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The politics of plasticity: Sex and gender in the 21st century brain

Kleinherenbrink, A.V.

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t the beginning of this century, the idea that the brain is plastic—that its P Astructure and function can change in response to stimulation or injury— olitics began to replace the belief that adult brains are fixed. The claim that sex differences are hardwired into the brain, however, is still frequently endorsed.

This study builds on feminist scholarship that has critiqued this claim, and of the politics of plasticity that has argued for a reconsideration of the relationship between sex/gender P SEX AND GENDER IN THE 21ST CENTURY BRAIN and the brain through the lens of . Is plasticity indeed the right lasticity tool for to challenge neurobiological determinism with? By mapping the ontological, epistemological, and ethical considerations provoked by this question, The Politics of Plasticity examines the stakes involved in (re)thinking the sexed/gendered subject as a neuroplastic subject. A nnelies K leinherenbrin k

Annelies Kleinherenbrink

THE POLITICS OF PLASTICITY

Sex and Gender in the 21st Century Brain

Annelies Véronique Kleinherenbrink

Cover design: Sander de Wit Cover image: Brain Blonde by Paul Schietekat Printed by: CPI Koninklijke Wöhrmann

© Annelies V. Kleinherenbrink, Amsterdam, The Netherlands

THE POLITICS OF PLASTICITY

Sex and Gender in the 21st Century Brain

ACADEMISCH PROEFSCHRIFT ter verkrijging van de graad van doctor aan de Universiteit van Amsterdam op gezag van de Rector Magnificus prof. dr. ir. K.I.J. Maex ten overstaan van een door het College voor Promoties ingestelde commissie, in het openbaar te verdedigen in de Agnietenkapel op vrijdag 21 oktober 2016, te 12:00 uur door Annelies Véronique Kleinherenbrink geboren te Apeldoorn

Promotiecommissie:

Promotor: Prof. dr. P.P.R.W. Pisters Universiteit van Amsterdam

Overige leden: Prof. dr. J.F.T.M. van Dijck Universiteit van Amsterdam Prof. dr. G. Grossi SUNI New Paltz University Prof. dr. A.A. M’charek Universiteit van Amsterdam Prof. dr. V. Pitts-Taylor Wesleyan University Connecticut Prof. dr. E.S. Schliesser Universiteit van Amsterdam Dr. K.V.Q. Vintges Universiteit van Amsterdam

Faculteit der Geesteswetenschappen

This research was supported by an ASCA PhD fellowship from the Amsterdam School for Cultural Analysis.

Contents

Acknowledgements ix

Introduction. A tale of two brains 1 Preludes 1 A tale of two brains 2 Sexual differentiation and brain plasticity: a shared history 6 The neuroscientific turn and the politics of plasticity 9 Challenges in mobilizing plasticity 12 Chapter outline 14

1. Sex/gender in the plastic brain 17 Introduction 17 Vive la différence? Imag(in)ing sex in the brain 21 Brain sex in context: the plasticity of sex differences 26 Sex differences in plasticity 30 Conclusion 34

2. Situating sex, situating science 37 Introduction 37 Mobilizing plasticity 38 How matter comes to matter 42 How sex/gender comes to matter in the brain 45 Culture into nature, nature into culture 49

3. Becoming a boy: brain sex in the classroom 51 Introduction 51 The rise of the boy crisis 53 Backlash against feminism 53 The marketisation of education 54 Educational 55

‘Boys and learn differently’ 59 Boys becoming boys 63 Nurturing nature: Gurian’s invisible pedagogy 64 Reaching for excellence: Gurian in the Netherlands 68 Conclusion 71

4. Plastic parenting: a family portrait 73 Introduction 73 ‘Get it right in the early years’: the plastic infant brain 75 ‘ are made, not born’: the plastic maternal brain 80 ‘Both mom and dad, brain-wise’: the plastic paternal brain 85 Interlude: train the gay away? 89 Fathers at risk and as risk 93 Conclusion 94

5. Women’s mental health and the therapeutic promise of brain sex 97 Introduction 97 Mainstreaming sex as a biological variable 100 The therapeutic promise of brain sex 105 Schizophrenia 106 115 Statistical panic: the female brain at risk 118 Conclusion 123

Conclusion 127

Summary 131

Samenvatting 133

Bibliography 137

Acknowledgements

I am delighted to express my gratitude here to those who have supported and inspired me over the past four years. First of all, I am sincerely grateful to my supervisor, Patricia Pisters. You have taught me to work with, and not against, my personal rhythms of inspiration and productivity. Thank you for your patience and your trust in me, and for continuing our meetings during your sabbatical. Besides Patricia, I would like to acknowledge some other wonderful teachers and mentors who have inspired and supported me greatly along the way. Kathrin Thiele and Iris van der Tuin (Utrecht University), studying with you has been such a joy. Your dedication and sharp minds inspired me to pursue a PhD in the first place, and continue to motivate me today. Veronica Vasterling (Radboud University Nijmegen), I deeply appreciate your guidance and support throughout the years. I also thank Karin Vintges (University of Amsterdam) and Tatjana van Strien (Radboud University Nijmegen) for their warm encouragement and kindness. Thank you also for offering me the opportunity to teach at the UvA and the RUN – I learned so much from the discussions with our students. This dissertation is greatly indebted to the NeuroGenderings Network. The opportunity to exchange my thoughts with its members has been wonderfully inspiring and encouraging. In particular, I thank Rebecca Jordan-Young, whose visit to Nijmegen many years ago first sparked my interest in neurofeminism, and whose intellectual vigour and kind generosity I admire greatly. I thank for advising me to go to the NeuroGenderings conference in Vienna when I met her in Budapest in 2011. This conference took place during the first week of my PhD candidacy, and the discussions there made me drastically reconsider my research project. I thank and Hannah Fitsch, whose visit to Amsterdam and Nijmegen together with Bec in 2013 was such a pleasure. I am also very grateful to Cynthia Kraus for inviting me to participate in the NG4 conference in New York in the spring of 2016, which provided me with just the stimulation I needed in the last stage of writing this dissertation, and which gave me the opportunity to collaborate with Sigrid, , Vanessa Gorley and Diana Schellenberg. At these and other meetings, I have received valuable feedback on the ideas developed in this dissertation. I have also drawn much inspiration from the Neurocultures & Neuroaesthetics reading group at the University of Amsterdam, led by Patricia. Flora Lysen, Tim Yaczo, Stephan Besser, Julian Kiverstein, Vera Stiphout, Daisy van der Zande, Machiel Keestra, Moosje

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Goossen, Nim Goede, Abe Geil, Halbe Kuipers, Manon Parry, and all other participants: thank you for making our meetings so interesting and so much fun. At ASCA, I have met many more wonderful colleagues and friends, including Lucy van de Wiel, Blandine Joret, Lara Mazurski, Enis Dinç, Nur Ozgenalp, Irene Villaescusa, and Melle Kromhout. I had a great time organizing the ASCA workshop in 2014 with Uzma Ansari, Artyom Anikin and Simon Ferdinand. I have come to cherish my friendship with Simon and his partner Suzanne Vonk in particular. My doctoral research has been fully supported by the Amsterdam School for Cultural Analysis, part of the University of Amsterdam, for which I am tremendously grateful. I thank Eliza Steinbock for her advice during the application procedure. I also want to give thanks to Eloe Kingma, whose assistance and kindness can always be counted on at ASCA. I thank my dear friends Renée Jansen and Bas Bunnik for being by my side during so many moments of celebration and moments of desperation – your loving enthusiasm has made all the difference. Other friends who have given me joy, comfort and support during this process include Simone van Hulst, Maartje Meuwissen, Eline van Uden, Christel Meijer, Eveline Quist, and Anne Colder. A special thanks to my brother Arjen, whom I love and admire so very much, for always pushing my thinking and stimulating my self-confidence. I am so happy and proud to have you by my side during my defence. I also give thanks to my and father, Herma and Guus, who have nourished my brain from early on. Thank you for all your love and emotional support. Finally, of course, I thank my wonderful husband Sander de Wit. Thank you for coming with me to Amsterdam without hesitation four years ago, and for making a home and a marriage here with me. Thank you for always giving me the space I needed to do this work, for believing in me so unconditionally, for being proud of me and loving me. I dedicate this thesis to you.

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Introduction A Tale of Two Brains

Prelude 1

Mark Gungor is on stage. He is standing over a pillar that supports a model of a man’s head. The head is missing the top of his skull so that his brain is exposed. Some ten feet away, another pillar supports his female counterpart. Gungor is in the middle of ‘A Tale of Two Brains’, the opening session of his marriage seminar ‘Laugh Your Way to a Better Marriage’. He is just explaining to the couples in his audience that men’s brains are ‘made up of little boxes’, each containing one item: a box for the car, a box for the kids, etcetera. ‘And the rule is’, Gungor exclaims, ‘the boxes don’t touch!’ The couples in the audience giggle as Gungor dishes up examples of men’s single-track minds. When Gungor crosses the stage to the other pillar, nervous laughter ripples through the room. Women’s brains, Gungor continues, are quite another story: they are made up of ‘a big ball of wire’, in which ‘everything is connected to everything’, buzzing with the energy of emotion. This is why ‘women remember everything’, while ‘men just don’t care’. The couples hoot and applaud. As the title of the seminar suggests, Gungor is not only a marriage counsellor—and a pastor—he also a comedian. All jokes aside, however, he is quite serious about the differences between male and female brains. These differences, he claims, shape the ‘laws of relational physics’. Understanding these differences, then, is the key to a happy marriage. (all quotes taken from ‘Laugh Your Way’.)

Prelude 2

Barbara Arrowsmith Young is on stage. She telling her life story, the story of ‘The Who Changed Her Brain’ (2012). Arrowsmith Young was born with severe learning disabilities that fragmented her sense of the world and of herself. She could not tell time, understand jokes, comprehend cause and effect, or see how her aunt could also be her mother’s sister. Somehow, she made it through high school and went on to study , where she came across The Man with a Shattered World (1972), Luria’s account of a Russian soldier who was left severely disabled after being shot in the head. ‘This man was living my life’, she tells the public. Now she knew what was wrong with her: a dysfunction in her left hemisphere. Shortly thereafter, she discovered a possible solution, too, when she read the work of Mark

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Rosenzweig, who had discovered that environmental enrichment improved rats’ learning abilities, which corresponded to neurological changes. ‘And this was neuroplasticity in action,’ Arrowsmith Young says, ‘Neuroplasticity: simply put, the brain’s ability to change physiologically and functionally as a result of stimulation.’ Inspired by this research, she set out to stimulate herself with self-designed exercises. This is how she came to change her brain: over time, her disabilities improved. The ease with which she delivers this talk testifies to her success. Yes, she concludes, the brain shapes us, but thanks to plasticity we can also shape the brain and overcome the limitations it may set.

A tale of two brains

Gungor offers his tale of two brains—a tale of the male and female brain as two distinct, universal entities—as a mirror. Understanding sex differences in the brain, he promises, will allow us to understand what makes us and our spouse ‘tick’. Indeed, the meaningful glances exchanged by the couples in his audience express joyful recognition: ‘we do that!’. Stories like Arrowsmith Young’s, stories that do not speak to the brain’s sex-specific idiosyncrasies but rather to its universal plastic potential, evoke an altogether different response: ‘we want that!’. Instead of holding up a neuronal mirror image in relation to which we can contextualize and calibrate our expectations and goals, stories about plasticity invite us to adjust the brain so that it meets our expectations and goals. Together, then, these two stories also tell another tale of two brains, besides that of male and female brains: a tale of the fixed, immutable brain and the plastic, changing brain. For most of the 20th century, scientists believed that the was ‘hardwired’: organized in fixed, function-specific circuits. From the 1970s onwards, however, the idea began to take hold that the brain possesses the adaptive capability to change—or be changed— structurally and functionally in response to intrinsic or extrinsic stimuli throughout adulthood. This plasticity is expressed in the strengthening and weakening of existing synaptic connections (synaptic modulation), in the emergence of new synaptic connections (synaptogenesis), and— most dramatically—in the birth of new neurons (neurogenesis). These processes can result in transient or long-term changes, which have been linked to memory and learning, stress responses, reorganization or repair after injury, and the development of pathology (Fuchs & Flügge 2014). Even though the details and exact timing of the history of plasticity are somewhat controversial, what is generally agreed upon is that by the beginning of the 21st century,

2 plasticity had taken over the scientific and cultural imaginary of the brain. ‘Where once fixity reigned, now plasticity rules’ (Rees 2010). The discovery that the brain remains sensitive to experience throughout life has been hailed as the ‘end-game’ for Cartesian mind-body dualism and the nature-nurture debate (Mohr 2003). By allowing social influences to be ‘translated into a measurable activation in the brain’ (Beaulieu 2003, 563), the plastic brain has become an ‘obligatory point of passage, through which … social and cultural phenomena are to be translated’ (Beaulieu 2000, 13). In other words, what is seen as the novelty of brain plasticity is ‘not that nature and nurture both contribute to who we are, but that they actually speak the same language’ (LeDoux 2002, 2). Due to the plastic brain, nature and nurture could now be conceptualized as ‘different ways of doing the same thing–wiring synapses in the brain’ (3). The emergence of plasticity as a dominant way of thinking about the brain was not just a shift in scientific thought, but also marked a shift in brain-based understandings of self and society. As Rees (2010) has written, the notions of fixity and plasticity each imply ‘different ways of being neurologically human’ (153). He therefore describes the dawn of ‘plastic reason’ (156), which he witnessed in Paris at the break of the 21st century, as an ethical event: ‘a profound mutation of the neurological human, a metamorphosis of the confines within which neuroscience requires all those who live under the spell of the brain, deliberately or not, to think and to live their lives’ (153). If neuroplasticity1 has indeed replaced fixity, and if ‘being neurologically human’ in the 21st century does indeed mean being a neuroplastic subject, then the claim that men and women are wired differently—and that these differences are innate—seems rather anachronistic. Yet a recently wrote that in light of recent research, it seems that Gungor’s ‘analogies may be more apt than he could have known’ (Cahill 2014a, 2). Indeed, many researchers today subscribe to the view that sex differences in personality, cognition and behavior—along with gender identity and sexual orientation—are present or programmed at birth by prenatal hormonal (and to some extent genetic) factors (e.g. Bao & Swaab 2010). It is this contradiction between the authoritative presence of ‘brain organization theory’ (Jordan- Young 2010) on the one hand, and current preoccupations with plasticity on the other, that focuses this study. Upon close reading, (how) do scientific and popular accounts of sex differences in the brain omit, reject, incorporate, and/or transform notions of plasticity? And what does it mean to (re)think the sexed/gendered subject as a specifically neuroplastic subject?

