Megan: Thank you so very much for your time, Lianne. I really appreciate you taking the time away from your busy schedule to do this interview. Gender Identity and Gender Issues have received a fair amount of attention in the online world (especially on Tumblr and Youtube) however, much of the focus is on Transgender folks and many people do not really know what Intersex is. Can you share what it means to be Intersex and how it differs from or is similar to being Transgendered?
Lianne: Disorder of Sex Development (DSD) is an umbrella term for any medical condition affecting sex differentiation or development. One reason clinicians came up with DSD is that the word Intersex had become so political. No one could agree on which conditions to include. Hermaphrodite is a medical term that was once in common use, but people confuse it with that creature of Greek mythology. Confessions deals with two types of DSD—one of which results in genital ambiguity. And I would stress that the genitals are between male and female. There aren’t two sets. Jamie can’t function sexually as male and female, but as neither, at least at the beginning of the book. Complicating Jamie’s situation are her short stature and her feminine, pixie face. The visual cues shout female. Testosterone could eventually give her beard growth, but she’d still be tiny. It’s a simplification, but someone who is transgender identifies with a gender other than the one normally associated with their biological sex. DSD or Intersex means that not all of the person's biological sex markers—genetics, gonads, genitals, hormones, puberty—agree. In some cases, Intersex means having to make an arbitrary decision whether to raise the child as a boy or a girl. An intersex child may dispute that choice, but they usually don't reject their body. Jamie experiences some of that disconnect between biology and being, but it’s because she believes the lie that minor surgery will make her like other boys. Even then, Jamie doesn’t have the strong drive to be a girl that is expressed by most male to female transsexuals. She has a strong drive to be a normal boy or a normal girl. She realizes that being petite and pretty would make it easier to be a girl than a boy. And she does have a strong maternal drive.
Megan: This story was incredibly moving for me to read as a parent to four young children. It angered me and even made me sick to see the struggle that Jamie went through with her parents. Do Intersex children typically deal with that kind of issue? Are expectations from parents and society a huge issue for them?
Lianne: For a long time doctors thought that if you made an Intersex baby’s genitals appear female then the child would be happy as a girl. But only if her parents allowed no doubts about her gender and she never discovered what was done to her. That secrecy led to a sense of shame—the girls knew there was a secret so bad that nobody could talk about it, and guilt—for the doubts about their gender, and sexual orientation, and even the differences they noticed about their bodies. Jamie’s parents didn’t allow surgery, and didn’t enforce strict gender rules. But society and circumstance forced Jamie to at least temporarily live as a boy. After that, doctors kept telling Jamie’s parents that allowing her to live as a girl again would only result in further gender confusion. And to even talk with Jamie about that option might raise doubts in her mind. And to be fair to Jamie's mom—she thought a woman would be more accepting of what was between Jamie's legs. To her that meant that if Jamie were ever to find love, it would have to be as a feminine man with an understanding woman. Expectations from parents and society can be a huge issue. And children like Jamie often try to please their parents instead of insisting on who they are. Without external help, Jameson would probably have continued living in dreams. Just to please her family. But, back to your question—Yes, a number of Intersex children must ultimately decide whether to accept or reject their assigned gender. That’s why it’s so important to delay surgery until the child can participate in medical decisions. And why it’s so important that the child be made aware of their condition and their options.
Megan: There were also issues with the doctors that Jamie saw, while most felt one way, there was no clear consensus on how to best help her. Is this still an issue that Intersex folk face?
Lianne: Standard practices have been improving over the past decade. However, there is no clear consensus on how to treat Intersex children. And Intersex children who question their assigned gender are still being judged as transgender based on what sex the doctors think they should be. For instance, an Intersex youngster being raised as a boy was about to undergo surgery that would allow him to stand up to pee. It was canceled when he expressed a desire to be a girl. Although they were willing to use surgery to make the child more like a boy, she’ll probably have to wait until she’s eighteen to have surgery to make her more like a girl.
Megan: I have seen some parents lately being condemned for allowing their Transgendered children to start the hormone therapy before they go through the "wrong" puberty. It's something that weighs heavily for me as I have seen first hand how painful binding and tucking can be. I have seen friends with bruises and one who had breathing problems due to use of a binder. It seems like it would be less awful to just keep them from going through the "wrong" puberty but at the same time, it is a huge decision and one that can't be taken back. Jamie and Jameson don't really seem to have gone through puberty as such but there was still the huge choice of hormone therapy. It would make sense for surgical assignment to wait until a child could make the decision themselves. Is hormone therapy held off until after surgery or is it something that is started before hand? Lianne: In disorders of sex development where there is no gonadal function, an attempt is made to simulate the hormonal status appropriate to the child's age and gender. One of the reasons Jamie is so immature is the delay in puberty. It can be traumatic for a sixteen-year-old girl to be flat-chested and not have her period. Or for a sixteen-year-old boy to be a soprano who has no muscle development. I didn't bring it up in the book, but there are other consequences of a delayed or non-existent puberty. You remember the Da Vinci drawing of the Vitruvian man? After puberty, height and armspan are supposed to be the same. In eunuchs the armspan is greater than height because, without hormones, the long bones keep growing. So Jamie would have had long arms and long legs relative to the rest of her body. In Androgen Insensitivity Syndrome the testes are usually removed. Unfortunately, many AIS women will tell you that they felt much better before the surgery than they do on estrogen. Hormone Replacement Therapy (HRT) only simulates gonadal function. It's not as good as normal gonads. Many women with AIS or Swyer Syndrome, who have been on HRT most of their lives, have bone density problems as adults. Jamie would likely have osteopenia, a mild form of osteoporosis. Some doctors are now relocating AIS testes to a place where they can be monitored for cancer, rather than removing them. And quite a few AIS women take testosterone, either instead of estrogen, or in addition to it.
