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A scientist has not been burned at the stake in over 350 years – and even then it was Giordano Bruno, not Galileo. Find out how Professor Alice Dreger (PhD) become an advocate for survivors of intersex sexual reassignment surgery and she becomes a strong candidate to be burned in effigy by those for whom she was advocating.
This is a reposting of a book review from 2015, now included as a podcast (originally recorded on April 29, 2015 with Alice Dreger, PhD, Professor of Medical Humanities, Northwestern Feinberg School of Medicine).
With transgender dynamics, identity, politics, and everything exploding in the headlines, the need for empathy around sexual identity and related issues is even more urgent and timely today than when originally broadcast.
Join me for a conversation with Alice Dreger about the conflict between scientific evidence and some interpretations of social justice and “empathy” (in quotation marks). Dreger starts out as a graduate student exploring the condition [previously] known as “hermaphroditism,” people born with sex organs that are ambiguous as to male or female, now called “intersex.”
In reading the text books studied by her medical student husband, she discovers the interventions performed to “normalize” people sexually into the two canonical categories of male or female. The parents usually follow the recommendations of the physician-surgeon who are articulating a supposed community standard that one’s genitals should unambiguously be either male or female. Dreger discovers that many of the people whose genitals were surgically transformed were subsequently lied to about their natal [birth] sex by well-intentioned doctors and well-intentioned parents following the well-intentioned doctor’s guidance. Thus, the road to hell. Find out what happens when Dreger’s research surfaces evidence that does not align perfectly with the interpretation of a social justice agenda.
This is a powerful and disturbing work. Dreger delivers a compelling narrative. A penis smaller than a person’s adult thumb or clitorises larger than one little finger, according to (some) conventional wisdom, have got to go. I am not making this up. The standard procedure was to surgically “delete” the offending member and surgically construct [some version of] the female genitals. This will, of course, resonate with Freudians everywhere as something motivated at the deepest levels of the unconscious. Not so Freudian is the proposition that if sex assignment from male to female and the raising of the infant as one rather than the other sex is the consequence, so be it. (Dreger is not interested in Freud in this text – that is my hobby.)
Dreger marshals evidence that people whose genitals are not surgically transformed as infants – but who have non-standard but otherwise healthy functioning genitals – are not worse off than those whose genitals were modified, and in many cases flourish. In at least one case, where the boy could not urinate standing up – and write his name in the snow with the stream of urine – due to the opening to the urethra being beneath the pen, the result of the surgery often produces a “cripple”. Yet the surgery continues to be performed. In other instance, the major concern expressed by the medical text books was that the child would become lesbian or gay. Ouch.
Dreger “goes to bat” for these intersex individuals, recovering their narratives out of medical records and journals where they had been documented as cases. She advocates for them. She lobbies, blogs, publishes in the popular press. Then the unintended consequences hit. Some of those for whom she is advocating don’t like some of the evidence Dreger publishes. It is not sufficiently “on point” about transgender issues being exclusively a function of a man’s brain born in a woman’s body or vice versa. The idea that a man could love himself as a woman and so want to become a woman does not compute.
As one might expect, research produces subtle nuances that require more than a sound byte or even a blog post. Suddenly Dreger finds herself the target of anger from the advocates for whom she was lobbying. It is not pretty. It gets ugly. Think self-righteous indignation as an expression of narcissistic rage and having one’s deeply felt values questioned by the evidence. There is no easy way to say it: some advocates of social justice seem to feel that the end justifies the means. The “means” include rampant forms of bullying and in-your-face confrontation, including charges of dubious ethical violations, invalid research, fictional claims about the researcher’s relations with his or her children and family, and the posting of toxic gossip on the Internet. The cause may be righteous, but the behavior is wicked and mischievous if not heinous.
Dreger survives and is vindicated. But then she begins to wonder if her experience of the collision of scientific evidence with advocacy and versions of its conventional wisdom was exceptional. Like most survivors she asks: “Is it just me?” It is not. It reminds her of the conflict between Galileo and the sedimented beliefs of the Church of his time.
A point that underlies Dreger’s work and may usefully be made more explicit: The facts of empirical science are fragile. Not only can they be shouted down by bullies, purged by tyrants such the Italian Inquisition of the 16th century, or simply ignored by the average person, the facts can also be set upon by academic, university, or institutional agendas more dedicated to building a corporate brand – and being financially well funded – than attaining an evidence-based version of the truth.