1. Throughout this thesis, I will use the terms ‘plasticity’, ‘brain plasticity’ and ‘neuroplasticity’ interchangeably.

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These questions are prompted by the rich body of feminist scholarship that argues against the claim that sex differences are ‘hardwired’ in the brain (e.g. Bleier 1984; Fausto- Sterling 2000; Fine 2011; Jordan-Young 2010; Rogers 2001). This work has highlighted the methodological shortcomings, inconsistencies, unwarranted assumptions, and problematic biases in neuroscientific studies of sex differences, as well as the pernicious impact of such studies on individuals and on society. Fine (2011) has coined the term ‘’ to capture how scientifically unjustifiable claims about male and female brains draw on, and further entrench, harmful gender ideologies. The term ‘neurofeminism’ emerged subsequently, in reference to feminist scholarship that critiques neurosexism, develops and implements alternative research practices, and/or critically (re)considers the place and meaning of neural theories of difference (Bluhm, Jacobson & Maibom 2012). It is with this scholarship that The Politics of Plasticity stages a conversation. This study critically examines how sex and gender are imag(in)ed in the 21st century brain. The central interest of this study is to ask if and how neuroplasticity does (not), could, and/or should impact scientific, political, and popular conceptualizations of sex differences in the brain. To explore this question, I have selected three key areas in which a neuroscientific perspective has been brought to bear on : education, parenting, and mental health. By closely reading neuroscientific publications, brain-based advice literature, and relevant public policies in these contexts, my analysis traces how the relations between sex, gender and the brain are currently construed. This analysis will demonstrate that in each of these areas, there is in fact not only biological determinism, but an interplay of hardwiring and plasticity at work in the construction of these relations. By zooming in on the ways in which this interplay preserves, transforms and/or subverts gender norms in specific contexts, this analysis lays bare what is at stake in (re)thinking the sexed/gendered subject as a neuroplastic subject. My analysis takes its cue from feminists who have used plasticity to theorize the inseparability of nature and nurture and of sex and gender, and who have argued that neuroscientific studies of sex differences should acknowledge, and incorporate, plasticity in their research questions, methodology, and interpretations. For example, Kaiser and colleagues (2009) have asserted that ‘neuronal plasticity is a crucial factor in elucidating the question of sex/gender differences in the brain’ (56).2 If cultural experiences indeed shape the brain, then

2. Kaiser and colleagues (2009) use the term ‘sex/gender’–which was subsequently adopted in much neurofeminist work–to highlight the entanglement of the biological and the social. Throughout this thesis, I will use this term whenever I aim to highlight this intertwinement. Otherwise, I will use the term ‘sex differences’

4 sex differences in the brain are not necessarily innate but might be a reflection of gender- specific influences. So, Jordan-Young and Rumiati (2012) have claimed that: ‘Given pervasive gender socialization and widespread gender segregation in occupation and family responsibilities, it is utterly predictable that we would observe group-level differences between men and women in various cognitive functions’ ( 312). Supplementing this , Rippon and colleagues (2014) have written that,

Whatever male/female behavioral and therefore brain differences are observed in [a] particular sample are contingent on both chronic and short-term factors such as social group (such as social class, ethnicity), place, historical period, and social context and therefore cannot be assumed a priori to be generalizable to other populations or even situations (such as the same task performed in a different social context). (5)

To capture the influence of social factors on the brain, imaging studies would have to include additional variables in their design and trade their usual ‘snapshot approach’ (Schmitz 2010) for a longitudinal, developmental approach (Fine 2013; Rippon et al. 2014). Up to this moment, however,

investigation of experience-dependent plasticity has only rarely been applied to the emergence, maintenance, and plasticity of gendered behavior. Instead, studies tend simply to compare the biological sexes, as though the implicit aim were to identify fixed, universal female versus male signatures. (Fine et al. 2013, 551)

In this introduction, I will first highlight the fact that there is a shared history between studies of sexual differentiation in the brain and studies of adult neurogenesis. This shared history is what partially motivates the present study’s focus on the interplay between notions of hardwiring and plasticity in contemporary representations of sex/gender in the brain. Next, I will discuss the politics of plasticity, that is, the affinity between popular plasticity discourses and certain economic and social paradigms. After that, I will discuss a number of challenges faced by a neurofeminist project that aims to mobilize plasticity as an argument against

when referring to neuroscientific findings, and the term ‘gender’ when referring to social influences or concepts (e.g. ‘gender stereotypes’, ‘gender roles’ or ‘gender equality’). This is in the interest of readability and should not be understood as an endorsement of the conceptual separation of sex and gender.

5 biological determinism. These challenges further focus this study. At the end of this introduction, I will provide an outline of the chapters.

Sexual differentiation and brain plasticity: a shared history

The central premise of brain organization theory is that sex differences are ‘programmed’ in the womb under the influence of hormones—especially testosterone—similar to the way hormones influence the sexual differentiation of the external genitalia. The process begins when sex chromosomes determine gonadal differentiation (i.e. the development of testes or ovaries). The developing testes secrete testosterone, which supposedly ‘masculinizes’ (or ‘defeminizes’) the brain. In the absence of testes, and thus of high testosterone levels, a ‘feminized’ brain develops.3 In this account, ‘brain sex’ is decidedly pre-cultural: ‘from the start the environment is acting on differently wired brains in boys and girls’ (Kimura 1992, 118, my emphasis). Despite extensive critiques, brain organization theory is considered to be well established (Jordan-Young 2010), and sexual differentiation of the brain is associated with a range of sex differences in behaviour and cognition. In general, male brains are believed to be optimally wired for abstract thinking (e.g. spatial cognition) and fast action, whereas female brains are claimed to be more attuned to social cognition, emotional processing and language. These differences have been assessed in a variety of contexts, from toy preferences in children (Berenbaum & Hines 1992) to career choices in adults (Berenbaum & Resnick 2007). Besides these differences in and gender psychology, prenatal hormone exposure is believed to hardwired gender identity – the feeling of being male, female, or otherwise (although this latter option is not often considered). By proxy, brain organization is also associated with cis- versus transgender development: since the differentiation of the genitals takes place during an earlier stage of prenatal development than the differentiation of the brain, these two processes might take different routes (Bao & Swaab 2011). Third, brain organization is believed to hardwire sexual orientation. Whether we are straight, gay, lesbian or bisexual is said to be irreversibly pre-programmed in the womb – making any efforts to change this part of our identity later in life futile (Ibid.). Finally, sexual differentiation of the brain is associated with sex differences in psychological and neurological pathologies. A number of brain diseases

3. See Fausto-Sterling (2012) for a critical discussion of the representation of female development as the default mode.

6 affects men and women in different numbers and in different ways. hope to learn more about such disorders by elucidating the link with brain sex. Most of the direct evidence for brain organization theory is derived from experiments with non-human animals, in which hormonal manipulation is permitted. The first researchers to propose the theory were Charles Phoenix and colleagues, who injected pregnant guinea pigs with testosterone propionate and observed the effects on their offspring’s mating behaviour (Phoenix et al., 1959). They concluded that sex steroids act on the brain during early critical periods in sex-specific ways, with life-long effects. They furthermore distinguished this organizational effect of sex steroids—their effect on the prenatal development of neural circuits—from activational effects of sex steroids–their role in activating existing circuits in response to particular experiences (Ibid.; Young, Goy & Phoenix, 1964).4 Another landmark study in the history of brain organization theory is that of Nottebohm and Arnold (1976), who reported that several nuclei associated with song in zebra finches and canaries—species in which only the males sing—were several times larger in males than in females. In the canaries (but not the zebra finches), a testosterone injection enlarged these areas in the females, which enabled them to sing. Providing a textbook example of hormonally- controlled sexual differentiation of the brain, this finding gave an important impetus to brain organization theory.5 The observation that injected testosterone enlarged the song nuclei in adult females, however, also posed an enigma: ‘That was a real shock, because we had all been taught that an adult brain was supposed to stay the same size, with the same cells, forever’ (Nottebohm quoted in Specter 2001). Despite earlier reports on adult neurogenesis (e.g. Altman & Das 1965; Bayer, Yackel & Puri 1982), there was a strong scientific consensus that neurons could be lost, but not replaced. Backed up by better methods and a more established reputation compared to those who reported neurogenesis before, Nottebohm argued that new neurons were indeed generated in the vocal control nucleus of the canary (Goldman & Nottebohm 1983; Gross 2000). Although Nottebohm’s work was initially met with scepticism—especially his suggestion that his discoveries might have implications for the human brain—it is now credited for instigating ‘one of the great paradigm shifts of modern biology’ (Kandel quoted in Specter 2001, 45), namely, the shift from fixity to plasticity. In Nottebohm’s work (and that of others)

4 This organization-activation distinction has acted as an important heuristic for (neuro)endocrinological research, although not all empirical data fits this strict distinction (Arnold & Breedlove, 1985). 5. The relationships between sex, brain structure, and brain function are not so straightforward in all singing bird species, however. Fausto-Sterling (2012) discusses the example of African weaver birds, where males and females show distinct brain differences but sing in unison (31).

7 on birdsong, then, the history of brain organization theory and that of neuroplasticity come together. Whereas feminist critiques often represent the two research fields as fundamentally incompatible, this shared history suggests there are spaces where the two are integrated–spaces that might be worthy of critical analysis. Even though Nottebohm’s findings had planted the seed, it would be some time before the plastic ‘paradigm shift’ or, as Rubin (2009) has described it, ‘thought style’ (Fleck 1981), was achieved. The acceptance of neurogenesis in the human brain amongst neuroscientists was ‘delayed, turbulent and noisy’ (Rees 2010): a series of repeated (re)discoveries and contestations. Two important figures in this history are Elizabeth Gould, who started to investigate neurogenesis in the rat in Bruce McEwen’s lab in the 1990s (e.g. Gould et al. 1992), and Fred Gage, a prominent biomedical scientist who oversaw the first demonstration of neurogenesis in the human brain (Eriksson et al. 1998). Rees (2010) describes how around 2000, following these discoveries,

a major and passionate debate [arose] about the significance of plasticity: Does it really exist? If so, then do plasticity have a function? Are they minor phenomena, occurring only in “less important” brain regions? Would one really have to think of plasticity as the main feature of the brain …? (151)

Rubin (2009) argues that when adult neurogenesis in the human brain finally gained broad acceptance, this was to an important extent due to Gage’s affiliation with the biomedical field, which allowed plasticity research to be convincingly framed around a ‘therapeutic promise’ (419). The ‘neurobiological line of defense’ (417) that had been drawn around the human brain was relinquished as it became apparent that plasticity ‘opened up unprecedented possibilities for therapeutic intervention’ (419). This does not mean, however, that plasticity was now accepted in equal measure in all quarters. Rubin argues that alongside the prominent therapeutic discourse, which frames plasticity as widespread and full of promise and potential, a conservative neuroscientific discourse still remains, which ‘attempts to assign a proper place to neuronal renewal, as an interesting, albeit not dominating principle of the physiology of the adult mammalian brain’ (420). Although contradictory, these two views of plasticity are often found in the same spaces:

Reflections on the as yet unknown physiological role of structural plasticity are found alongside affirmations of its therapeutic potential. Within one and the same publication,

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the need for further research to properly assess the extent and physiological role of neurogenesis is proclaimed, while expectations for its therapeutic application are raised. (420)

It is useful to view the contemporary controversies over brain sex and plasticity in light of Rubin’s observation that, very broadly speaking, plasticity is generally conceptualized in one of two ways: either as a defining and pervasive feature of the brain or, alternatively, as a property of an otherwise stable, structured brain (Kleinherenbrink 2014). As this study will bring to light, across a range of scientific and popular contexts, plasticity is conceptualized as a property of male and female brains—similar to how it has been studied in the field of birdsong. In these cases, brain sex is placed behind the ‘neurobiological line of defense’ (Rubin 2009, 419) that separates the immutable from the malleable. Feminist critiques that call attention to the plasticity of sex itself, on the other hand, aim to raze this defence line. Importantly, as this study will consider in more detail, the claim that sex itself is plastic should not be intended to ‘haul phenomena back and forth across the biological border’ (Oyama 2000a, 190), as happens so often in nature-nurture debates. Rather, we can use plasticity as a tool to rethink the very meaning of the biological and its relation to the social.