Megan: I have a pretty strong issue with gender roles and stereotypes and it drives me nuts when I catch myself enforcing them with my kids. How do you feel society and parents can encourage positive self image in children? How can we as parents and members of society raise our children to be more accepting of others? Is it possible or are we as a race, always going to want to sort people into neat like categories?
Lianne: I don't think the problem is having categories. Male and female, boy and girl, are valid distinctions. Where we run into problems is with the exceptions and the outliers. Women with AIS have male sex chromosomes--they are XY. They have testes instead of ovaries and uterus. But they're born with normal female genitals and develop breasts and hips at puberty. They have a normal female gender. They're women. People should get over it. When I lived in the Philippines, I got used to seeing teens holding hands. Boy with boy. Girl with girl. For most, all it meant was they were friends. We've lost something if our teens can't hold hands without it becoming a statement about their sexual orientation. During the time that Jamie was supposed to be a boy, her parents let her babysit for infants. Her mother taught her to cook and sew. They figured those things were all right for a boy--even a boy whom they suspected had gender issues. They would allow Jamie most anything--except being a girl.
Megan: Jamie herself was a beautiful character who narrates in a different way because of how she sees herself. She still manages to make herself known to the reader and you really fall in love with her, in a way. I found myself praying for her to find the things that she'd always wanted. Is Jamie based on someone from real life, a conglomerate of many people or someone purely made up?
Lianne: Jamie’s character and many of the things that happened to her are drawn from the lives of friends of mine, as well as from my own experiences. Peggy has Partial Androgen Insensitivity Syndrome. She was raised as a boy. When she developed breasts, the doctors removed them. Peggy didn’t object because she didn’t think she had any choice. Boys don’t have breasts and she had to be a boy. Some of her doctors thought she should have been raised female, but nobody told her. They also kept saying it was too late for her to change. When she finally discovered how feminine her body was, she transitioned to female. In order to do so, she had to meet some of the same requirements as transsexuals do. As a child I was tiny and frail. At nine I could share clothes with my six-year-old sister. I had a pixie face which rounded out as I grew up. My mother was a nurse who sheltered me from doctors and who sent me antibiotics at college for my frequent respiratory and urinary tract infections. And, like Jamie, I had my appendix out during the week of finals while attending the University of Miami.
Megan: I really loved Jamie's amazing sense of self. Even in the face of Jameson, Jamie (the faie princess) knew who she was, what she wanted and what she needed. What is your favorite thing about Jamie?
Lianne: I like Jamie’s resilience. It’s a characteristic often found in Intersex children. Most are able to thrive in spite of their conditions and mistreatment at the hands of doctors.
Megan: Sean was another lovely character. I really enjoyed how open and accepting he was of Jamie whether she was being herself or trying to be Jameson. He protected her and befriended her for who she was and her gender had nothing to do with it. What inspired you to create Sean?
Lianne: In earlier drafts Sean started out as a bad guy—someone who wanted to use Jamie. Even as her protector, it was for his own ends. But giving Sean a sister with a condition similar to Jamie’s gave Sean some compassion for her situation. And Sean was already confident enough in his own sexuality that Jamie was no threat to him. He could help Jameson/Jamie without concern for what anyone else might think.
Megan: You gave Jamie a support group of sorts in the group of girls that she is introduced to by Lisa. I thought that having that support gave Jamie more power and faith in herself. Do you feel strongly about support for teens and young adults who have any of the Intersex conditions?
Lianne: Yes! I have seen teenage girls cry after meeting a total stranger who just happens to have the same condition as them. Grown women share their innermost secrets with each other five minutes after they meet. Simply because they’re both faie. I would urge anyone with a Disorder of Sex Development to contact www.aisdsd.org.
Megan: It made me so happy to see that you wrote Jamie/Jameson as having a strong faith. What made you want to show this character of faith?
Lianne: When I first spoke with several Intersex adults, I was appalled at the way they’d been treated by other Christians. One reason for writing Confessions was to help raise awareness about these conditions within the church. The subject is one that is largely either ignored or avoided. And many Christians seem to think of Intersex as a moral failure rather than as a medical condition. I wanted to show how a Christian child with a DSD might struggle with faith, family, and church, and yet be innocent.
Megan: I just have to say, again, how much I loved this book. I'm having my husband read it. Now, to learn more about you. What was your writing experience in writing this book? Did you write with music or just sit in a quiet space? What was your creative process?
Lianne: A quiet place works out best for me. I find that I have to write from the heart to get the depth of emotion I’d like in my writing. Confessions required becoming Jamie, at least at some level, to put the story on paper.
Megan: What is your current favorite book and/or author?
Lianne: I like Neal Stephenson. Cryptonomicon is one of my favorites. Frances Hodgson Burnett’s writing is comforting. You know—A Little Princess. The Secret Garden.
Megan: The Secret Garden has always been one of my favorites! Do you have any book recommendations?
Lianne: There are so many good books! I would say find a blogger with similar interests and read their reviews. And don’t be afraid to branch out. But I would also suggest reading an extended excerpt before purchasing any book.
Megan: Will you have another book forthcoming?
Lianne: Yes. Two actually. The question though is how long they’ll take to finish.
Megan: Thank you again so very much for the chance to review your book and for agreeing to this interview. I really hope that everyone will read this book and possibly have their life changed by it. I also am happy to be able to inform you that your book will be featured on my Top Books of 2012 during the annual blog event, Best I've Read.
Lianne: Ooh! Really? Thank you.
Thanks again go out to Lianne for agreeing to this Interview! You can find Lianne Simon on Twitter, Facebook and on her website. You can click here to add this book to your Goodreads and I really hope that you will.
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