diagnosis, as the concept of ‘dysphoria’ was in clinical use already in the literature from the 1980s (e.g. Steiner, 1985).

During the time when Green was conducting his research, George Rekers and Ole Ivar Løvaas also began conducting behavior modification experiments on ‘effeminate boys’ through a token system of rewards and punishments (Rekers, 1982). Løvaas already had a successful career in experimenting the use of physical punishment and electroshocks in the treatment of autistic children (Moser & Grant, 1965).

One of Rekers’ most famous test subjects was a four-year-old ‘boy’ who appears in Rekers’ literature with the pseudonym ‘Karl’. Rekers describes ‘Karl’s’ failure to meet the expectations of masculine behavior in the following way: ‘[…] he seemed void of masculine behaviors, being both unable and unwilling to play the ‘rough-and-tumble’ games of boys his age in his immediate neighborhood … he declined to defend himself among peers, and he was fearful of getting hurt’ (Rekers & Løvaas, 1974, p. 175). ‘Karl’ was more interested in playing with girls, dressing up in their mother’s clothes and using make-up and pearls. These descriptions of ‘boyhood effeminacy’ are highly reminiscent of the earlier studies conducted by MacDonald (1938) and Bender and Paster (1941). Yet, what constitutes the disciplinary technique of ‘treatment’ is unique to Rekers & Løvaas’ experiment.

In order to interfere with ‘Karl's’ ‘cross-gender identification’, they was put in a clinic playroom with toys that had been sex-typed as either masculine or feminine. Rekers and his students observed the child from behind a dark glass in a room outside the playroom. ‘Karl’ was then given blue reward tokens for ‘sex-typed affect expression’, in other words, ‘masculine aggression’ (Rekers & Løvaas, 1974, p. 176) and for playing with

[…] a plastic football helmet, a sea captain’s hat, an army helmet, an army ‘fatigue’ shirt with stripes and other military decorations, an army belt with hatchet holder, and a battery-operated play electric razor. […] guns with darts … and a set of plastic cowboys and Indians (42 pieces, 2 in. tall each).

If ‘Karl’ on the other hand was playing with ‘[…] girls cosmetic articles and girls apparel, consisting of a woman’s wig, a long-sleeve dress (children’s size), a play cosmetic set (lipstick and manicure items), and a set of jewelry consisting of bracelets, necklaces, rings and earrings … ’ (Rekers & Løvaas, 1974) and showing the ‘sex-typed affect expression’ of ‘maternal nurturance’, they was given red punishment tokens. Depending on how many blue and red tokens ‘Karl’ had received by the end of the day, they was either taken out for ice cream or beaten up by their father. What would account for child abuse in contemporary terms was an intentional treatment method in Rekers’ experiments.

In Rekers’ behavior modification experiments young ‘girls’ referred to the clinic due to male identification or masculine behavior were rewarded for playing with feminine and gender appropriate toys, such as a ‘Barbie doll’, a ‘baby doll’, cooking utilities, jewelry and dresses, ‘high heel shoes’, and wigs and make-up, whereas playing with ‘plastic race cars’, ‘plastic soldiers’, ‘airplanes’, ‘walkie-talkies’, a ‘basketball’ or ‘marbles’ led to the absence of reward (Burke, 1996, pp. 4–19; Rekers & Oram, 2009). Likewise, in a study inspired by Zucker’s work, Bailey, Bechtold, and Berembaum (2002) measured masculinity in ‘tomboys’ by observing the participants play with ‘feminine’ (‘dolls and accessories, kitchen supplies, play jewelry and cosmetics’) and ‘masculine’ (‘vehicles, Lincoln Logs, transformer, and gun and holster’) toys. In none of these studies did the authors regard the specific cultural and geographical context of toys – such as ‘cowboys and Indians’, a ‘Barbie doll’, ‘Lincoln Logs’ or a ‘Transformer’ action figure – as a variable that might have influenced the ways in which children’s toys were perceived as sex-typed.

According to Feder (1997, 2014), the clinic, the home and the school constitute a Foucauldian panopticon, through which disciplinary power is internalized not only by the children in treatment, but also by their parents, neighbors, teachers and fellow students. The child and the parents participate in the practice of confession of the violation of sex-typed gender roles, whereas the neighbors, teachers and schoolyard children participate in the surveillance and correction of these violations (see also Pyne, 2014).

Bryant (2006, 2007) has shown that early critiques of Green, Rekers and the GIDC diagnosis in general targeted the underlying bias of homophobia in these studies (i.e. Green, 1987; Rekers, 1972). The argument of Sedgwick (1991), for instance, in the famous essay ‘How to bring up your kids gay’ is that the GIDC diagnosis (and adult transsexuality) appeared in the DSM-III (1980) at the same time when homosexuality as a mental illness was removed from the DSM. Hence, the GIDC category enabled the targeting of homosexual children and brought the pathologization of homosexuality into the DSM-III through the backdoor. This argument forms the core of also Rottnek (1999). However, as Bryant argues, these critiques strengthen the clinical and historical notion that childhood gender nonconformity and adult sexual orientation must be seen as essentially interconnected, whereas in reality the question is far more complex. The main motivation of Sedgwick’s critique then is not the pathologization of gender nonconformity per se, but the targeting of an adolescent group of homosexuals.