The neuroscientific turn and the politics of plasticity

The shift from fixity to plasticity has not only transformed the , but has reverberated through the entire academic landscape. The idea that the brain literally embodies the immaterial opened up a new realm of inquiry for neuroscientists: it now makes sense to study questions about free will, consciousness or other mysteries of the mind by looking into the brain. Concurrently, those scholars who have been traditionally concerned with the human psyche and its products are now compelled to engage with the brain not (only) as a cultural or rhetorical phenomenon but as a fleshy, material entity. In what has been described as ‘the neuroscientific turn’, neuroscientific theories and concepts have been incorporated in a range of philosophical, political, theoretical, literary and artistic works, and have even given rise to a range of new disciplines like neurohistory, and (Littlefield & Johnson 2012). Whereas many non-scientists have drawn inspiration from the neurosciences, many have also expressed concerns about this pervasive ‘neurofication’ of academia. For example, the ‘critical neuroscience’ project emerged to analyse the influence of the neurosciences (Choudhury, Nagel & Slaby 2009). Others directly argued that philosophers and

9 cultural scholars have started to rely too much on neuroscientific literature and distort findings to fit their needs (e.g. Leys 2011; Papoulias & Callard 2010). Rather than taking a firm position in these debates, The Politics of Plasticity explores both the promises and the perils of ‘neurofeminism’: what might feminism gain, and what might it risk, in theorizing the sexed/gendered subject through the lens of neuroplasticity? As mentioned above, the shift from fixity to plasticity implies a shift in ‘ways of being neurologically human’ (Rees 2010, 153). Scholars have therefore assessed and reflected on the ways in which neuroscientific concepts affect understandings of self and society, tracing the modes of subjectivity and governmentality that emerge in popular neuroscientific discourses (e.g. Rose 2007; Vidal 2009). Many of these analyses have highlighted the affinities between neuroplasticity and neoliberalism. In popular discourses, neuroplasticity invokes notions of autonomy, flexibility, individual responsibility, and optimization, thereby compelling individuals to self-monitor and self-manage their lifestyle in ways that benefit the economic and political order. Malabou (2008), for example, has argued in What Should We Do With Our Brain? that the emergence of neuroplasticity has coincided with the development of an economic system that revolves around flexibility, delocalization and decentralization. Neuroplasticity can give us freedom, Malabou contends, yet ‘separat[ing] us from our brain is an ideological screen’ which equates the plastic ‘neuronal man’ with the flex-worker of high capitalism (40). Similarly, Pitts-Taylor has described how, in popular neuroculture, the plastic brain is conceptualized as a flexible, limitless resource that ‘ought to be tapped’ (642), and how this brain is linked to notions of responsibility and risk. As a result, ‘plasticity firmly situates the subject in a normative, neoliberal ethic of personal self-care and responsibility linked to modifying the body’ (2010, 639). Thornton (2011a) has also argued that the anxiety, guilt, hope and anticipation generated by popular neuroscience give rise to an entrepreneurial subject, who assesses and adjusts her conduct to maximize her happiness and her productivity (which, in neoliberal discourse, coincide). ‘Because these entrepreneurial models are articulated in neuroscientific languages,’ she writes, ‘they acquire a veneer of truthfulness and obviousness that is not provided by solely economic discourses’ (156). Popular plasticity discourse thus does not merely reflect the socioeconomic order in which it is embedded, but actively participates in its concomitant modes of governmentality and practices of the self. This study will address this alignment between neuroplasticity and neoliberalism when it considers contemporary conceptualizations of sex/gender in the brain in the areas of education, parenting and mental health. Its analysis will thus pay attention to the interplay between the selected texts and the social, political and economic context in which they occur.

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As such, it attends to the entanglement of scientific practices with social norms and power structures, as theorized by scholars in the field of science and technology studies:

we gain explanatory power by thinking of natural and social orders as being produced together. The texture of any historical period, and perhaps modernity most of all, as well as of particular cultural and political formations, can be properly appreciated only if we take this co-production into account. Briefly stated, co-production is shorthand for the proposition that the ways in which we know and represent the world (both nature and society) are inseparable from the ways in which we choose to live in it. (Jasanoff 2004, 2)

This perspective of co-production understands science not as a mirror of nature, nor as a social construct; instead, ‘it calls attention to the social dimensions of cognitive commitments and understandings, while at the same time underscoring the epistemic and material correlates of social formations’ (3). In other words, this study considers theories of brain sex as ‘things always-already engaged, as interlocutors, within the larger culture from which they have emerged’ (Bal 2002, 16). Specifically, this study pays attention to the presence of a postfeminist discourse, as defined by McRobbie (2004) and Gill (2007, 2008). McRobbie (2004) has discussed in terms of ‘female individualisation’, or the imperative for (young) women to independently choose and construct their lives (260-261). In this discourse, an ambivalent relationship (or ‘double entanglement’) to feminism is expressed: it is accepted insofar that this is required to state it is in the past, and therefore it is considered at once commonsensical and ‘fiercely repudiated, indeed almost hated’ (256). Gill (2007), in her analyses of recent media culture, describes a similar contradiction at the heart of what she terms ‘postfeminist sensibility’ (148). Women’s bodies are continuously scrutinized and evaluated, but the efforts they have to engage in to adhere to beauty standards are represented in terms of freedom, fun, and pleasing oneself. Similarly, biological sex differences in psychology are widely (re)affirmed, yet these are also construed as sexy, inevitable and even pleasurable. This ‘grammar of individualism’ (153) articulated by postfeminism represents women as fully agentic, yet compels them to engage in intense self-surveillance and self-disciplining. Gill notes how strongly this postfeminist sensibility resonates with neoliberalism. ‘At the heart of both’, she argues, ‘is the notion of the “choice biography” and the contemporary injunction to render one’s life knowable

11 and meaningful through a narrative of free choice and autonomy, however constrained one might actually be’ (154). This postfeminist sensibility provides a useful framework for interrogating and situating the representations of plasticity as a property of male and female brains that are encountered in this study. Like postfeminist media culture, such representations assert innate sexual difference—conceptualized as innocent, even useful—whilst thematising individual freedom, choice, and optimization. By considering how these representations resonate with neoliberal postfeminism, this study aims to gain deeper insight into their place and meaning.

Challenges in mobilizing plasticity

Schmitz and Höppner (2014) describe plasticity-based, biosocial approaches to the brain as a ‘virus with which neurofeminism has inoculated neuroscientific discourse during the last decade’ (16). Indeed, the phenomenon of plasticity constitutes a powerful challenge to neurosexism. Yet on the other hand, Schmitz and Höpner note, it also poses several challenges to those who wish to mobilize it in service of a critical neurofeminist perspective. First, popular representations of plasticity tend to conceptualize the brain as a passive and neutral substrate that can moulded at will. Recent work in , however, has insisted on the importance of considering the mutual constitution of the material and the discursive, and to theorize the biological body in its lively, material specificity. This ‘feminist new materialism’6 emerged at the beginning of the 21st century (Coole & Frost 2010; Dolphijn &Van der Tuin 2012; Hekman & Alaimo 2008). Building on and pushing back against the postmodern ‘linguistic turn’ that privileges discursive analysis, new materialists reappraise matter as resilient and productive rather than passive and inert: an active participant in the construction of reality and meaning (Grosz 1994; Barad 2007). Feminist materialists thus reject a mechanistic understanding of matter, foregrounding the radically unpredictable, indeterminate proliferation of differences instead (e.g. Grosz 2004, 2010). Difference, including sexual difference, is understood here not as referring to essences (either biological or social), but as referring to the ongoing, dynamic intersection of the material and the discursive (e.g. Braidotti 1989, Grosz 1994). This ‘involves a rewriting of sexual difference and sexuality not by means of dualist premises, but as a practical in which difference in itself comes to being’ (Dolphijn & Van der Tuin 2012, 141). New materialism thus attends to the way in which bodies

6. See Ahmed (2008) and Davis (2009) for a discussion of the purported ‘newness’ of these materialisms.

12 materialize in relation to, and participate in the materialization of, the personal and collective meanings (truths, knowledges, subjectivities) attached to them. Neurobiological accounts of sexual difference are not necessarily oppressive, nor are they necessarily liberating. Yet as Wilson (1998) has argued, to successfully challenge deterministic, essentialist account of sex and sexuality requires actively engaging with the material brain and appreciating its inherent complexity and contingency. In this study, I therefore adopt and elaborate a performative, materialist perspective that considers the brain, and the differences it embodies, as materializing in the ongoing, dynamic interaction of material and immaterial forces. This includes a consideration of the technoscientific practices through which knowledge of these differences is produced. As Barad (2007) has argued, and as I will develop more fully in this thesis, scientific practices do not merely reveal these differences but actively co- constitute them. This is not to argue that science cannot grasp the material world, but rather to stress the fundamentally relational nature of material phenomena and the enmeshment of being and knowing. A second concern raised by Schmitz and Höppner (2014) is that even though plasticity constitutes a powerful argument against biological determinism, it does not necessarily subvert essentialism. In an earlier paper, Schmitz (2012) has drawn attention to what she calls ‘modern neurodeterminism’:

this concept of determinism does not care whether brain structures and functions are innate or formed by experiences during lifetime, or by technologies, respectively. It is irrelevant whether the individual brain at a certain point in time is as it is by nature or by nurture, but its current status should predict all processes of thinking and action (262)

This concept of ‘modern neurodeterminism’ points to contemporary understandings of the brain as both the cause and the consequence of our experiences: our brain is what we make of it, but we are also still our brain. As Thornton (2011a) has noted, ‘it is in part because of these tensions that the brain obsession has so much purchase on our lives’ (4). It is this modern neurodeterminism that underpins the resonance of plasticity discourses with neoliberal values, as discussed above: ‘when everyday affairs are translated into the scientific languages of neuroscience, they are endowed with regulatory significance’ (7). In light of this concern, Kraus (2012) has insisted that neurofeminism takes stock of the following questions before deciding whether plasticity is the right tool for the job of challenging biological determinism:

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what kinds of cerebral subjects/identities of sex, gender and sexuality are being produced (or not) through the notion of brain plasticity and the related sex/gender term? … what does it mean and take to develop a critical stance when biosocial, plastic and idiosyncratic arguments are, it seems, so desired and promoted both inside and outside of neuroscience? … Should feminist-informed critiques contribute to increasing the robustness of the neuroscientific endeavor …? (252-253)

Taking these considerations as a starting point, The Politics of Plasticity not only considers the question what sex/gender differences in the brain are and how these differences are known, but also the question what kinds of subjectivities the very preoccupation with brains gives rise to. As such, it approaches the question ‘what does it mean to (re)think the sexed/gendered subject as a neuroplastic subject?’ as an ontological, epistemological and ethical challenge. Intertwined as they are, these three levels of concern will not be addressed in isolation, but rather considered in relation to each other throughout this thesis. Drawing on neuroscience, feminist theory, science and technology studies, sociology, history, and other disciplines, this study investigates the concept of plasticity by tracing how it travels and connects, what kinds of work it performs in different contexts, and where it might be taken next.

Chapter outline

The Politics of Plasticity is roughly divided into two parts. The first two chapters serve to further introduce brain organization theory, the critiques that have been levelled against it, the role of plasticity in these critiques, and my own theoretical perspective on how and when sex/gender comes to matter in the brain. Once this stage is set, so to speak, the remaining chapters will examine how sex and gender are understood in relation to the brain in three contexts: education, parenting, and mental health. I have selected these topics because in each area, neuroscientific studies, brain-based policies, and brain-based popular advise literature have emerged that relate directly to gender equality. I will closely read these texts in order to uncover the role of both hardwiring-based and plasticity-based claims with respect to sex and gender. In each chapter, I will pay attention to the scientific and social orders in which these claims emerge: to which questions or concerns about sex/gender do they respond? Which values do they enact and encourage? What kind of subjectivities do they give rise to? Which bodies are invested with potential and/or risk, and marked as appropriate targets for intervention? What do they make visible or legible, and who or what gets excluded?

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Chapter 1 will review the most pertinent critiques that have been raised against brain organization theory by feminist critics, using as an example the study that, according to one neuroscientist in the field, suggests Gungor’s tale of two brains aptly reflects how male and female brains are really wired (Cahill 2014a). This review will explicate how the claim that brain sex is dichotomous and hardwired is supported by particular, highly selective ways of generating, comparing and representing data. To challenge the claim that sex differences in the brain must be present or programmed at birth, I review evidence from a range of research areas that suggests post-natal influences indeed affect the sexual differentiation of the brain. Finally, I will discuss research programs in which plasticity is studied as a property of male and female brains, which shows that the shared history between brain organization theory and plasticity research has continued into the present. It is important to recognize that plasticity is not necessarily antithetical to the notion of hardwired brain sex but can, in fact, be incorporated into—and used as evidence in favour of—brain organization theory. This insight will contribute to the analyses in the subsequent chapters. In Chapter 2, I will develop my own perspective on how to understand sex/gender differences in the brain. The question that prompts this chapter is: how to mobilize plasticity as a powerful tool against biological determinism, without promoting understandings of the self and society that erase both the resilient, productive nature of the material body and the social order that impinges on the body? Drawing from feminist theories that challenge the separation between nature and nurture or the material and the discursive, this chapter reads a classic experiment on sex differences in different environments (Juraska et al. 1985) as a ‘material- discursive phenomenon’ (Barad 2007) in which brain sex materializes in the intra-action of genes, environmental stimuli, and the technoscientific apparatuses used to render them visible. Here, plasticity appears as a useful tool to theorize the entanglement of sex and gender. In the next chapters, the study will proceed to analyse understandings of sex/gender and the brain in public discourses. Chapter 3 engages with the so-called ‘boy crisis’–a concern over boys’ educational achievement which has been spreading internationally since the turn of the century. Best-selling boy advocates have mobilized brain organization theory as an explanation of, and solution to, this crisis: boys and girls learn differently, they claim, therefore schools (which are perceived as feminized) must adjust their curriculum to boys’ natural needs (e.g. Gurian et al. 2010 [2001]; Sax 2008). I argue that when analyses and critiques of these claims focus purely on biological determinism, they fail to fully appreciate why this genre is so successful. Reading the claim that boys and girls learn differently as an assertion of ‘sex differences in plasticity’, I demonstrate how neuro-inspired boy advocates successfully respond

15 to a changing society by simultaneously reaffirming masculinity as a natural essence and thematising individuality and freedom. I furthermore discuss how male brains, in this literature, are conceptualized as a source of potential and of risk that requires an ‘invisible pedagogy’ (Bernstein 1977). Finally, I consider the impact of these views on Dutch educational policy. In Chapter 4, I turn to the family. The infant brain, the maternal brain and–very recently– the paternal brain have all been conceptualized in scientific, political and popular discourses as limited windows of exceptional plasticity. I discuss how these representations foster an ideology of intensive parenting (Hays 1996) which responds to, and further enacts, social (gendered, classed) inequalities. As a result, certain parents are designated as at risk and a risk, and therefore as appropriate targets for intervention. I also make the case that research on the plastic parental brain can be read differently, namely, as a challenge to women’s naturalized role of the primary caregiver and to the ideal of the nuclear family as the optimal developmental environment. Chapter 5, finally, focuses on women’s mental and brain health. It discusses how the progressive neurofication of mental disorders, together with the emergence of a women’s health movement that promotes research on sex as a biological variable, has imbued brain organization therapy with a therapeutic promise. Research on hardwired brain sex is promoted as a crucial way of understanding, curing and preventing psychological and psychiatric disorders. Using schizophrenia and autism as examples, I argue that this approach obscures crucial information and reifies both brain sex and (sex/gender differences in) mental disorders. This chapter also considers how the mobilization of brain sex and brain plasticity in ‘consumer’-oriented material provided by women’s health organizations constructs women as inherently at-risk but simultaneously capable of (and thus responsible for) pro-actively managing their health. One of the central questions in The Politics of Plasticity is whether plasticity is the right tool for a feminist critique of neurobiological determinism (Kraus 2012). However, the study will not yield a definite answer to that question. Plasticity is itself a plastic concept–it can adapt itself with ease to the needs of its user. Mobilizing it to advance a critical feminist project will therefore always carry benefits and risks. Rather, what I aim for by analysing contemporary understandings of sex/gender and the brain is to gain a clearer view of these benefits and risks, so that we might perhaps navigate them with success.