(An early version of this thesis, perhaps unknown to Dreger, is Hannah Arendt’s work on Truth and Politics. Not a historian of medicine but of political theory, Arendt makes the powerful point that if all versions of Euclid’s Geometry had been destroyed, mathematicians would still be able to recreate formal geometry out of the a priori forms of space and time; but if Stalin had really succeeded in purging all examples that such a person as Leon Trotsky had existed, then we really never would have heard of such an individual’s factual existence. Facts are fragile. )
A case in point. It is conventional wisdom since Susan Brownmiller’s Against Our Wills (1975), that rape is primarily an act of power by the perpetrator (usually a man), not one of sex. While not primarily a scientific treatise, it becomes the basis for research that gathers sufficient evidence and the thesis “power not sex” becomes “conventional wisdom.”
Enter a young (male) scholar who has a strong hunch he can prove an exception to the rule. No, sometimes rape is motivated by sex. Sometimes a guy, who has no prospect that the intended woman would have sex with him (but who he desires sexually) decides to use force. This naïve academic sees a dissertation topic that is a cut above the usual scholarly drivel. A dissertation is delivered to that effect. Not only does all hell break loose – he is silenced by angry activists – but it gets worse. The phone rings. It is a prosecuting attorney needing help with a case.
The District Attorney is bringing charges against a perpetrator, an alleged rapist standing trial for his crime. The defense is arguing effectively that science has shown that rape is about power, not sex. The perpetrator could not possibly have been motivated to the crime by sex. Science says so. Wait a minute. Rape is never about sex? It is now a defense against rape that there was no other motive than sex?
Since 1975 we have seen date rape and the use of incapacitating “date rape drugs” such as anesthetics facilitate the violation. Surely advocates and scientists can encompass the possibility that sometimes rape is about power, sometimes it is about sex, and sometimes, it is both (p. 125). Don’t be too sure. There is a deep lesson about human nature here. Constant dialogue is needed to keep people in rational communication without distortion and manipulation. The desire to be righteous and justified is pervasive and extends across all political spectrums. The ability to listen has rarely been in such short supply.
Another case. Napoleon Chagnon writes an innovative and disruptive work of anthropology (Yanomamö: The Fierce People). He argues that Margaret Mead’s vision of a peaceful coming of age in Samoa in a sexually liberated version of a hippie-like commune may not be the only paradigm of the life of native indigenous peoples. (Mead herself was subjected to a debunking, the factual basis of which turned out to be, shall we say, less than rock solid.) The Yanomamö in South America are more like warring bands of Hobbes’ “war of all against all” or the tribes of the Peloponnesian peninsula, with Achilles throwing a narcissistic fit – “I stole her fair and square” – because Agamemnon took his plundered woman.
Chagnon is a virtual Dreyfus Affair in the American Association of Anthropologists. Alfred Dreyfus (you may recall) was stripped of his epaulets, his campaign badges ripped off his chest, and he was banished to Devil’s Island (my metaphor, not Dreger’s). Years later, Chagnon is vindicated (as was Dreyfus) and “rehabilitated.” But only after years of upset, suffering, and the monumental expense of mounting a defense against false accusations as recounted in his My Life Among Two Dangerous Tribes – the Yanomamö and the Anthropologists. The bottom line? According to Dreger, in addition to the political infighting, wicked and mischievous gossip, and an alleged series of narcissistic injuries unintentionally committed by Chagnon against colleagues, it was politically inexpedient to represent indigenous peoples as warlike.
Dreger documents in detail the appalling political intrigues, plots misfired and rebounding onto the heads of the perpetrators, and the narrow mindedness of academics who ought to have adhered to scientific standards rather than tit-for-tat gamesmanship. Dreger’s work is definitely a page turner, reading like a spy novel or an account out of Kafka’s The Trial. Speaking personally, it made me paranoid at points. I felt discouraged at the alternating narcissistic rage and petty retaliation enacted for real or imagined slights to which both scientists and advocates for social justice seem all-too-prone.
The drama goes on. It escalates. Maria New, MD, is a celebrity woman’s doctor of long service and, at least initially, significant distinction. Dr New advocates that early stage pregnant women take dexamethasone (off-label, though FDA approved to prevent miscarriage) when the parental profile shows a one in eight chance that the female fetus may have congenital adrenal hyperplasic (CAH)). Basically CAH means that the baby might be a “boyish girl” if left untreated. Heavens to mergatroid – a lesbian? But since there were never any controlled studies of the consequences of taking dexamethasone (dex), it is not clear if the cognitive impairment, the deformed genitals, other anomalies, were due to the action of the drug or whether the drug was simply ineffective for its off-label use.
Dreger believes she has an “open and shut” case of an ethical violation that research subjects were not informed that they were participating in what amounts to a experiment, a far cry from a “safe and effective” treatment. The FDA oversight representative embedded in the research teams raises a number of red flags. Her career is ended on a pretext, and Dr New transitions to a different university without so much as a warning in any file.
