Journal of Women's History

Anti-trans legislation is sweeping the nation, and much of the vitriol feeding this legislation portrays trans women and girls as a physical, sexual, and political danger to their cisgender peers. In short, who "counts" as a woman is a matter of urgent, national concern. Two recent and very different books on the construction of women and gender in the United States appear at a critical moment. Lillian Faderman's Woman is a more than 500-page synthetic history tracing the evolution of "woman" as an ideological concept from the seventeenth century to the present. Sandra Eder's How the Clinic Made Gender is a much slimmer, more focused study that uncovers the mid-twentieth-century emergence of "gender" as an idea and a term meant to distinguish between physical sex characteristics and socially and culturally constructed gender roles. While Woman does little to challenge a biologically-based understanding of womanhood, How the Clinic Made Gender reveals the labor that has worked to maintain the fiction of our binary gender system.

Although published with an academic press, Woman is aimed at a broad public readership unfamiliar with the contours of American women's and gender history. Faderman begins by describing her own experiences in the 1950s, coming of age as the daughter of a single-mother immigrant in a largely Mexican American high school in Los Angeles. Branded as juvenile delinquents, she and her peers struggled to see themselves in the dominant popular images of American womanhood at this moment: perfectly quaffed and endlessly patient white middle-class mothers and homemakers. "How, when, and why had that ideal of woman been created?" Faderman asks. Woman, she explains, was borne of a "personal quest" to answer these questions (3). While Faderman portrays her project as one that seeks to understand "woman" in a broad and abstract sense, she is chiefly interested in how some (mostly white) women have been imagined and portrayed as domestic creatures destined to serve men and children as wives and mothers. [End Page 147]

Faderman's writing is as accessible and engaging as always, capturing her readers' attention and guiding them through four centuries of history at a swift pace. Over fifteen chapters, most of them focused on the twentieth century, she paints a battle between two dominant images of womanhood: one that ties women to the home and family and one that encourages and celebrates their intellectual, political, and economic achievements in the world beyond it. In Faderman's telling, this battle began with the founding of the Massachusetts Bay Colony and the Puritan civil and religious leaders who instructed women to keep to the home, help "in the propagating of mankind," and subordinate themselves to their husbands' authority (13). The Puritans' hold on the idea of woman, she argues, has continued to the beginning of the twenty-first century. While Faderman acknowledges that the Puritan "helpmeet" is not synonymous with the post-World War II housewife or the contemporary "opt-out" mom who left her white-collar career to care for her kids, she is less concerned with the differences between these figures than their similarities.

Faderman has attempted to craft a multi-ethnic, multi-racial history of American women, and Woman does include stories of many well-known women of color, including American Indian activist Zitkála-Šá, civil rights activist Ella Baker, labor organizer Dolores Huerta, and writer Alice Walker, among others. Faderman recognizes that women of color have often been excluded from the category "woman," but their struggles to be seen as women, and to gain access to the protections and power that status can carry, are not her chief concern. Faderman also downplays white women's investment in white supremacy and their complicity in a racially exclusive understanding of "woman." So, while Faderman concedes that "some white women" were slaveholders, she does not discuss the ways that white women collectively benefited from enslavement (51). Furthermore, while she admits that white Northern suffragists "could not transcend their prejudices" when it came to women of color, she minimizes the significance of their racist arguments for the vote (188). In Faderman's telling, white women's racism is a failure, to be sure, but not a concerted and enduring strategy of political advancement.

Faderman similarly tries to call into question our binary gender system, but this effort falls short. She discusses briefly how many Native American tribes in the seventeenth century accepted and supported individuals' self-proclaimed gender identities regardless of their biological sex. Throughout the book, she mentions transmasculine figures of uncertain gender identification who were raised as women but lived part or all of their adult lives as men. In her introduction and epilogue, Faderman marvels at the growing commonality of terms like nonbinary and genderqueer, as well as how trans people today are challenging simplistic notions of masculinity and femininity. However, Faderman's lack of a substantive discussion of the trans movement or trans women's experiences (save for two women briefly mentioned in the epilogue) reifies a notion of "woman" as grounded in the body.

Faderman ultimately narrates a movement away from what she calls "the old dominant notions" of domestic womanhood toward alternative understandings of [End Page 148] women as citizens and leaders in the public sphere (7). In concluding her book, Faderman highlights famous figures like billionaire executive Sheryl Sandburg, who advised women to "lean in" to their careers; activist Tarana Burke, who launched the #MeToo movement; and lesbian soccer star Megan Rapinoe, who has campaigned for equal pay. Faderman also surprisingly points to Justice Amy Coney Barrett's appointment to the U.S. Supreme Court and Republican Congresswoman Marjorie Taylor Greene's "lank hair" and violent rhetoric as symbols of how much understandings of "woman" have changed, even on the Right (416). Following Roe v. Wade's demise and escalating violence against trans women, not to mention the pandemic's effect on women's labor force participation, this celebratory ending feels off. Moreover, while Faderman acknowledges that the responsibilities for childcare and housework still fall disproportionately on women's shoulders, she does not discuss the extent to which poor, immigrant, and often undocumented women's domestic labor has enabled their wealthier counterparts' flight from the home and into high-powered careers.