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Chapter one Sex/gender in the plastic brain

‘I know ten thousand women called Jane and Mary Jane, but I've not seen any two who really were the same’ (Angelou, ‘Human Family’)

Introduction

The news broke on a Monday morning in December 2013. Penn Medicine announced that its latest brain study had found ‘striking differences in the neural wiring of men and women’, thus ‘lending credence to some commonly-held beliefs about their behaviors’ (Penn Medicine 2013). Soon, the news went global and digital headlines exploded: ‘Brains of men and women poles apart’ (Gray 2013), ‘Men can’t multitask, women have better memory’ (Press Trust of India), ‘Vive la Différence!’ (The Economist). The study, published in the high-impact journal PNAS the following month, had investigated sex differences in the structural of the brain using diffusion tensor imaging (DTI), a magnetic resonance imaging technique that charts the diffusion of water molecules in the brain to construct a map of the connective tissue (Ingalhalikar et al. 2014a). The research was conducted with an impressively large sample: 949 youths, aged 8 to 22, participated. The Figure 1. Ingalhalikar et al.’s (2014a) published results reported group-based sex visual maps depicting the increased connectivity in males (upper) and differences in the connective tissue of the brain, and females (lower) (826) visualised them with an accompanying series of maps. There was a pair of brain maps for each age group as well as for the entire sample: in each set, one map showed the connections that were stronger in the males with blue lines, and the other showed the connections that were stronger in the females with orange lines.

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Connections that were, on average, stronger in the males were mostly connections within the hemispheres, whereas the average stronger connections in the females were mostly connections between the hemispheres.7 In each successive age group, the differences became more numerous. The maps representing the data of the entire sample (Figure 1) were included in the press release and widely circulated in the press, online blogs, and other media outlets. The authors concluded that, as they mature, ‘male brains are optimized for intrahemispheric and female brains for interhemispheric communication’ (823), whereby men’s wiring ‘confer[s] an efficient system for coordinated action’, and women’s wiring ‘facilitate[s] integration of the analytical and sequential reasoning modes of the left hemisphere with the spatial, intuitive processing of information of the right hemisphere’ (826). In lay terms, according to one of the study’s researchers, Ragini Verma, the study corroborates that:

if there’s a task that involves doing both [logical and intuitive thinking], it would seem that women are hardwired to do those better. Women are better at intuitive thinking. Women are better at remembering things. When you talk women are more emotionally involved – they will listen more. (quoted in Sample 2013)

Commenting on the significance of intuitive thinking in the Independent, Verma further remarks that ‘Women tend to be better than men at these kinds of skill which are linked with being good mothers’ (quoted in Connor 2013). Drawing these links between global brain connectivity, modes of cognition, and gender roles, Verma expresses her surprise that the results ‘matched a lot of the stereotypes that we think we have in our heads’ (Ibid.). Ingalhalikar’s co- author, Ruben Gur, confirms this observation: ‘As much as we hate stereotypes,’ he said to the National Post, ‘a lot of them have some kernel of truth in them’ (quoted in Boesveld 2013). Verma’s expression of surprise is intriguing, and testifies to the capability of novel brain imaging techniques to lend new cachet to overly familiar claims about sex differences. In other words, studies like the connectome study are old news and newsworthy at the same time. On the one hand, as the press announcement indicates, the results confirm ‘commonly-held beliefs’ that are already pervasive. Various media, in turn, echoed this sentiment: ‘Scientists have drawn on nearly 1,000 brain scans to confirm what many had surely concluded long ago’ (Connor 2013), ‘Women have known it for generations – and the proof has finally arrived’ (Spencer

7. This difference was found for the supratentorial region of the brain, which consists of the cerebral cortex and subcortical structures such as the hippocampus. In the cerebellum, the pattern of sex differences was reversed.

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2013). On the other hand, brain maps that reflect these familiar beliefs also evoke excitement and wonder.8 Interestingly, the specifics of the neuroscientific data are not always what invites such fascination. Analysing the online coverage of the connectome study, O’Connor and Joffe (2014) found that in most sources, ‘the precise ways in which the sexes differed was secondary to the ‘proof’ that they were different. The unspecified concept of difference was meaningful in itself, independently of where that difference lay’ (8). Thus, the gratification that studies like Penn Medicine’s offer to the general public appears to lie precisely in the combination of old and new, which allows people to ‘enjoy the satisfaction of brain science bolstering our observations from the field’, as the Canadian National Post reported (Boesveld 2013). Claims about hardwired differences in male and female brains generate enthusiasm as well as critique. A large body of feminist analyses, spanning back decades to the present, exposes numerous inconsistencies, contradictions, and methodological flaws in the evidence for the existence of hardwired sex differences in the brain (e.g. Bleier 1984; Fausto-Sterling 2000; Fine 2011; Jordan-Young 2010; Rogers 2001). This exposure of is accompanied by an exposure of the ‘cycle of bias’ (Caplan and Caplan 1994, 1) that shapes scientific research, gender stereotypes, and actual sex/gender differences. As such, these archives teach two main conditions about the neuroscience of sex difference. One, existing gender stereotypes and gender inequality affect the design and interpretation of neuroscientific studies. Two, scientific claims about hardwired sex differences—even when outcomes frame these differences in terms of equality—naturalise and further entrench gender ideologies. As a result, these claims have the power to increase the endorsement of gender stereotypes, the current gender status quo, and gender-based discrimination (e.g. Brescoll and LaFrance 2004; Morton, Postmes, Haslam and Hornsey 2009), and to encourage conformity to gender stereotypes (e.g. Dar-Nimrod and Heine 2006; see also Fine 2012). In other words, there is a circularity at work in the relationship between science and society that demands critical analysis. Gender stereotypes—and, by extension, the scientific theories that naturalize them— might even shape the very brains of the men and women participating in studies. Research in neuroscientific areas other than sex difference studies demonstrates that a wide range of experiences—including musical training, juggling, playing video games, and taxi-driver training—can result in group-based brain differences in various structures and functions (e.g. Draganski et al. 2004; Herholz and Zatorre 2012; Kühn et al. 2014; Maguire et al. 2000; see

8. A range of scholars has discussed the apparently special status of neuroscientific findings, particularly when represented in brain maps, in the general public perception (e.g. Racine, Bar-Ilan and Illes 2005; Ramani 2009; McCabe and Castel 2008; Weisberg et al. 2008).

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Thomas and Baker 2013 for a critical review).9 However, studies reporting sex differences in the brain typically assume—without clear justification—that postnatal experiences have not affected these differences (Fine 2013). Instead, brain organization theory serves as the (implicit) theoretical framework that guides interpretation. Picking up on new insights about the malleability of the brain, recent feminist critiques of brain sex studies have considered the possibility that gender-specific experiences may affect the development of sex differences in the human brain (e.g. Fine, Jordan-Young, Kaiser and Rippon 2013; Joel 2011; Vidal 2012). This overlooked perspective prompts re-readings of existing research and reconsiderations of the place and meaning of theories about neural difference. The development of such productive directions—which crucially supplement, but cannot replace, critiques of ongoing research— will be the focus of Chapter 2. First, this chapter will lay the necessary groundwork for such an account by reviewing the most significant critiques of brain organization theory, with a particular focus on the relationship between sex/gender and brain plasticity: Which gaps in our current state of knowledge about sexual differentiation in the human brain does the notion of plasticity highlight? To what extent is plasticity ignored in the field of brain sex research? Which lines of evidence suggest that environmental influences indeed impact the development of sex differences in the brain? And does acknowledgement of plasticity necessarily undermine brain organization theory? Whilst addressing these questions, it is important to keep in mind that by asking whether gendered experiences might predict sex differences in the brain, the very existence and significance of those sex differences should not be taken for granted. As feminist scholars have noted long ago, sex/gender categories are a useful way of describing structural power inequalities but to assert that women, as a group, share specific traits or experiences is fraught with difficulties. The experience of being a woman—or a man—intersects with, and is mutually constitutive of, other experiences, including but not limited to race/ethnicity, social class, sexual orientation, or able-bodiedness (Crenshaw 1991). If gender-related experiences impact brain development, then the resulting neural phenotypes should be expected to reflect this wide diversity—possibly to the extent that sex differences will not be recognizable as such. My discussion will therefore begin by considering how the claim that brain sex is dichotomous and homogenous is sustained through particular ways of representing data that in fact reflects much more diversity, using the connectome study (Ingalhalikar et al. 2014) as a recurrent example. Next, I will review existing evidence that points to the plasticity of sex differences, thus

9. This plasticity also affects the structural connectome: a single map ‘would only represent a snapshot of a dynamic process’ (Sporns 2013, 57).

20 challenging the assumption that sex differences observed in the brain must have been present or programmed at birth. Finally, I will discuss that despite this overlooked perspective, research on sex differences in the brain and the discovery of plasticity do, in fact, have a shared history and are often considered in relation to each other. Specifically, sex differences in plasticity are frequently asserted in neuroscientific studies. From this perspective, plasticity does not undermine but precisely corroborate brain organization theory.

Vive la différence? Imag(in)ing sex in the brain

Neuroscientists seek sex differences in the brain to explain sex differences in cognition and behaviour. The connectome study (Ingalhalikar et al. 2014a), for example, aimed to find the neural substrates of the ‘behavioral complementarity’ (826) between men and women with respect to motor and spatial skills (men’s supposed strong suits), and memory and social cognition (women’s purported talents). The researchers subjected those who participated in the imaging study to a battery of neurocognitive tests to assess executive control, episodic memory, complex verbal, non-verbal and spatial cognition, social cognition, and sensorimotor skills. According to Ingalhalikar et al. (2014a), these cognitive tests—published separately in (Gur et al. 2012)—yielded ‘pronounced sex differences’ (826). Upon inspection of the data, however, what is most striking is the similarity between the male and female groups (Gur et al. 2012). Of the 26 statistical tests of cognitive sex differences performed, five showed no effect whatsoever, six had an effect size so close to zero as to be negligible (< 0.10), and the other 15 had a small effect size (11 effect sizes of 0.10 < d < 0.20, 4 effect sizes of 0.20 < d < 0.35) (Ibid.). The largest effect size was found for speed of emotional identification, whereby females outperformed males (d = 0.33); even so, the groups overlapped by more than 85%, meaning that there was a 40% chance that a random male outperformed a random female. Thus, sex explains only a small proportion of the individual variation in cognitive performance found in the entire sample on this test. Nevertheless, this effect is interpreted as pronounced ‘behavioral complementarity’ in order to motivate and justify the search for sex differences in the brain. A decade ago, Janet Shibley Hyde (2005) demonstrated that males and females are much more similar than they are different in most psychological and behavioural traits. A number of more recent studies confirm this finding (e.g. Carothers & Reis 2013; Hyde 2014; Zell, Krizan & Teeter 2015), and the American Psychological Association (2005) also endorses it by affirming that ‘one’s sex has little or no bearing on personality, cognition and leadership’. Although small differences can be meaningful, they do not warrant a portrayal of men and

21 women as two different natural kinds, which is what happens when a scientific study or media depiction focuses on differences without quantifying them. Such a portrayal naturalises and further entrenches gender stereotypes, which has potentially negative consequences on gender equality in a range of areas, including work and family life. Despite the proliferation of studies reporting sex differences in the brain, Hyde’s (2005) ‘similarities hypothesis’ seems to be applicable to neuroscientific evidence as well as to behavioural and cognitive evidence. Critical analyses of neuroscientific studies show that few, if any, sex differences in the brain are consistently and reliably supported by the available evidence (e.g. Jordan-Young 2010). For example, Fausto-Sterling (2000) examines the idea that women have a larger corpus callosum—the wide, flat bundle of fibres connecting the hemispheres—than men. An article in Science (De Lacoste-Utamsing and Holloway 1982) first popularised the idea in the early 1980s by reporting a size-difference observation and relating it to purported sex differences in visuospatial skills. Fausto-Sterling (2000) finds an absence of consensus in subsequent publications on the topic: many studies claimed a sex difference in size or in shape, in weight or in volume, in this part or that, relative to brain size or not, and many others did not find any difference at all. ‘Relationships among gender, brain function, and anatomy are hard to interpret and difficult to see’, Fausto-Sterling notes (115). Indeed, the manifestation of sex differences in the brain depends on many factors, including technological procedures and statistical decisions. One of the most robust known differences concerns overall brain size: women’s brains are, on average, somewhat smaller than men’s (even when controlled for body size; see Cosgrove, Mazure & Staley 2007). A century ago, this difference was used to explain women’s supposed intellectual inferiority (Romanes 1887). Today, scientists often dismiss it as a confounding factor with no significant bearing on cognition: a factor to be controlled when looking for sex differences that are meaningful. Not all researchers make this correction, however, and amongst those who do, there is debate about what the proper methods are (Ardekani, Figarsky & Sidtis 2013; Luders, Toga & Thompson 2014; Smith 2005). As a recent meta-analysis of sex differences in hippocampal volume demonstrates, such decisions can make all the difference (Tan et al. 2016). The hippocampus is often claimed to be larger in females, yet this meta-analysis of 76 studies found a slightly larger volume in the male group, which disappeared entirely after correcting for individual variation in total or intracranial volume (357-58).10 Nevertheless, the authors note, most reviews

10. They conclude that ‘any sex difference in [hippocampal volume] is modest and highly sensitive to the method of brain size correction’ (357-58; see also Perlaki et al. 2014).

