I read this book a couple of years ago, but recently some of her writing has come up in various discussions I've been having. I'll admit that when I reviewed my notes from a few years ago that I didn't entirely agree with her arguments when I read Sexing the Body at the time.
However, it was in reading this response to the book, I found myself re-examining my notes and re-evaluating things in the light of what I know and understand today.
At the time I read "Sexing the Body" a couple of years ago, I was well immersed in reading a bunch of somewhat unrelated work by Judith Butler, and my disagreements with Butler appear to have significantly coloured my understanding of Fausto-Sterling's work at the time.
However, looking at it today, I find myself thinking that there's a fundamental point that I agree with Fausto-Sterling on - namely that the current models for describing physical gender are far too limited for the realities that we are gradually, but persistently uncovering. Gender is about the only part of medicine which is absolute - we are categorized as "male" or "female" at birth and so it must remain for all time.
The clinician's response is to suggest that a model of gender that is a continuum removes any meaning from the term Intersex, rendering it unusable for diagnostic purposes. I agree that this will be a significant problem for clinicians - when an entire spectrum of variation arguably describes the notion of Intersex, the term Intersex ceases to be terribly meaningful.
But, this is hardly a new phenomenon in the world of diagnostics. The concept of gender identity has changed dramatically in the psychiatric literature since Harry Benjamin started researching transsexuality in the 1940s. Over 3 editions of the DSM, we have seen the concept evolve from describing fetishistic crossdressing, eventually to include transsexuals, and in the DSM IV, the GID diagnosis is surprisingly broad - providing diagnosis covering a wide range of cross-gender experiences.
However, Fausto-Sterling is not entirely arguing from a clinical, or biological standpoint. She is integrating in significant amounts of social and political discourse into her position. While the clinical categorization of someone's gender may become significantly complicated by a model which describes physical gender as a spectrum, we must also recognize the social and political aspects of gender, and that is where a spectrum is a much more important and powerful tool.
What a spectrum model does to clinicians is force the use of objectively correct language for each individual case. Someone who has Klinefelter's Syndrome, and someone who has Congenital Adrenal Hyperplasia cannot simply be categorized as "Intersex". This means that a more precise level of diagnosis and tracking will have to be undertaken - not a bad thing in the least.
Socially, however, this presents a much stronger foundation upon which to rest the conversations about the social and political aspects of gender that are ongoing parts of our cultural evolution. First of all, it takes the notion of biological determinism out of the picture. It removes the weapons of exclusion from all of the interested parties in gender discussion. The radical feminist that argues that MtF transsexuals aren't really women because they cannot bear children (I'm vastly oversimplifying the argument here, but I do find it ironic that the RadFem argument against transwomen boils down to the same biological determinism that feminism has fought for decades) Fundamentally, biology is then recognized as sufficiently plastic to accommodate a wide range of gender experiences and behaviours - and none of those should be seen as erasing anyone else's experience.
By taking biology somewhat out of the discussion, we can then move into a world of discussion social gender in its own right without the noise in the background of the internecine warfare that goes on between the various factions. It has always been clear to me that Feminist theory is on very solid ground when it is working from the context of the social constructs that are a significant part of our gendered life experiences - it has typically fallen apart quite badly when it has attempted to describe the underpinnings of gender at the level of biology and identity.
The real issues with gender in our society today exist as social issues - whether it is roles, expectations or demands placed on members of either sex. Feminism as a movement was born out of the recognition that our society had developed along patriarchal lines for centuries, and how that evolution was marginalizing half the population.
The treatment of both Intersex and transgender people in our society has arisen in part on the heels of feminism, and in part out of a recognition that there are groups where the imposition of "normal" as it applies to most of the population doesn't work so well. Marginalization and discrimination are rampant, and ill-informed treatment at the hands of medical professionals is all too common for both of these groups.
Appropriate treatment remains a problem for both IS and Trans communities. A more precise sense of diagnosis and classification will in fact work to the advantage of both groups. A more broadly based model of gender should permit greater individual autonomy with respect to treatment decisions, since each case must be examined individually. Hopefully, this will also have the benefit of making it easier for parents to move beyond the often panic/worry related treatment decisions that are so often made before an IS child is ready to make their own decisions.
I've argued before that when we are talking about humanity, it is important to view our attributes along the lines of spectrums - primarily because absolutes inevitably seem to encounter problems with exceptions. Where I disagree with Fausto-Sterling is in the interaction between mind and body. I am not at all convinced by the two constitute an "indivisible whole", which implies that they are distinct, but intertwined entities. Somehow, I'd rather leave this particular conversation open ended until we have a better understanding of how DNA and the complex chemistry that we all carry within us interact - to assume that mind is distinct from body feels a little too "pat" an answer, especially in light of the growing body of evidence that has raised the whole notion of transsexualism as being a subset of IS - a concept that a mere few years in the past would have seemed quite laughable. Then again, I haven't seen the bulk of neuroscience in the last decade or two that might lead towards a clearer understanding of the interaction of the body and the mind (or the intersection of). There is no doubt in my own experience that the chemistry of the body influences our minds in surprising and unique ways that should not be overlooked.