In 2005, Zucker and Spitzer (2005) responded to critiques of GIDC by appeal to a wide range of clinical examples and rationales. They argue that GIDC was based on ‘expert consensus’. However, I argue that the authors do not address how ‘effeminate boys’ became a population worth to be studied, diagnosed and treated. The disciplinary techniques around gender nonconforming children reveal how heteromasculinity in the experiments was constructed through repetition and ritual. It took hundreds of clinic sessions and at times years of treatment in order for the subjects to internalize the particular, culturally and geographically coded ideal of masculinity, and even then, the patients often failed to perform their gender in accordance with this ideal. The studies moreover reveal an important paradox. The psychiatrists claimed that violent masculine behavior is biologically inherent and natural to the ‘male sex’, and yet the clinics had to desperately try to generate this type of behavior through strict, laboratory controlled repetition, ritual, punishment and reward.

Although critics, such as Feder (1997, 2007) and Pyne (2014), have attempted to frame the experiments of Green and Rekers in particular through Foucault’s account of disciplinary power, they do not examine the biopolitical, regulating power discourse of positive eugenics that made it possible for Money, Green, Rekers and others to experiment with these children in the first place. I argue that since the 1930s, the research tradition on gender nonconforming children has operated not only through disciplinary techniques over the individual body of the child, but also through a biopolitics of health, reproduction and citizenship. As eugenic practices evolved through Indiana State Reformatory’s sterilization experiments to Terman and Miles’ early configurations of positive eugenics, a certain ideal of sexually responsible citizenship was strengthened. Positive eugenics operated through a normative matrix in which the white, middle-class, heterosexual nuclear family became a site of biopower. As the American social and political order depended for its existence and legitimation on a future-oriented ideal of healthy, racially fit citizens and future generations, citizenship and rights became linked to sexual reproduction, leaving those who were unwilling, not able, or not allowed to reproduce as abject. It is in this biopolitical context that ‘boyhood femininity’ and adult ‘male effeminacy’ as subjects of immense government sponsored research must be understood.

Conclusion

The rationality of the ‘sissy’ as pathological was present already in the early generation of the American eugenic movement. By the mid twentieth century, a whole apparatus of negative and positive eugenic techniques had been developed, tested and deployed for the governing of feminine boys. Through my genealogy of gender nonconformity as a psychopathology, I have aimed to show that the late nineteenth- and early twentieth-century figure of the ‘sissy’ reappears in a new form in the clinical literature on GIDC. Not as the feebleminded invert or masturbator troubling American and European eugenicists, nor the delinquent young child with ‘atypical sexual experiences’, but as the child suffering from a mental disorder called ‘sissy boy syndrome’.

Today, academics, advocate and activist groups, Parliaments of European states as well as medical professionals debate the removal of the WHO and DSM diagnoses. Both the UN and The Council of Europe Commissioners for Human rights have addressed the transgender mental illness diagnostic procedure as well as government enforced sterilization practices as human rights violations. Nevertheless, these debates are largely ahistorical and focus mainly on legal questions concerning access to affordable medical care and insurance. The debate centered on the current legal framework is urgent. Yet, an understanding of the history of American influence on European eugenic sterilization practices and the connection of the eugenic rationality to present-day biopolitics of Trans and intersex populations remains incomplete. In other words, a history of the present, in Foucault’s sense, is missing.

Some scholars such as Rabinov & Rose (2006) and Rose (2007) have argued that the era of eugenic sterilization in Sweden came to an end in 1975 and that references to eugenics in contemporary debates have merely a rhetorical function since the governing of populations no longer operates ‘according to the biopolitical diagram of eugenics’ (Rabinov & Rose, 2006, p. 210; cf. Reilly, 2015; Rose, 2007, p. 60–61). Yet, the apparatus of negative and positive eugenics that I have teased out from the historical examples of American criminological, sexological and psychiatric studies shows that to the contrary, eugenic thinking has not disappeared. Rather, it has evolved into new disciplinary and biopolitical forms of power. Even if ‘eugenics’ originally meant ‘maximizing racial fitness in the service of a biological struggle between nation states’ (Rabinov & Rose, 2006, p. 210; cf. Reilly, 2015), and does not operate precisely in this same form in today’s context of neoliberal capitalism, I contend that it is urgent to ask what types of truth discourses and apparatuses of power the eugenic movement did set forth? Furthermore, it is my contention that the contemporary biopolitics of Trans sterilization would not have made sense and would not have been possible without the previous history of eugenics.

Acknowledgements

I wish to thank the two anonymous reviewers for detailed comments on previous versions of this paper. I also thank Sander Gilman, Peter Hegarty and Alexandra Minna Stern for valuable suggestions during the course of my research that led to this paper.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes on contributor

Julian Honkasalo is a Kone Foundation postdoc scholar in gender studies at the University of Helsinki as well as a Ph.D. candidate in politics at The New School for Social Research (NYC). Honkasalo’s research project ‘Unfit for citizenship: Eugenics and the pathologization of gender nonconformity’ (2015–2018) advances and reconstructs earlier scholarly literature on twentieth-century eugenic discourses by examining sex-reassignment related sterilization legislation in Scandinavian countries from a Foucauldian, genealogical perspective.

Additional information

Funding

The research was funded by the Kone Foundation.

Notes

1. Although I analyze historical periods that precede the works of John Money (who coined the term ‘gender’), I use the umbrella term gender nonconforming as an adjective to denote various lives that violate the heteropatriarchal gender binary, as well as to describe persons who might have self-identified as transgender or genderqueer in today’s terminology. I use quotation marks (‘boy’, ‘girl’) and the neutral pronoun ‘they’ to denote persons assumed by courts or psychiatrists to be boys or girls without knowledge of their own self-identification. For a genealogical reading of John Money’s notion on gender, see Germon (2009).