22 on the topic claim that the evidence for a larger hippocampus in women is consistent, and only cite a few early studies without taking into account more recent, contradictory evidence. Similarly, the idea that women’s brains are less lateralised (i.e. have more interhemispheric connections) than men’s brains is commonly asserted as a reliable fact, with reference to the study by Shaywitz and colleagues (1995) that found phonological processing lateralised in men and not in women. Ingalhalikar et al. (2014a) also cites the Shaywitz study as a corroboration of their data (826). Several meta-analyses, however, demonstrate that the lateralisation finding is not consistently replicated (Sommer et al. 2004, 2008). Investigating the citational practices in brain sex literature, Fine (2013) reports that the majority of articles (62 out of 74) that refer to the Shaywitz study do not mention the existence of contradictory findings (378). She concludes that the literature on brain sex is unduly biased towards confirming the existence of sex differences.11 This bias towards asserting sex differences is also manifest in the way research papers present findings, both verbally and visually. The authors of the connectome study (Ingalhalikar et al. 2014a), for example, qualify the sex differences in their data as ‘overwhelming’ and ‘fundamental’ (826) and as ‘striking’ and ‘stark’ in the press release (Penn Medicine 2013). Upon inspection of the visual maps representing the data (Figure 1), one is indeed struck, and possibly even overwhelmed, by the contrast between the two images. But what do these images actually show? Highlighted in blue and orange lines are the nodes for which a sex difference was detected. Not shown are the nodes where no sex difference was detected. Nor do the maps clue us in about the variations within individual brains, even though brains are a mosaic of properties that are sometimes more, sometimes less typical of one’s sex (Joel 2012; Joel et al. 2015). Most importantly, neither the captions nor the rest of the paper’s text offer information about the actual size of the differences mapped. The reader therefore cannot know the variation within each group or the overlap between the groups, even though individual variation in brain connectivity is known to be substantial (Sporns 2013). This unacknowledged variation demonstrates a bias that prioritizes difference over similarity and dimorphism over variation. As Dumit (2004) argues in his discussion of PET scans, the juxtaposition of two (or more) brain images with group-based labels invites a reading that collapses brain, scan, and person, and creates the impression that one is observing categorically different brains belonging

11. This bias is exacerbated by the fact that publishers prefer positive results over null findings, which creates a ‘file drawer’ effect whereby studies in which a sex difference is not detected are less likely to be published than studies in which a sex difference is detected (see Fine 2011).

23 to categorically different people (6). When scientific and popular media employ such images to display sex differences in the brain, as Meynell (2012) writes in relation to fMRI, it creates,

two objects from nowhere—the male brain and the female brain—where the constructed lack of continuity between the two suggests an absolute sex dimorphism—two objects that are two distinct forms of brain, two fundamentally different kinds of people—despite the fact that typically the raw data do not. (26)

The maps from Penn Medicine’s connectome study are a prime example of this process. By depicting non-dichotomous sex differences in two maps, one for each sex, without any information about effect size and variability, the images already assume, and actively contribute to the construction of, the ‘overwhelming’ and ‘stark’ complementarity between males and females. ‘[T]he mode or presentation totally elides variation’, Meynell writes; ‘[t]hus visually the question is begged’ whether brain sex is dichotomous rather than complex, contingent, multiple, and/or (multi-)dimensional (25). With the phrase ‘objects from nowhere’, Meynell conveys the fact that male and female brains are not material, fleshy realities but abstract, mathematical fictions. It also echoes Haraway’s analysis of modern, Western scientific vision as a view from nowhere. Haraway shows that the ideal of Western science positions the scientist as a value-free, passive observer of Nature (e.g. 1988; 1997). Possessing a disembodied ‘view from nowhere’, this ideal scientist is untroubled by any kind of biased perspective shaped by social conditions. Against this ‘god trick’ (581), Haraway (1988) argues for explicitly situated, embodied knowledges. Later in this chapter, I will return to Haraway’s notion of situated knowledge. Here, I want to highlight how this ‘view from nowhere’ applies to brain imaging. Brain images are not pictures of the brain: they do not even represent visual or physiological properties (Catani et al. 2013; Roskies 2008). They are highly mediated, composite representations of statistical procedures performed upon a vast amount of quantitative data acquired through complex technological operations that involve a series of choices on behalf of the researchers.12 These choices include technical decisions, such as choosing an appropriate method to control for overall brain size or head movement, operationalising sex as a dichotomous variable, or choosing to visualise the results in paired maps that omit crucial information. The discrepancy between the apparent and actual

12. These measurements, moreover, do not assess brain structure or function directly but via a variable that is believed to correlate reliably with structure or function, such as the diffusion of water in DTI or the blood oxygen level in fMRI.

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‘inferential distance’ (Roskies 2008, 20) of brain images is easily forgotten when neuroscientists speak of brain imaging as a non-invasive, neutral way of watching the living brain in action (Dumit 2004), or when they conflate physiological and statistical properties by using ‘terminology that alludes to anatomical properties when in fact it reflects only features of the derived maps or graphs’ (Catani et al. 2013, 10). Testifying to the apparent photographic realism of brain images, the media widely mislabelled the connectome maps as depicting the (average or typical) male and female brain. Responding to criticism that the study presents a quantitative difference as a qualitative one (Joel & Tarrasch 2014), the connectome study authors (Ingalhalikar et al. 2014b) write that their critics ‘shoot the messenger’ (E638). ‘Disliking the findings of a study that does not agree with one’s beliefs is understandable’, they argue (Ibid.). Any misinterpretation of the brain maps, they suggest, is due to scientific illiteracy of the reader. Yet by positioning themselves as neutral messengers from nature and by writing about male or female brains as if they were real, fleshy entities, the authors of the connectome study actively encourage their audience to mistake an abstract model for reality.13 Again, the point is not that small differences are meaningless. The point is that the notions of male brains, female brains, and brain-sex-as-dichotomy are misguiding, and that we need better ways of researching the relationships between sex/gender and the brain. To this end, Rippon and colleagues (2014) recently recommend that studies of sex differences in the brain pay attention to four key principles: overlap, mosaicism, contingency, and entanglement. Overlap, as discussed, refers to the fact that sex differences in the brain are often small and difficult to establish with certainty, and that they are certainly not dimorphic. Mosaicism, mentioned above, indicates that individual brains are not uniformly male-like or female-like, just like individual personalities are not uniformly masculine or feminine. Contingency and entanglement are connected to brain plasticity, the main focus of the rest of this chapter: ‘there is considerable evidence that average female/male differences can be modified, neutralized, or even reversed by specific context …. Clearly, this will be reflected in the neural substrates of such behavior, which therefore cannot be universal or fixed’ (4). Whereas the development of sex/gender differences is commonly understood as following ‘a causal pathway that runs from genes to hormones to brain to behavior to social structure’ (3), Rippon et al. urge researchers

13. The press release (Penn Medicine 2013) encourages this even further when it states that ‘in females, the wiring goes between the left and right hemispheres’, as if the lines in the map actually represent real wiring, and males do not have interhemispheric connections.

25 to consider the ‘on-going interactive and reciprocal influences of biology and environment in brain structure and function’ (4). This interaction is the focus of the rest of this chapter.

Brain sex in context: the plasticity of sex differences

Ingalhalikar and colleagues link their finding of sex differences in structural connectivity to intuitive thinking, multitasking, emotional involvement, and even mothering. The idea that sex differences in the brain give rise to sex differences in cognition and behaviour is indeed intuitive. However, even when we leave the philosophical problems involved with the leap from brain to mind aside, linking brain structure, brain activity, and psychology/behaviour together is fraught with difficulties. Anatomical connections do not always correspond to functional connections (Honey, Thivierge & Sporns 2010), and different neural processes can result in the same behaviour by compensating for other physiological differences (De Vries 2004; Grabowski et al. 2003; Piefke et al. 2005). As a result, fewer or greater connections do not always entail lower or higher correspondence with behaviour, respectively, and the psychological or behavioural implications of a brain difference cannot be assumed. If the insula, a brain area associated with homeostasis and self-awareness, is larger in women but denser in men, what do we make of that? Even if we can correlate a sex difference in the brain to a sex difference in behaviour, it is not immediately clear ‘what, for example, a difference in cell number buys one sex over the other in terms of function’ (De Vries & Södersten 2009, 4). Leaping from structure to function without empirically testing the presupposed links, as the authors of the connectome study do, is therefore unwarranted, and risks the filling in of knowledge gaps with presuppositions animated by gender stereotypes. It is now well established that structure and function are reciprocally related, so even if we can confirm a reliable and meaningful connection between a structural and a functional difference, the question of causality remains. The connectome study’s (Ingalhalikar et al. 2014a) authors claim that the differences they report are ‘hardwired’ (quoted in Sample 2013), even though these differences appeared to emerge with age.14 Their use of the term ‘hardwired’ implies that these different developmental trajectories are pre-programmed before birth. They do not consider the alternative explanation their data clearly invite: that boys and girls, on average, have different life experiences that impact brain connectivity. Although it is less common for neuroscientists to explicitly state that brain sex is hardwired (Kaiser 2010),

14. Even though there was no significant age-by-sex interaction, a ‘divergence in developmental trajectory’ was noted (Ingalhalikar et al. 2014a, 2).

26 literature on brain sex typically ignore post-natal influences on brain development. Imaging studies are generally more concerned with establishing the existence of a sex difference rather than with tracing its origins, favouring a ‘snapshot approach’ over a developmental approach (Fine 2013; Schmitz 2012). Some researchers are more outspoken, and explicitly reject the possibility that plasticity is involved. Cahill (2014b), for example, criticises feminist scholars who express interest in this possibility by stating that:

Yes, brains are plastic, but only within the limits set by biology. It is decidedly not the case that environmental experience can turn anything into anything, and equally easily, in the brain. The specious plasticity argument invoked by anti-sex difference authors appears to be just a modern incarnation of the long-debunked “blank slate” view of human brain function, the idea that all people’s brains start out as blank slates, thus are equally moldable to become anything through experience. (paragraph 23)

Cahill’s statement invites two responses. First, considering the possible role of environmental factors in the emergence of sex differences in the brain does not necessarily amount to blank- slate thinking. By asserting that this is the case, Cahill forces a choice between biological and social determinism. In popular neuroscientific discourses, brain plasticity is indeed often used to argue that our brain can be changed in any way we like by manipulating environmental influences or altering individual conduct. Yet feminist critics of brain organisation theory who mobilise plasticity arguments are often as weary of social determinism (and claims of self- determination) as they are of biological determinism. As I will elaborate in Chapter 2, an account of how and when sex comes to matter in the brain can avoid both. Second, the ‘key in the plasticity argument’ made by feminist critics, Cahill argues, is that they suggest ‘that the brain is perfectly plastic. It is not. The brain is plastic only within the limits set by biology’ (paragraph 19). These limits, for Cahill, are set by sexual differentiation: brain sex transcends plasticity. Yet, it is premature to argue that plasticity is irrelevant to sexual differentiation in the human brain. As I mentioned in the above, there is a dearth of empirical research on this matter. There are, however, several lines of (mostly circumstantial) evidence that suggest plasticity is, in fact, consequential for sexual differentiation. I will briefly review a selection of the evidence in this section (for more extensive reviews, see Miller & Halpern 2014; Wade 2013). First, there is evidence from non-human animal studies. It is well known that post-natal experiences impact behaviour that is supposedly hardwired by prenatal hormone exposure. For

27 example, Celia Moore’s (1984) classic work on mother-infant interactions in rats demonstrated that the physical contact between mother and pup interacts with hormones, affecting future sexual behaviour (see also Cameron, Fish & Meany 2008). Other traits regarded as sex-specific but shown to be affected by (early) experiences include parental behaviour (Champagne 2011) and aggression (Marler, Bester-Meredith & Trainor 2003). In addition, a large body of work demonstrates similar effects on sex differences in the brain. Maternal care, housing conditions, stress, and other experiences can change the size or even the direction of sex differences in brain structures, functions and chemistry. One of the earliest demonstrations of such an effect was a study by Juraska and colleagues (1985). Comparing rats raised in a standard environment with rats raised in an enriched environment, they found that a known sex difference in the dendritic morphology of the hippocampus was reproduced in the standard environment, but reversed in the enriched condition. Sex differences in the brain thus appeared to be relative to the developmental environment. In Chapter 2, I will return to this study and elaborate in more detail why this experiment gives us a prime example of the dynamic, irreducible interaction of nature and nurture. Second, in humans, the size and direction of sex differences in cognition and behaviour are often attributed to ‘hardwiring’, yet they also appear to be sensitive to postnatal experiences. For example, sex/gender differences in mathematical, verbal, and spatial skills vary with cross- cultural factors like gender equality and, therefore, change over time (e.g. Guiso, Monte, Sapienza & Zingales 2008; Hyde et al. 2008; Reilly 2012). Demographic variables like socioeconomic status or education also affect sex/gender differences in cognition and behaviour (e.g. Hoffman, Gneezy & List 2001; Levine et al. 2005). Furthermore, these differences can be affected by short-term contextual effects. Studies exploring stereotype threat effects, for example, suggest that the salience of gender stereotypes can encourage gender-typical behaviour, although there is some debate over the robustness of this effect (Flore & Wicherts 2015; Spencer, Steele & Quinn 1999; Stoet & Geary 2012; Walton & Spencer 2009). A review of male-female differences in aggression by Richardson and Hammock (2007) demonstrates that gender alone does not predict aggression but is only meaningful when considered in a particular context. Finally, certain differences can disappear after training, as a study using video game training to close the gap in spatial cognition demonstrates (Feng et al. 2007; see also Uttal et al. 2013 for a different finding and discussion). Third, research linking variation and change in sex differences in human cognition and behaviour to sex differences in the brain is exceedingly scarce, but there are some recent studies available. Haier and colleagues (2009) trained adolescent girls’ visual-spatial problem-solving

28 skills for three months with the computer game Tetris, and observed both structural and functional changes afterward. Some cortical regions displayed thickening, whereas other regions (mostly frontal areas) displayed decreased activity. In a similar study, Jaušovec and Jaušovec (2012) write that 18 hours of training mental rotation skills with origami significantly decreased frontal brain activity and increased activity in parietal areas in a group of women compared to a control group. Other studies in this vein focus on the neural correlates of stereotype threat effects. Wraga and colleagues (2006) used fMRI to trace the effects of stereotype threat in a group of women completing a mental rotation task. In their study, women confronted with a negative stereotype about their mental rotation skills performed worse on the task and showed increased activity in areas associated with emotional load. Women confronted with a positive stereotype about their perspective-taking skills showed increased activation in visual processing areas and no increased emotional load. The researchers then used these activation patterns to successfully predict performance on the mental rotation task. Krendl and colleagues (2008), who examined the neural impact of stereotype threat in women using a maths test, obtained similar results. Compared to the control group, women who were confronted with a negative stereotype about their maths performance showed less activation in areas that are associated with maths performance, and more activation in areas associated with self-monitoring and emotional processing. It has been suggested that stereotype threat effects can ‘spill over’ and affect performance on subsequent tasks (Inzlicht et al. 2011). Inzlicht and Kang (2010) assess the neural processes involved in this effect with a between-sex experiment. They measured event- related potentials (ERPs) on a task that assessed attention and self-control after participants had completed a maths test intended to induce stereotype threat. As hypothesised, women performed worse than men on the second task. Analysis of medial-frontal ERPs suggests that a heightened state of vigilance and self-monitoring, which detracts from the task at hand, attributes to women’s underperformance on the attention and self-control task (see also Derks, Inzlicht & Kang 2008). A similar study finds that stereotype threat during a maths test interfered with women’s subsequent learning process upon retest: in the stereotype threat group, but not in the control group, emotional burden of negative feedback (assessed with ERPs) predicted successful learning (Mangels et al. 2012). Finally, Dunst and colleagues (2013) failed to replicate a stereotype threat effect on the performance on a mental rotation task in an EEG study with boys and girls, but they did find that stereotype activation affected the relationship between intelligence and efficiency of brain activations for boys but not girls.