One thing is for sure. Taking the case to the FDA and the Office of Human Research Protection (OHRP) reveals a level of indifference, human clumsiness, and subtle, unexamined conflicts of interest and self-dealing that again approach’s Kafka’s The Trial. Appalling. By the way, if ones want to receive this treatment during early stage pregnancy with the hope of dialing down the masculinization of the fetus, it is still legally available from Dr New and her associates, though Dreger has made it her project to dominate the Google listings with warnings about the risks of the treatment.
Dreger’s point is that the use of dex to influence the process of masculization of the fetus is experimental as used off label (the “on label” use is not to treat CAH, but to prevent miscarriage, for which it seems to be effective). The women to whom it was given to treat CAH were never told and never signed an informed consent form to participate in what was basically an experimental use of the drug. “Safe and effective” remains unproven for CAH, and evidence to the contrary is emerging. However, what really put the kabash on the treatment with dex is that it has been branded an anti-Lesbian drug. More good news. It is not as bad as thalidomide; but possibly another DES fiasco in the making.
In conclusion, Dreger offers reflections inspired by the Founding Fathers of the early days of the United States and such politician-statesmen as Benjamin Franklin. No stranger to risk, Franklin was both flying a kite in a thunderstorm and building a structure of government capable of correcting its own errors (not on the same day). Thanks to such men, we are all better off than Galileo when speaking truth to power. Free scientific inquiry needs a free social and fair political space to flourish. Justice requires access to accurate facts and a way of testing evidence that distinguishes fact from fiction The truth is vulnerable to the influences and distortions of the social organization of power.
Granted that a scientist has not been burned at the stake for over 500 years, that is no reason for complacency. I could not help but think that Professor Dreger was well on the way to being a candidate, though admittedly the burning was “in effigy.” Bad enough! There have been many ruined careers and damaged lives due to bullying and political abuses. Dreger bemoans the “push down” of the press and investigative journalism – in short, the decline of the press beneath the pressures of a publishing market in distress, the Google-ad-industrial-complex, and on the Internet no one knows you are a dog. While the Internet is a multi-edged sword and sends fear into the hearts of tyrants everywhere, it is easy to abuse. It is a dubious format for rational discourse and evidence-based anything. That should not stop one from posting her or his peer-reviewed research (this is not an example of that) but it means one must also mount the soap-box on a regular basis and speak truth to power.
Alice Dreger. (2015). Galileo’s Middle Finger: Heretics, Activists, and the Search for Justice in Science. New York: Penguin.
(c) Lou Agosta, PhD and the Chicago Empathy Project
Biology is not destiny. As Simone de Beauvoir noted in The Second Sex, woman is not a mere womb. Likewise, I note: man is not mere testosterone. [Note: This post is an excerpt from the final section of Chapter Seven on my book: A Critical Review of a Philosophy of Empathy, available here: click here to examine complete book.]
Biology is important, but biology is not destiny. That was one of the key points of the feminist revolution. Raising children is a job – a big job; and so is being the CEO of IBM as was Virginia Rometty until earlier this year.
The matter is delicate. These human beings – we human beings – are an aggressive species. It is usually the men that are doing the aggressing. That is indeed a function of testosterone – as well as upbringing [child rearing practices], enculturation, and the evaluation of the species.
Common sense suggests that woman is the more nurturing gender, given her role in giving birth and keeping the home fires burning in agricultural, hunting, and traditional indigenous cultures. Women are keeping the home fires burning, so what are the men doing? Men are out systematically doing battle with saber-toothed tigers and hostile neighbors. If this seems like an over-simplification, it is. Yet it is a compelling one, given the evolution and history of the species.
This issue of empathy and gender becomes controversial. Claims have been made that a man’s brain is different than a woman’s. In particular, men are “wired” for systematizing; and women are “wired” for empathy – for relating, especially relating to children and other human beings in general. This research – usually credited to neuropsychologist Simon Baron Cohen but also to Frans de Waal – has for sometime now been debunked – shown to be limited, distorted, and flat out wrong.
When one looks at the methods and the data in detail, no consistent gender difference in empathy have been observed – read on!
I provide the reference point upfront. As noted, the research by Simon Baron Cohen that men’s brains are “wired” for systematizing and women’s for relating and relationships are questioned and indeed debunked in Robyn Blum’s article in Heidi L. Maibom, ed. (2017). (For Bluhm’s original article see The Routledge Handbook of the Philosophy of Empathy. London/New York: Routledge (Taylor and Francis): 396 pp. )
Robyn Bluhm’s article probes the research on the evidential basis of this nurturing role and inquires: does it extend to empathy and how far?