While Faderman uses the concept of "woman" as the starting point for a sweeping study of American women's history, Eder digs into the specific historical circumstances that produced the concept of "gender." From everyday legal forms to partisan political debates, today the word gender is inescapable. Yet, despite its ubiquity, it has fairly recent origins. Psychologist John Money famously coined the term "gender role" in 1954 based on his three-year study of children with intersex characteristics in the Pediatric Endocrinology Clinic at Johns Hopkins University. In both the popular consciousness and the scholarly literature, the emergence of the concept has been attributed almost solely to Money, who is demonized in some accounts and lauded in others.

Eder makes two central interventions in this history. First, Eder decenters Money. Although Money still plays a critical role in Eder's book, she emphasizes the ways "gender" evolved from the specific historical moment in which he came of age, the intellectual environment in which he was trained, and, most importantly, the daily realities of the clinical practice in which he worked. Gender was not the product of a lone "genius," but an outcome of interactions between doctors, psychiatrists, psychologists, parents, and patients over the course of decades. Second, while gender as a concept has become imbued with liberatory meaning and associated with the feminist and trans movements, Eder elucidates how clinicians used it to serve profoundly normalizing purposes. "Gender" was forged not to disrupt, but to enforce a binary between men and women and uphold their conventional societal roles.

The first four chapters of How the Clinic Made Gender uncover gender's intellectual roots at Johns Hopkins' Pediatric Endocrinology Clinic, which opened in 1935. The Clinic focused on the treatment of children, almost exclusively white children, with Congenital Adrenal Hyperplasia (CAH), which leads to the overproduction of androgen. CAH produces a life-threatening condition of salt-loss, as well as the premature development of pubic hair, muscles, genitalia, and sexual desires. In patients with XX chromosomes, it can lead to "virilization" or a more conventionally masculine appearance, including the enlargement of the clitoris such that it may resemble a penis (19). [End Page 149] In the Clinic's early years in the 1930s and 1940s, many of these children had been raised as female, only to become increasingly masculine over time, in ways that they and their parents often found disturbing. Other patients were assigned and raised as male, only to discover upon treatment that they had XX chromosomes.

These patients were of great concern to the Clinic's founding director, Lawson Wilkins, and they transformed his understanding of sex. When Money arrived at the Clinic in 1951, Wilkins had already begun to distinguish biological sex, or "true sex" in his terms, from "best sex," meaning that which would serve and suit his patients' needs better (37). By mid-century, the psychologization of society had taken hold. In Wilkins' clinic, psychologists and psychiatrists argued that children's mental or interior sex identification mattered far more than their chromosomes or physical form. They urged Wilkins and other medical practitioners to hold off on irreversible surgeries and treatment plans until after psychiatrists and psychologists had been allowed to interview them. With "gender role," Money essentially created a new term for an idea that Wilkins and his team had already begun to formulate.

Although gender has come to signal a separation from biology, in Money's original formulation, the concept pointed to an intersection between society, culture, and the body. Money argued that children were malleable, and that the gender role in which they were raised was far more important in determining their identities than their bodies. He also believed that in order to live full and happy lives, children needed to adjust to their normative social roles as husbands and wives, providers and caretakers. He therefore advised that children with intersex conditions be assigned a sex as early as possible, ideally in infancy, based on their parents' desires and their genitalia. He believed that those with male-appearing genitals should be raised correspondingly (regardless of their chromosomes), and he recommended genital surgery on toddlers in order to make their bodies better correspond with their assigned sex.

Eder depends heavily on the Clinic's patient records, which are a rich but troubling source material that allows her to show in fine-grained detail how clinicians and parents attempted to parse which gender suited children best. The voices of the patients themselves are lacking in such patient records, particularly when they underwent treatment as children. Many of the patients who visited the clinic were treated there for decades, and in three stand-alone case histories—subtitled, respectively, "Hope," "Coming of Age," and "Despair"—Eder uses these files to help her readers understand the perspectives and experiences of some of the clinic's patients in-depth. Eder's readings of these materials and her close attention to those moments in the archive when a patient's voice seeps through are among the most powerful and painful aspects of the book.

Gender's afterlife is of less interest to Eder than its origins, but the final two chapters of How the Clinic Made Gender follow gender as it circulated among medical professionals and beyond the medical world. She traces the international network of pediatricians who both embraced and critiqued the concept of gender in the 1950s, as well as the ways it was institutionalized in textbooks and in the standardized treatment of intersex children. Eder then shows how trans and feminist activists took up the term [End Page 150] in the 1960s in their own ways. In part because of Money's research in both the Pediatric Endocrinology Clinic and a later clinic for intersex children, he became involved in opening a Gender Identity Clinic at Johns Hopkins Hospital, one of the nation's first to provide gender affirming treatment for trans patients in 1966. Yet Money and his colleagues demanded that patients aspire to fulfill conventional, heteronormative gender roles, and denied treatment to those who did not.

Together Woman and How the Clinic Made Gender demonstrate the peril and possibility of historical scholarship that speaks to our present moment. Historians will find much of Faderman's book familiar, but Eder's study is vital reading for scholars of U.S. women's and gender history as well as scholars of feminist, queer, and trans studies. It could also work well in the undergraduate classroom, powerfully revealing the complexity of the human body, and the troubling history behind a term many of us have taken for granted. [End Page 151]