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A fourth line of relevant evidence comes from recent work in the field of social (Van Anders & Watson 2006). Even though most research to date focuses on predicting behaviour based on hormone levels, hormones—including sex steroids—are affected by our experiences. Testosterone amounts in men, for example, rise and fall in response to specific situations, such as competition (Booth et al. 1989, 1999) or positive stereotyping (Hausman et al. 2009), and in response to major life events, such as becoming a parent (Gettler et al. 2011). Factors like cultural norms or social class appear to mediate these effects (Dabbs & Morris 1990; Muller et al. 2009). Sex steroids are important mediators of neural plasticity (Parducz et al. 2006). As such, their role are a key consideration in accounts of sexed/gendered brain-body-world relationships. Together with research demonstrating how certain experiences can cause group-based brain differences other than sex/gender differences (mentioned above), these lines of evidence reviewed here suggest that sex differences in the human brain are indeed most likely co- constituted by environmental factors. Of course, more research is needed to understand how, exactly, sex/gender differences may emerge from the dynamic interaction of biological and environmental factors. But the assumption that any given sex difference in the brain must have been present or programmed at birth—as Ingalhalikar and colleagues (2014) do—is clearly challenged by the existing evidence. As Fine (2013) notes, studies operating under this assumption ‘can neither produce data to challenge [the idea of fixed sex differences in the brain (and behaviour)], nor illuminate or support any other account of how behavioral sex differences might arise’ (397).

Sex differences in plasticity

I have addressed the fact that research on sex differences in the brain commonly fail to consider the plasticity of sex differences. This, however, does not mean that research on sex differences in the brain and research on brain plasticity are neatly separated fields of inquiry. As I have discussed in the general introduction to this thesis, the two fields have a shared history. The study of birdsong, in particular, has highlighted sex-specific plasticity. When considered as a property of male and female brains—or even as a sex difference in itself— plasticity does nothing to challenge the hardwired hypothesis. After all, by conceptualising plasticity as a property of already sexed brains, the hardwired nature of brain sex is already assumed. Plasticity can then only serve to corroborate, rather than to challenge, brain organisation theory. Whereas studies that investigate how environmental influences co-

30 constitute sex differences in the brain are relatively scarce, there are many examples of studies investigating environmental influences as they impinge on already sexed brains. In other words, whereas the plasticity of sex differences is a neglected field of inquiry, sex differences in plasticity are frequently explored. I will detail the study of sex differences in plasticity using two examples: research on environmental enrichment (EE), and research on oestrogen effects. Together with experiments with sensory deprivation, research into the effects of EE on the brains of animals has been one of the pillars on which plasticity research is founded. Van Praag, Kemperman and Gage (2000) credit Hebb (1947) as the first to propose EE as an experimental concept after observing behavioural differences between rats he took home and rats that remained in the laboratory, after which Rosenzweig and colleagues (1962) took up EE as a formal . Ever since, EE has been found to affect a large variety of brain properties, and these effects have been ascribed to increases in both cognitive and physical activity associated with EE (Nithianantharajah & Hannan 2009). Discussions of EE frequently address the ‘sexually dimorphic influence [of] housing conditions’ (Beck & Luine 2002, 661). The general consensus is that ‘EE can exert different effects on male and female animals, both with respect to healthy and diseased states’ (Nithianantharajah & Hannan 2009, 374). How environmental factors affect the development of sex in the first place is rarely considered. The EE is often discussed in terms of providing the most natural environment for a species. Not only is this needed to maximise animal welfare, it is also supposed to increase the validity of experimental outcomes, since ‘enriched subjects’ are considered ‘healthier and more normal’ (Balcombe 2006, 40). Whereas effects obtained in standard or impoverished conditions are discussed in terms of ‘artefacts’, results obtained using EE are often considered to reflect naturalistic, i.e. real effects. The belief that there is a ‘most natural’ environment in which animal development unfolds ‘normally’ rests on the idea that environmental influences can be erased altogether, and that, underneath, we can find an internal ideal. The result of this implicit assumption is that sex differences found in an EE would appear as pure nature, unaffected by environmental influences. Würbel (2002) argues that this assumption, although implicit, has become a dogma for all laboratory animal science: ‘Interactions of genetic or other experimental treatments … with environmental background … are considered a nuisance,’ he writes, ‘and environmental standardization serves to remove them’ (3, my emphasis). However, it is obvious that these interactions cannot be removed at all: some factors can be kept constant, but they will still exert an influence. This influence depends, furthermore, on factors that are varied: ‘many mutations … are likely to affect the ways in which the environment impinges on the organism. Thus, equating environmental background across mutant and wild type animals

31 does not appear to be feasible’ (6). Würbel therefore advocates a practice that prioritises the systematic variation of genetic and environmental background in order to tease out interactive effects (2001; 2002). This approach would also recognize that sexual differentiation is best understood relative to a particular environment. Instead, investigations of sexual differentiation in EE are often conducted to investigate environmental influences on brains assumed as already sexed before the environment starts to impinge on the individual. And once this assumption is made, any sex-by-environment interaction in neuronal or behavioural response serves as proof for brain organisation theory rather than for the active participation of environmental factors in the emergence of sex differences in the brain. Another example of this logic can be found in studies of oestrogen actions in the brain. The modulation of brain plasticity by steroid hormones has been documented extensively since the early nineties, when McEwen and colleagues described a relationship between oestrogen and hippocampal dendritic spine density (Gould et al. 1990; Woolley & McEwen 1993). The number of publications on oestrogen actions in the brain has increased ever since, averaging nearly two papers a day for the past several years (Gillies & McArthur 2010). I base this brief discussion on recent reviews in the field. Oestrogen effects are typically examined by studying endogenous oestrogen fluctuations in female animals (due to oestrous cycle, pregnancy and parturition, ageing), and by experimental manipulation of hormonal levels. The specific effects of oestrogens (and other hormones), and the specific mechanisms involved, are complex, numerous, and multi-layered. A number of these oestrogen effects have been found to be different, weaker, or altogether absent in genetically male animals when compared to female animals (Brandt, Vierk & Rune 2013; Galea et al. 2013; Gillies & McArthur 2010; Mizuno & Giese 2010). This disparity, despite the enormous complexity of sex-brain-hormone-experience interactions to which this literature testifies, allows the idea of hardwired binary sex to persist. For example, Gillies and McArthur (2010) start their review of oestrogen actions in the brain from the claim that ‘male and female brains’ show ‘marked sex dimorphisms in brain morphology, , hard- wiring, and functional outcomes’ (157). Subscribing to the organizational theory of brain sex development, they write that ‘[in] addition to producing sex dimorphisms in the “hard-wiring”, peri-natal exposure to testosterone (after aromatization) can also program dimorphic patterns in [oestrogen receptor] expression’ (158). They assert that

sex-specific organization of susceptible neural circuitries at critical stages of development [is] a major factor underlying the sexually dimorphic effects of estrogen

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in the brain. This is dependent to a large extent on a transitory surge of testosterone production in males during development, which, after its conversion to estradiol, masculinizes and defeminizes the brain. (190)

In other words, the authors claim that oestrogen effects differ between males and females because their brains are programmed differently before or shortly after birth. Similarly, in their review of sex differences in memory formation, Mizuno and Giese (2010) argue that ‘[sex] differences in hippocampus-dependent memory formation could result from sex differences in structural synaptic plasticity that are present before memory formation. The relevant neuronal circuits are in different states in males and females before behavioral training in a memory task’ (285). Ruling out the possibility that training influences oestrogen-dependent processes (286), they seek the origin of sex differences in memory formation in either gonadal hormone exposure or sex chromosome expression (288). It is not clear, however, on which grounds they rule out this possibility. Galea et al. (2013) do discuss some findings that training on specific tasks modulates oestrogen effects on hippocampal neurogenesis (1047). They argue that ‘sex and experience (both reproductive and cognitive) mediate the effects of steroid hormones on hippocampal neurogenesis, morphology and cognition’ (1052). However, despite their appreciation of the influence of experience, they still consider sex only as an independent factor. Likewise, reviewing findings on sex, stress, and plasticity, McEwen (2010) describes the ways in which sex, stress, and other life experiences modulate the effect of oestrogen in the brain, without discussing the possible impact of social experience of sex/gender differences in the brain. In this area of investigation, brain plasticity is primarily conceptualized as yet another sex difference in the brain. Brain sex is even used as a key principle for organising findings on brain plasticity; for example, Gillies and McArthur (2010) ‘argue for the presence of two broad categories of oestrogen action in the brain: one in which the actions are the same in both sexes, and one where they are different’ (190). So, rather than prompting questions about the contingency of sex differences in the brain, plasticity here marks brain sex, adding new features to the growing list of male and female brain characteristics and bolstering the practice of investigating sex (as separate from gender) as an independent variable rather than as a developmental outcome. Whereas those interested in the plasticity of sex differences wish to focus on the way in which ‘environmental events … may create, enhance, reverse or eliminate sex differences in different characteristics’ (Joel & Yankelevitsch-Yahav 2014, 4621), those interested in sex differences in plasticity rather focus on how ‘the sex of subjects [can]

33 powerfully alter, negate, and even reverse findings (hence, conclusions)’ about other variables (Cahill 2014a, 577). In the following chapter, I will argue that the key to understanding how and when sex/gender might come to matter in the brain is to combine these perspectives and to pay attention to the ways in which sex and environmental factors reciprocally determine each other’s effects as they interact.

Conclusion

In this chapter, I have discussed how the literature on brain sex is biased towards confirmation of its existence and exaggerates the size and significance of sex differences in the brain. Selective citation practices, suggestive visualisations, and sweeping terminology serve to uphold the impression that brain sex is dichotomous and universal. In addition, arguments about causal links between brain differences and psychological differences can be tenuous, leaping from structure to function without actually assessing these connections. Furthermore, research on sex differences in the brain conceptualizes causality in one direction only: from structure to function. The compelling alternative hypothesis that male-female brain differences are co-constituted by gendered experiences has not been sufficiently explored, despite available evidence suggesting that this is indeed a fruitful research direction. The male and female brains brought to life in brain sex studies take on a life of their own as they are widely circulated by the press, the brain-based self-help industry, and other channels intended to educate and entertain a broad public. Yet these idealised, highly mediated, abstract entities live only in our minds, not in our heads. Brain sex researchers are, of course, aware of this and often emphasise that brain organisation theory only addresses differences at the level of groups. Some argue, therefore, that the hardwiring hypothesis cannot be sexist because it does not justify inferences about individuals (e.g. Baron-Cohen 2003). Yet as every discussion about women in STEM fields demonstrates, group-based claims can and do impact gender equality because policies are made at the level of groups. If men are believed to be inherently superior at abstract reasoning on average, then policies aimed at increasing the number of women in scientific fields will seem pointless. In addition, stereotypes owe their robustness and power precisely to the fact that we understand there are always exceptions to the rule–as a result, counter-examples do not require a reconsideration of one’s world view (Glick & Fiske 1997). More to the point, when scientists continue the use of the terms ‘male brain’ and ‘female brain’, and depict and write about these brains as if they exist in the world as real entities that act in and through us, they foster a process of that encourages

34 readers to mistake a model for reality. An ethically responsible scientific practice does not distance itself from this process by presuming that reification only starts once results leave the laboratories and the impassionate, neutral scientist’s hands. These stakes in this debate are effectively obscured when brain organisation advocates claim that feminist critiques of male and female brains attack a . For example, this happened when and colleagues (2015) published their research finding that ‘brains do not fall into two classes, one typical of males and the other typical of females, nor are they aligned along a “male brain–female brain” continuum’, but rather, they are complex mosaics of features that are sometimes more, sometimes less average for one’s sex (5). Dick Swaab, well known for his support for brain organisation theory and the idea that children’s brains are programmed in the womb for gender-specific toy preferences, responded that these findings do not conflict with his own ideas at all: ‘This study shows again that the differences between male and female brains are not black and white,’ Swaab states; ‘At the level of the group characteristics do exist’ (quoted in Vermeulen 2015). Responses like his—an acknowledgement of individual variation, accompanied by an immediate reaffirmation of male and female brains—precisely engender a way of speaking about brain sex that is clearly an inadequate characterization of how sex, gender and brains relate. This negates (feminist) critiques by erasing a key point of controversy, and reifies male and female brains as real entities. Needed, therefore, is a different way to talk about sex differences in the brain that will demand different methodologies for investigating and capturing it. This requires an alternative theoretical framework against which to interpret findings of sex differences in the brain, one that does not promote the essentialist tendencies of brain organisation theory. As a number of critical feminist scientists recently wrote:

We are neither ‘for’ nor ‘against’ sex differences …. We need to develop a new framework for thinking of the relation between sex, brain, and gender that better fits current knowledge, and that takes into account distributions, changes, overlap, variance, and most of all, context. (Fine et al. 2014, paragraph 3)

In the following chapter, I will elaborate how the notion of plasticity may aid in the construction of such a framework.