Early gender-empathy studies were vulnerable to self-report biases and gender stereotyping that pervasively depicted females in a biased way as the more empathic gender. According to Bluhm, these early studies simply do not stand up to critical scrutiny. Case closed on them. Dismissed. Enter Simon Baron-Cohen and his innovative research, renewing the debate and shifting it in the direction of neural science as opposed to social roles and their self-fulfilling stereotypes.
Bluhm points out in detail that as Baron-Cohen’s work gained exposure and traction in the academic market place of ideas subtle shifts occurred in his presentation of the results. At first Baron-Cohen highlighted measures that were supposed to assess both cognitive and affective empathy, but later the affective dimension fell out of the equation (and the research) and only cognitive empathy was the target of inquiry and was engaged (p. 381).
Though Baron-Cohen’s initial research described the “male brain” as having “spatial skills,” his later publications, once he became a celebrity academic (once again, my term, not Bluhm’s), redescribe the male brain as “hardwired for systematizing”; likewise, the “female-type” brain, initially credited with being better at “linguistic skills,” was redescribed as “hardwired for empathy.” The language shifts from being about “social skills.” Baron-Cohen speaks of “empathy” rather than “social skills,” so that the two distinctions are virtually synonymous (p. 384).
As the honest broker, Bluhm notes that, as with the earlier research in gender differences, Baron-Cohen’s research has been influential but controversial. Men and women have different routes to accessing and activating their empathy; they respond to different pressures to conform to (or rebel against) what the community defines as gender-appropriate behavior; and men and women even have different incentives for empathic performance.
For example, “…[M]en’s scores on an empathy task equaled women’s when a monetary reward for good performance was offered” (p. 384). Monetary rewards up; empathy up? Though Bluhm does not say so, I came away with the distinct impression of a much needed debunking of the neurohype—what we would now call “fake news”—a job well done.
Bluhm’s work is especially pertinent in constraining celebrity, executive consultants (once again, my term), running with the neuro-spin, and publishing in the Harvard Business Review, who assert that brain science shows we need more women executives on corporate boards to expand empathy.
I hasten to add that we do indeed need more women executives, but that is not something demonstrated by brain science, at least as of this date (Q2 2020). We need more women executives because it is demonstrated by statistics (just one of many sources of reasons other than brain science) that to devalue the contributions to innovation, service, and productivity of slightly more than half the population is bad business practice—foolish, inefficient, and wasteful. The challenge is that the practices that make one good at business—beating the competition, engaging technology problems, solving legal disputes—do not necessarily expand one’s empathy, regardless of gender.
[In a separate, informal email conversation (dated July 2, 2018), Bluhm calls out Cordelia Fine’s fine takedown of “The Myth of the Lehman Sisters” in the last chapter of Fine’s book (not otherwise a part of Bluhm’s review): Cordelia Fine, (2017), Testosterone Rex: Myths of Sex, Science and Society. New York: W. W. Norton. It is a bold statement of the obvious – that the part of basic anatomy that differs between men and women is definitely NOT the brain. But that is missed due to lack of empathy which is committed to responding to the whole person – not just the brain or the sex organs.]
In an expression of insightful and thunderous understatement, Bluhm concludes: “With the exception of studies that rely on participants’ self-reports or on other’s reports of their behavior [which are invalid for other reasons], no consistent gender differences in empathy have been observed. This raises the possibility that gender differences in empathy are in the eye of the beholder, and that the beholder is influenced by gender stereotypes…” (p. 386). Just so.
Okay, having debunked the myth that men’s brains are different – and in particular less empathic – what to do about the situation that many men (and women?) struggle to expand their empathy? The recommendation is not to treat empathy and an on-off switch. Empathy is rather a dial – to be tuned up or down based on the situation. That takes practice.
Some men – many men – may start out with an empathic disadvantage in experiencing their feelings after having been taught such stuff as “big boys don’t cry.” But if people, including men, practice getting in touch with their experience, then they get better at it – experiencing their experience. Likewise, with empathy. If you practice, you get better at it. For those interested in practicing, but not working too hard, may I recommend: Empathy: A Lazy Person’s Guide: click here to examine (and buy!) the book.
Ickes, William & Gesn, Paul & GRAHAM, TIFFANY. (2000). Gender differences in empathic accuracy: Differential ability or differential motivation?. Personal Relationships. 7. 95 – 109. 10.1111/j.1475-6811.2000.tb00006.x.
(c) Lou Agosta, PhD and The Chicago Empathy Project