Author Interview with Sandra Eder: How the Clinic Made Gender

June 13, 2023

Sandra Eder is a history professor at UC Berkeley. In 2022, she wrote How the Clinic Made Gender: The Medical History of a Transformative Idea, a book that explores the history of how the concept of gender emerged out of the medical sector and influenced society. Eder was interviewed during Pride Month 2023 as issues surrounding gender expression and identity were at the forefront of public discussion.

What sparked your idea to write a book on this topic?

In my research, gender always played an important role, but I increasingly became interested in the history of gender itself. I discovered that the term “gender” was first used in medicine in the 1950s when clinicians introduced a new concept of sex, claiming that experiences rather than biology shape much of what we identify as masculine and feminine behavior — or as they called it, gender role.

This raised a set of questions for me: How did we start thinking about gender as shaped by learning, by environment, and by culture? How and why did this shift happen and what are the implications for the emergence of what we now call the sex/gender binary, the often problematized idea that sex is biological while gender is cultural? What were the consequences for the people, many of them children, who found themselves as the objects of these investigations? With these questions in mind, I set out to historicize this formulation of “gender” and to tell what I call an uneasy origin story, an inconsistent history that is with us to this day in recurring, highly contested debates about the true nature of gender and sex.

Your book covers the development of gender through clinical practice in the 1950s. Even as midcentury physicians revealed the differences between sex, gender roles, and gender identity, they still stuck to binary gender constructs and heterosexuality. To what extent were social norms still influencing their thinking?

Social norms were actually the basis of the clinicians' new definition of gender. In the late 1940s, physicians who were seeing children with intersex traits at their clinics wondered how to determine their ‘correct’ or ‘true’ biological sex, especially when they were newborns or infants. They were wondering which of a set of sometimes contradictory sex variables should determine whether a child should live as either a boy or a girl— and these categories included gonadal sex, hormonal sex, chromosomal sex, genitals, internal reproductive structures, and assigned sex/sex of rearing.

At the Johns Hopkins Hospital and its adjacent children’s hospital, a team of clinicians consisting of pediatric endocrinologist Lawson Wilkins, psychologist John Money, and psychiatrist couple Joan and John Hampson tried to solve this ‘problem.’ They argued children learned to be a boy or a girl while growing up. They claimed that their evaluation of about 100 children with intersex traits had shown that these children most consistently identified with the sex they were raised in, even when it contradicted their sex chromosomes, gonads, or genitals. Gender role was a new term they introduced to describe “all those things that a person says or does to disclose himself or herself as having the status of boy or man, girl or woman, respectively.” You could assign these children as male or female at birth, they claimed, and they would grow up in the respective gender role.

There was no escape from this binary, however. Social differentiation between boy and girl was considered as pivotal to raising well-adjusted children. Money and the Hampsons were convinced that children had to be raised within the social norms of being male or female. They based their definition of masculinity and femininity on contemporary social norms.

Think about it this way: Once biological sex was pushed off its pedestal, gender had thus to be rooted in social norms. This meant, for example, that girls were meant to be caring, gentle, domestic, and aspiring to marriage. Even more important was sexuality. Heterosexuality was a sign of proper adjustment to one’s gender role. One of the consequences was that a focus on culture and environment could be as deterministic as a focus on biology.

This Pride Month has felt especially fraught for trans folks. What do you hope readers will take away from How the Clinic Made Gender, and in particular, what do you wish more people understood about gender and sex?

As a historian, I would like for people to understand that the ways in which we think about gender, about sex, about masculinity and femininity have a history. They change over time, they are shaped by their context — by social, cultural, and political circumstances — and by evolving ideas about who counts as a human, whose story is being heard. For example, in the 1960s, medical protocols for what was then called ‘transsexuality’ were developed to follow the Hopkins model of binary gender roles and heterosexuality. Trans individuals were pathologized, and offered a narrow definition of gender that often did not reflect their lived experiences. Trans activists early on challenged this normative understanding of gender that was used to gatekeep access to gender-confirming care.

In the 1970s, gender left the clinic and was appropriated by different groups, often in ways that contradicted the narrow definitions developed at Hopkins. Feminists argued that if gender roles were learned, they could be unlearned. Women and girls could be boisterous, independent, play with cars, even fall in love with other women and girls, and would still be female. Queer communities applied the term “gender” to practices in which they mixed gender signals and roles to call into question the sex/gender binary of male and female.

In other words, gender is a dynamic concept shaped and informed by shifts in American culture and policies. Gender matters; it is the site of ongoing social and cultural struggle about who owns the word as an idea, who may instill it with meaning, define its implications, and judge its importance. This is obvious in recent moral panics around trans folks that seek to strip them of their human rights. It is important to understand that the meaning of gender and of categories like “woman” have always been historically contingent — and saturated with politics too.

It’s been just over a year since How the Clinic Made Gender came out. How has that experience been for you as an author?

It has been a wonderful and rewarding experience. I had the opportunity to connect with different communities and learn about new forums in which these important themes are being discussed. Radio interviews, podcasts, and talks are such a wonderful way to engage with audiences in different ways and these engagements pushed me as an author to think even more about the historical, political, and personal implications of my work. I have met a lot of great folks while promoting my book.

You’re working on another book, The Science of Happiness: Gender, Identity, and Measurement. How will this book build on your previous work?

As I was working on How the Clinic made Gender, I was — again and again — struck by the centrality of happiness in medical care. It occurred to me that in the medical management of transgender, intersex, and homosexuality, happiness often appeared as a treatment incentive, the focus of prognosis, and the assessment of treatment success. The new book explores happiness as an indicator of a new notion of sexuality and health throughout the twentieth century.

Sandra Eder

​S​andra Eder is an associate professor in the History Department at the University of California, Berkeley. Her research expertise lies in topics of gender, sexuality, and medicine. She is the author of How the Clinic Made Gender: The Medical History of a Transformative Idea (University of Chicago Press, 2022), which examines the emergence of our modern sex/gender binary in mid-twentieth-century clinical practices in the U.S. Learn more