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Chapter two Situating sex, situating science

‘neurological determinism is most powerfully contested through neurological intimacy’ (Wilson 1998, 417)

Introduction

In the previous chapter, I have discussed how the possibility that sex/gender differences in the brain—insofar as these can be said to exist—emerge from the interaction between biological and environmental factors, rather than from exclusively genetic and hormonal factors, is systematically omitted or even explicitly rejected in contemporary research. I have reviewed available evidence that suggests the human brain is, indeed, responsive to gender- specific experiences. In this chapter, I take my cue from this overlooked perspective in order to explore the critical potential of plasticity as an alternative starting-point for thinking about sex, gender, and the brain. Here, I engage with plasticity not so much as an opportunity to critique brain organization theory but as an opportunity to establish what Wilson names ‘neurological intimacy’ (Wilson 1998, 417). As the ‘Decade of the Brain’ drew to a close, Wilson warned feminist scholars that offering purely sociocultural explanations as an alternative to neurobiological determinism maintains an unrealistic separation between the natural and the cultural and forecloses potentially valuable sources of knowledge. Instead, she argued, engaging with the fleshy materiality of the body will uncover a complexity that attests to the unfeasibility of and biological determinism. Given the fact that plasticity is popularly understood as limitless malleability facilitating full self-determination, the challenge addressed in this chapter is, then, to mobilize plasticity as a powerful argument against biological determinism without resorting to social determinism.15 A number of feminist writers have argued for a performative account of sex/gender in the brain that understands the brain not as a passive surface inscribed by its outside, but as generative and agentic in its materiality (e.g. Pitts-Taylor 2016; Roy 2012; Schmitz and

15. Parts of this chapter have appeared, in an earlier version, in Tijdschrift voor Genderstudies. See Kleinherenbrink (2014).

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Höppner 2014). Following this line of work, I will approach the question of how and when sex/gender might come to matter in the brain by reading the work of Susan Oyama, Donna Haraway, and Karen Barad together. I focus on these authors specifically, because they each offer unique insights that pertain to this question. Oyama’s (2000a; 2000b [1985]) work on developmental system biology offers one of the most concrete and effective accounts of the dynamic, or in her terms ‘constructivist’ (178), interaction of biology and environmental factors in development. Haraway’s work (e.g. 1991, 1997) similarly engages with the entanglement of the material and the discursive, and offers unparalleled insight into the ethical stakes in producing scientific knowledge. Barad’s (2007, 2003) work extends that of Haraway by offering an analysis of the nature of scientific experimentation, and its relationship with the scientific object. All three thinkers represent what has been recently termed ‘new materialisms’, a school of thought that reworks the nature-nurture dichotomy in ways that refuse the reduction of one to the other by taking seriously the active, generative force of the (biological) material.

Mobilizing plasticity

Plasticity marks a potentially critical tool for feminism. Despite decades of feminist critiques of neuroscience and the proliferation of alternative theoretical perspectives, a recognisable field of empirical ‘feminist neuroscience’ that would study sex/gender as socially embodied and mediated is still lacking. For feminist scholars interested in how sex/gender might come to matter in the brain, plasticity may provide a productive ‘point of entry’ for such a practice, prompting work that does not merely critique certain accounts of brain sex but mobilises neuroscientific methods to develop alternative accounts. One promising development in that direction is the NeuroGenderings Network. Established in 2010, this international and transdisciplinary ‘platform for … neurofeminism’ aims to critically reflect on current neuroscientific practices, to foster dialogues across disciplines, and to develop approaches for a feminist neuroscience (Schmitz and Höppner 2014, 2). Since its instalment, the network has generated an on-going series of conferences and a number of collective publications (e.g. Bluhm, Jacobson & Maibom 2012; Dussauge & Kaiser 2012a; Schmitz & Höppner 2014). These publications mostly review existing neuroscientific work and suggest improvements for research practices, but also circulate some empirical work. Plasticity is an important leitmotif in this ‘neurofeminist’ literature. For example, Schmitz (2010) asks ‘To which extent brain structures and functions mirror ‘gendered’ experiences’ (71), noting the paucity of research on

38 this issue. Similarly, Vidal (2012) argues that the challenge to feminist scholars is no longer ‘to deny that there are brain differences between the sexes, but to find out their origin and to assess their significance in real-life situations’ (300). She suggests that ‘the revelation of the dynamism of brain plasticity’ will guide this challenge (300-301). Jordan-Young and Rumiati (2012) also propose more research on brain plasticity as a remedy to ‘neurosexism’ by suggesting an intersectional approach. Given the fact that experiments observe sex differences on a group level, even though between-group overlap and within-group variation are substantial, mapping the interplay of different group-based experiences impinging on brain development would be more enlightening than current attempts to map group-level brain differences to only one identity category:

more research on the ways in which sex/gender patterns in the brain and behavior are specific to social class, ethnicity, and nation might provide much more illumination on the concrete mechanisms through which the social world shapes behavior, and even becomes embodied (brain) difference. (312)

Jordan-Young and Rumiati challenge that ‘hardwiring’ is not only a scientifically poor metaphor but also an unethical one, and that plasticity should be foregrounded instead (311). Is plasticity, then, an ethical metaphor? Insofar as plasticity prompts us to conceptualise the material body, and in particular the brain, as inherently historical and contingent, and to understand the science of brain sex as necessarily partial and embodied, I would answer that yes, it can be an ethical metaphor. However, it is crucial to realise that plasticity already carries different connotations. The strong resonance between popular plasticity discourse and the values of neoliberal capitalism, for example, has been discussed amongst neurofeminists (e.g. Pitts-Taylor 2010). It is therefore crucial to attend to struggles over the production of knowledge. As Kaiser and Dussauge (2015) note, brain discourses are largely beyond the control of feminists and other social movements, and to engage with them risks ‘buying into a political economy of biomedical knowledge’ (11) in which they have little control. In addition, as I have noted in the previous chapter, plasticity arguments do not necessarily subvert biological determinism. They are easily incorporated into an account of two natural groups possessing different degrees or kinds of plasticity. These issues, which I will come back to in the following chapters, point to the necessity of developing an account of sex/gender and the brain that neither replaces biological determinism with social determinism nor combines the two in a hybrid account, but resists both.

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Decades of feminist scholarship on the dichotomies of nature/nurture and sex/gender offer a wealth of insights for the development of a determinism-resistant account. From the 1970s onwards, feminists usefully employed the sex-gender distinction to counter biological essentialism by locating the oppression of women in cultural practices (e.g. Rubin 1975). The social relations between men and women were understood as connected to, but not fully circumscribed by the sexed body: biology may be a given, but the social relations that determine the significance of bodily sex may function otherwise. This sex-gender division is still promoted as best practice in a range of feminist arenas (e.g. in gender-sensitive medicine, see Chapter 5), but many feminist scholars critique and rework the distinction.16 One of their most pressing concerns pertains to the normativity and particularity of women as a gender category: what kinds of experiences constitute being a woman, if different women (e.g. white women compared to women of colour, or heterosexual women compared to lesbian women) experience womanhood in different, sometimes irreconcilable ways (Spelman 1988; Butler 1990)? A different objection is that the separation of sex and gender relies on and reinstates the ontological separation of nature and nurture, thereby maintaining a division of labour between the biological and medical sciences on the one hand, and feminist theory on the other (Gatens 1983; Oudshoorn 1994). This division of labour implies that sex might be analysed without paying attention to gender (and vice versa), thus separating the body from experience. However, as I have discussed in the previous chapter, the classification of bodies as either male or female is not simply a neutral or natural given order.17 Not only is the way in which science chooses to ‘carve nature at its joints’ culturally conditioned, the development of the physical body itself is contingent upon the social and material conditions of our existence. Therefore, many feminist scholars claim that the distinction between sex and gender (and by analogy, between nature and nurture, mind and body, etc.) is unintelligible. Most famously, Judith Butler (1990) asserts that sex has ‘been gender all along’ (8). Gender, in her account, is not a state of being, but rather a doing: a performative act, shaped within a heteronormative power matrix that requires two genders. Sex, perceived as a fixed ground or boundary, materialises in this process of construction (Butler 1993). Butler’s theory has been and still is extremely influential in feminist theories, yet some critique her for ‘conflat[ing] the being of a thing with the mode in which it is known’ (Colebrook 2000, 78). So-called ‘new materialists’ address this alleged shortcoming in Butler’s work. They refuse the representationalism that reduces materiality to discourse, and foreground matter itself

16. For a full discussion of the sex/gender distinction, see Mikkola (2011). 17. This is even true for the classification of chromosomes, see Kraus (2000) and Richardson (2013).

40 as performative and agentic. Karen Barad (2003), for example, forcefully asks: ‘Why are language and culture granted their own agency and historicity while matter is figured as passive and immutable, or at best inherits a potential for change derivatively from language and culture?’ (801). Vicki Kirby (2008), playing on Butler’s assertion that ‘sex has been gender all along’, raises the question of whether culture has not been nature all along. Instead of bracketing the body, this line of work theorises the body as ‘changing and changeable, as transformable’, highlighting it’s ‘active response to change and contingency’ and the ways it ‘act[s] upon the world’ (Birke 1999, 45). Change and difference, here, are not imposed on inert matter. Rather, matter itself (including, but nor restricted to, organic matter) is performative, a doing rather than a being. Accounts of ‘what … bodies are that … inscription is possible’ (Grosz 2004, 2, my emphasis) supplement accounts of sociocultural practices that inscribe bodies.18 The performative nature of matter and the entanglement of the material and the discursive are not merely asserted via philosophical reasoning but also gleaned from the natural and biological sciences, where notions of non-linearity, emergence, and complex self- organisation are becoming increasingly prominent. In the context of neuroscience, Elizabeth Wilson (1998) pays close attention to research demonstrating ‘neurocognition’s indigenous malleability’ (201). She rejects what she sees as the typical feminist response to biological essentialism: ‘a mishmash of environmentalism, social construction, and discursive analysis, all of which leave the nature of neurological, genetic, or biochemical matter to one side’ (200). Critiques that conceptualise the social as that which ‘delivers difference and malleability to otherwise barren neurological matter’ lack critical and political power because ‘they have relied on, and reauthorized, a separation between the inside and the outside, the static and the changeable, the natural and the political, the chromosomal and the cultural’ (16, 200). Feminist engagements with neurological matter reveal and complexities not captured through the lens of brain organisation theory. Rather than dichotomous sex and sexuality, they encounter ‘perverse and disseminate sexual forms’ (Wilson 2015, 61), ‘a thousand tiny sexes’ (Grosz 1993, quoted in Roy 2012, 225), a mosaic or intersex brain (Joel 2011), or a queer brain (Dussauge & Kaiser 2012b). An explicitly new materialist framework conceptualises this proliferation of difference and complexity as material-semiotic rather than as social inscription upon a passive, inert surface (Pitts-Taylor 2010; Roy 2012; Schmitz &

18. New is related to other ‘material-semiotic’ frameworks, such as Actor-Network Theory. In addition, it is often associated with other recent turns to materiality and immanence, including object- oriented ontology and speculative realism (but there are crucial differences: see Åsberg, Thiele & Van der Tuin 2015).

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Höppner 2014). The latter would, as Wilson (1998) warns, ‘[abandon] neurobiology to the very biologism it claims to be contesting’ (16). In the next section, I will mobilise three scholars associated with new materialist feminism in order to give an account of the plasticity of sex differences that avoids this mistake.

How matter comes to matter

The psychologist and philosopher of science Susan Oyama is not mentioned as often in discussions of feminist materialism as one might expect given the strong resonance of her work with that of Haraway, Barad, and other scholars more frequently referenced as key figures in the genre (but see Kirby 1999). Her work, especially The Ontogeny of Information from 1985, has had a significant impact in the philosophy of biology, laying the foundation for developmental systems theory. In my opinion, her theory of ‘constructivist interactionism’ constitutes one of the most practical and effective critiques of the nature-nurture dichotomy, and offers a hands-on material-semiotic account of development. Oyama (2000b [1985]) takes issue with the fact that scientists routinely argue that the nature-nurture debate is dead, ‘sound the rallying cry “interactionism”, then proceed to discuss genetically encoded instructions and environmentally shaped traits’ (10). The language of ‘genetic predispositions’ and ‘limits to flexibility’ (2000a, 136), she argues, might seem less dualistic than older formulations but in fact still constitutes a form of preformationism:

saying that of course nature combines with, or interacts with, nurture suggests a continued reliance on a biological nature defined before development begins and merely modulated or deflected by environmental nurture. (Ibid.)

