I think what Koyama is ideally trying to do by turning to the discourse of disability is to separate medically identifiable physical condition (as a static identity) from socially constructed forms of identification. That is, there are seveal different discourses at work in her writing: disability, pathology, medicine, normality and identity (any more?). As much as possible, she’s trying to keep these ideas separate in our minds.
Especially disability is a difficult thing for us to divorce from pathology and medicine. It’s not an ideal example of common notions of disability, but for instance when we say that a person has a “broken leg” we are inadvertantly accessing the rhetoric of pathology and abnormality. Broken-ness immediately references ideas of “fixing” and “unbroken” as a normative category. I think that she sees the physical configuration of bodies as something that is pathologized, not through medicine as such, but through these broader social processes (inclusive of linguistics). The fact that we use medicine to identify conditions or physical configurations is not problematic, insofar as it is explicitly divorced from pathology — the construction of a normative category through discourses of normality and abnormality.
Intersex, then, as a physical configuration that has medically measurable and definable causes/traits, is unproblematic in its relationship to medicine. Medicine can be applied to achieve disparate goals with success or failure. But the goals that are realized in the medical industrial complex, in specific instances of doctors, HMOs, patients and conditions, and the relation between these instances, is highly problematic because it is primarily a social construction of relationship, nothing medical about it. If society is the site of the pathologization of physical configuration, then that is where we need to turn our attention.
This comes out in her discussion of GID and gender association, as well. I recommend people read her discussion of drivers’ licenses at http://eminism.org/interchange/2005/20050611-intersexedsociety.html, because she more explicitly discusses intersex’s relationship to trans/queer issues. If we look at the desire to identify with one sex or another, extant in society, we can see how this, too, works to pathologize intersex in a different way from the abstracted medical treatment of it as a condition or physical configuration. However this pathologization is achieved, it is our binary normative understanding of gender that raises the question of “which way will we perform the surgery?” or “should surgery be performed at birth?” These questions themselves are indicative of the social pathologization of intersex conditions.
Because intersex has been pathologized with reference to sex binarism, then, and because disability has become a stand-in for abnormailty, people may take offense or exception to being labeled “diabled” with an intersex condition. But I totally agree with her that a move away from the label of intersex, which supports binarism, and towards (hopefully, eventually)unpathologized medical identifications of the physical configuration of bodies (DSD) is a good thing. With this end in mind, we can also work towards divorcing the concept of personal gender identity from issues of creating community and support networks for people who are (medically) intersex. As a society, we have a lot of issues to work out around gender identification and the “authenticity” (again, that word!) of gender identities, but for the intersex community, it seems, these can’t be handled in addition to the personal immediate needs of individuals. This is where the instrumental use of “intersex” as a battlefield for gender politics by other groups becomes problematic, it seems to me.
I earlier wrote: “The fact that we use medicine to identify conditions or physical configurations is not problematic,” but I also have something to say about that which is not directly related to Koyama’s article. Fall quarter I read Shigehisa Kuriyama’s book “The Expressiveness of the Body” in class (highly highly recommended book), where he talks about the different historical development of European and Chinese medicine. It’s interesting because he draws into question a lot of the notions about medical “identification” and how they are the result of a particular (European) medical tradition of discourse. The direct association of the body with muscles, organs, and anotomically separable bodies within the body is not something that can be taken for granted. He contrasts this European discourse with Chinese medicine’s understanding of the body as A) made up of interrlated functional groupings and B) as dialectically embedded in world processes of change. I think in Koyama’s articles, we are interacting with a Eurocentric medical practice, which she represents in an abstracted, ideal form for a variety of reasons, but it might be interesting to also question how, when we (I) say “physical configuration,” it introduces an entirely different discourse on the nature of physicality and how that discourse itself is embedded in a socially specific history of pathology. So, yeah, everything is problematic afterall.