One of the main problems she identifies is the conceptualisation of causality commonly employed in theories of development. In particular, she targets the metaphor of the information gene: ‘The genome as constituting rules, instructions, or a program …. is so common a notion as not to seem metaphoric at all’ (2000b [1985], 59). Against the idea of genetic programming, Oyama argues that developmental information only becomes ‘biologically relevant’ in the process of ontogeny (16); it ‘neither preexists its operations nor arises from random disorder’ (3). For Oyama, the causal status of both genes and environmental influences depends on the process of development; without it, they cannot be said to be causes at all, and developmental information contained in them cannot be said to exist. To speak of information in the genes—

42 or, for that matter, in the environment—is only meaningful ‘as it is constituted as “information” by its developmental system. The result is not more information but significant information’ (16). This information, furthermore, does not relate to form, but to variation (179): ‘Information is a difference that makes a difference’ (3). In Oyama’s account, the effects of different developmental factors can only be determined in relation to one another: a gene is associated with different outcomes in different environments, and an environmental factor has different effects on different genomes. This is not because genes work as switches programmed to do A if B and do C if D, but because biological matter is fundamentally interactive:

If matter is inert, then organized processes can be explained only by reference to a structuring intelligence. But if it is interactive (think of any chemical reaction) under changing, interdependent constraints, such outside direction is not needed. (173)

The issue here is not that both genes and the environment are necessary for development to take place (something with which any scientist would agree) but that ‘there is no intelligible distinction between inherited (biological, genetically based) and acquired (environmentally mediated) characteristics’ (138). This is not to say that no useful distinctions of any kind can be made between, for example, the influence of hormonal levels and the influence of sensory input, but it does mean that the influence of each factor cannot be articulated without paying attention to the way it interacts with other factors: ‘Causation is multiply contingent, and influences both select each other and determine each other’s effects’ (2000b [1985], 24). Oyama’s reconceptualisation of development and developmental information changes the meaning of nature and nurture: ‘nature and nurture are not alternative causes but product and process’ (2000b [1985], 148). For her, nature properly refers ‘not to some static reality standing behind the changing characteristics of the phenotype, but to the changing organism itself’ (2000a, 181), and nurture should denote ‘all interactions that produce, maintain, and change natures’ (Ibid.). Crucially, this is an ongoing process: ‘coming into being continues throughout life’ (2000a, 168). Oyama’s conceptualization of the organism as emerging from the dynamic, ongoing interaction of factors that select and determine each other’s effects is echoed and expanded in Donna Haraway’s (2003) Whiteheadian formulation that ‘Beings do not preexist their relating’ (6) and in Karen Barad’s (2007) aphorism ‘relata do not preexist relations’ (140). For Haraway and Barad, bodies—not just living organisms, but all objects—emerge from their relationships,

43 rather than the other way around. All three thinkers therefore approach objects as constructed sites of change, but do not relegate them as purely ideological. Barad (2007) explains the relationship between the material and the semiotic as:

Neither discursive practices not material phenomena are ontologically or epistemologically prior. … Neither is reducible to the other. … Neither is articulated or articulable in the absence of the other; matter and meaning are mutually constituted. (152)

In addition, these thinkers articulate all bodies as temporary, since objects transform as soon as new relations arise: ‘the world is a knot in motion’ (Haraway 2003, 6). Rather than static being, there is only constant becoming. As such, the very notions of cause and effect demand reconsideration: ‘Changing patterns of difference are neither pure cause nor pure effect; indeed, they are that which effects, or rather enacts, a causal structure, differentiating cause and effect’ (Barad 2007, 137). The view that bodies only take on concrete characteristics in their relations and because of their relations has ramifications for the way we understand scientific practices. Haraway and Barad both challenge the prevailing understanding of scientific observation as non-invasive witnessing. Instead, knowledge claims become locally embodied and historically contingent (Haraway 1991). Haraway proposes to ‘switch metaphors’ (188): instead of understanding scientific vision as a gaze from nowhere reflecting nature, she emphasises diffraction: ‘Diffraction does not produce “the same” displaced, as reflection and refraction do. Diffraction is a mapping of interference, not of replication, reflection, or reproduction’ (2004 [1992], 70). Diffraction shows that knowledge is always partial, local, and contingent on the perspective of the knower: ‘Accounts of a “real” world do not, then, depend on a logic of “discovery”, but on a power-charged social relation of “conversation”’ (1991, 198). Scientific ‘observation’ is thus not a one-way process laying bare the object, but rather a two-way process between different actors in which certain aspects of its actors become relevant. Barad (2007) adopts Haraway’s notion of diffraction, weaving together ontological, epistemological and ethical concerns: ‘Making knowledge is not simply about making facts but about making worlds, or rather, it is about making specific worldly configurations’ (91). She argues that practices of representation affect (and effect) the object of investigation not so much because they mediate access to the object, but because they co-constitute the object in their relation to it. It is in their ‘intra-action’ that actors become determinate, that they acquire their

44 characteristics.19 Consequently, ‘agencies of observation’ (2007, 114) are part of the phenomena they aim to measure; and measurements refer not strictly to the scientific object, but to the whole scientific apparatus. This apparatus is a material-discursive phenomenon, involving not just some pieces of equipment but a ‘multitude of practices’ such as various design constraints, financial factors, political influences, legal constraints, professional training, and many more (203-204). The scientific apparatus delineates who or what is the object and who is the subject of knowledge. There is thus no inherent boundary between the knower and the known. To fix and to naturalise such boundaries is to postulate determinate ‘Cartesian cuts’ (114). On the other hand, to represent boundaries as situated, embodied, and contingent—which Barad terms ‘agential’ cuts (148) is a more ethical way of doing science.20 By making explicit the processes by which our scientific practices produce ‘differences that matter’, we can account for the way we participate in the marking of bodies of scientific ‘objects’ (348).

How sex/gender comes to matter in the brain

The work of Oyama, Haraway, and Barad inspires an account of how sex/gender might come to matter in the brain that offers a viable alternative to brain organisation theory. This account takes the material brain seriously as an active agent in development rather than casting it as an inert surface upon which effects from external factors are inscribed. In addition, it takes the scientific setting in which brain sex is observed as a relevant factor in its materialisation, rather than as a neutral backdrop against which biological facts can be observed. As an example, I will consider the experiment by Janice Juraska and colleagues, which I briefly discussed in the previous chapter. However, this kind of interpretation should be applicable to all kinds of sex differences in the brains of humans and other animals. In the 1980s, around the time that Oyama’s influential The Ontogeny of Information was first published, Juraska and her team performed a series of experiments on sexual differentiation in cognitive regions of rat brains, namely, the hippocampus and the cerebral cortex. Interested

19. Barad, here, aligns with Oyama’s (2000b [1985]) argument that only development itself can constitute ‘information’ in the genes or in the environment before their actual interaction, and what genes or environmental factors are cannot be said. As Barad (2007) makes clear by drawing on Niels Bohr’s understanding of quantum physics, this is not simply because we cannot know what they are, but more radically, because they cannot become determinate outside of relations. 20. See also Nancy Tuana (1983). Similar to Susan Oyama, she argues for an understanding of development as dynamic interaction: ‘genotype does not determine a set of characteristics or potentials (a human nature), but specifies patterns of reactions of a developing organism to the environment it encounters’ (628). As such, a trait can only be ‘inherited relative to a particular environment’ (629). Akin to Barad’s ‘agential cuts’, Tuana writes that ‘Distinctions can be made, but they will be time, situation, and value relative. … Such distinctions will not report “biological facts”’ ( 631).

45 in the impact of the developmental environment, they reared littermates in two different laboratory settings: an isolated condition with few stimuli, and an enriched cohabitation condition. The results showed that in the cognitive areas of the rat brain, the size and even the direction of sex differences varied as a function of housing conditions (Juraska et al. 1985). The first experiments focused on the dentate gyrus, which is involved in memory-formation and spatial navigation. Dendritic trees in this area were known to continue growing after weaning. Reflecting back in a later review, Juraska writes: ‘What we found was surprising enough that we repeated the experiment with a new set of rats’ (1991, 107). Whereas males had more dendritic material than females in the isolated condition, the difference was fully reversed in the enriched condition, with females displaying larger dendritic trees (Juraska et al. 1985). The reversal of the sex difference was driven largely by the difference between female rats in the isolated condition and female rats in the enriched condition. Put differently, the females showed greater hippocampal plasticity than the males. Literature on brain organisation theory cites Juraska’s work as an example of sex differences in plasticity. As such, it takes the study as evidence for hardwired brain sex. Cahill (2005), for example, cites Juraska’s work in an article in Scientific American in which he defends the idea that brain sex is hardwired before birth: ‘Even the neurons in the hippocampus behave differently in males and females’ (44). In his interpretation of Juraska’s work, then, brain sex is taken as a given, as a programmed process, and all following interactions and changes in the brain are considered as a function of brain sex; as if male and female brains each contain their own blueprint to ‘do A if B, do C if D’. Understood this way, even if the brain changes under the influence of the environment, brain sex as an underlying essence, as the blueprint carrying information, remains the same. When we view Juraska’s results in terms of Oyama’s constructive interactionism, we can give a different account, one that considers the way in which sex differences in the brain emerge from the dynamic interplay of physiological and environmental factors. Here, the brain does not respond to the environment because it runs on a program containing information about what to do in case of a specific input-event, but it responds simply because it is fundamentally responsive matter. If we assert that brains, as part of living organisms, are not static beings but dynamic, on-going processes of becoming, then the environmental influences in Juraska’s experiment do not simply reveal what brain sex is by eliciting a response from a sex-specific program, but intra-act with the continuous process of what brain sex is becoming. Based on Oyama’s understanding of causality as multiply contingent and of causes as mutually constitutive, we can see that physiological factors (e.g. chromosomal sex) matter to

46 this becoming of brain sex. But how they matter depends crucially on the environment: the effect of sex is not uniform across environments. Vice versa, how environmental factors matter to the emerging phenotype is fundamentally dependent on the rats’ physiological characteristics: the effect of the environment is not uniform across sex. In other words, physiology and environmental factors must be articulated through one another—even as they cannot be reduced to one another—because they are mutually constituted (see Barad 2007). So rather than only paying attention to how sex mediates the influence of environmental factors, or only paying attention to how environmental factors mediate the influence of sex, only a double or integrated perspective that takes into account both principles at the same time can fully account for how sex differences in the brain emerge. Neurological matter is then not a— blank or sexed—surface upon which environmental influences are inscribed. Instead, it is a difference that makes a difference, a force participating in the process of development along with other difference-makers, in which the organism is made anew at every moment. The interplay of these difference-makers gives rise to brain sex, itself another difference that, in turn, contributes to other differences. Sexual difference, then, does not refer to essences, but to dynamic relations. The idea that sexual difference materialises within specific material-discursive practices—either in a scientific setting or otherwise—is consequential. If sexual difference is only determinate due to specific arrangements, it can always function otherwise, and the future of sexual difference is radically open. As Juraska (1998) herself noted, given the fact that ‘sex differences can be induced and even reversed under various environmental conditions and are, therefore, dynamic’, it is ‘impossible to make a generalization about the nature of sex differences in the brain’ (20). It is therefore not possible, based on Juraska’s results, to predict the developmental outcome of rats with a similar genetic constitution in yet another environment; we cannot even assume sexual difference will be binary or present at all. This means that brain sex cannot be studied as a purely physiological phenomenon, but must always be studied in relation to its context. This account of how sex/gender relates to the brain does not do away with the notion of sex altogether by trading it in favour of gender. To do so would amount to the loss of ‘the body itself as anything but a blank page for social inscriptions, including those of biological discourse’ (Haraway 1991, 197). As Haraway notes in the context of primatology, accounts that conceptualise biological difference ‘as situational, not intrinsic’ change ‘the biological politics of the body’ (200). ‘The point is not that these new stories ... are simply true or not open to contestation and conversation’, she adds (Ibid.), but rather that they are preferable because they

47 constitute a situated, and therefore more ethical mode of knowledge production. Crucially, this entails not only situating brain sex in a developmental environment, but also situating it in the scientific context that makes it visible. The environment of Juraska’s rats is not limited to their cages; it expands to the entire scientific apparatus involved. It is one of the most familiar questions in laboratory science: how well do these results translate to ‘real-life’ settings? The language of confounds and artefacts in which scientists are trained suggests that there is, at least in theory, a perfectly neutral set-up in which such ‘real’ or ‘natural’ facts can be observed. Yet we should not be tempted into thinking that some kind of natural form observable in wildlife lies somewhere inside our lab rats. For Oyama (2000b), ‘the belief that variation is deviation from an internal ideal’ rests on a false distinction between the essential and the accidental (25). Instead, there is contingency: the variations found in the lab are inherently bound up with scientific practices, just as variations found in ‘the wild’ are inherently bound up with that environment. Hence, our scientific observations cannot determine natural facts (because there is, strictly speaking, no such thing), only context-specific phenomena. This means that sex differences in the brain, observed in a scientific setting, should not only be considered in light of the social factors that have impacted the brains of test subjects before they arrived at the lab. Rather, the materialisation of these differences in the form of brain scans is fundamentally inseparable from the particulars of the instruments, and from the technological, financial, political, and cultural factors affecting the choices and assumptions made by researchers (see also Birke, Bryld, & Lykke, 2004). The perspective offered here can be employed to re-read the connectome study (Ingalhalikar et al. 2014a) discussed in the previous chapter. The authors assert that the emergence of sex differences with age indicates that sex-specific developmental trajectories are pre-programmed at birth (825). As they mature, male and female brains specialise in different directions–a sex difference in plasticity (specifically: in maturation). However, the works of Oyama, Barad and Haraway discussed here offer strong reasons to insist that that boys’ and girls’ experiences contribute to their brain development. Importantly, to assert this does not necessarily imply that their brains are a passive, neutral receptacle for gendered inscriptions. Instead, the perspective elaborated here acknowledges the force of both biological and cultural factors. It would be wrong to assert that brains are ‘blank slates’, but it would be equally wrong to say that brain sex has a normal or natural shape. It is therefore very well possible that a shared experience has different effects, on average, on boys and girls because it interacts with genetic or hormonal factors. At the same time, the between-group overlap and within-group variation in the connectome data suggests that this effect is not universal or homogenous but interacts

48 dynamically with a range of other physiological and social characteristics that differ between individuals (e.g. BMI or social class). Furthermore, Barad’s (2007) work suggests that the differences observed in such a scientific setting are, strictly speaking, not located in the subjects’ brains, but rather enacted in the relationship between brains, scanners, observers, and the technosocial conditions in which these and other relevant actors are embedded.

Culture into nature, nature into culture

In A Manifesto for Cyborgs, Haraway (2004 [1985]) writes how the modern life sciences challenge and rework the male-female distinction and associated dualisms (nature-nurture, mind-body, organism-technology, etc.), shifting traditional identity categories (gender, race, and class). In the passage from an industrial society to a market based on information systems, ‘scary new networks’ replace ‘the comfortable old hierarchical dominations’ (20). Informatics and biologics pervade, translating the world into a coding problem in ‘search of a common language in which all resistance to instrumental control disappears and all heterogeneity can be submitted to disassembly, reassembly, investment, and exchange’ (23). Essential properties give way to boundaries, constraints, and rates of flow: ‘No objects, spaces, or bodies are sacred in themselves’ (22). These ‘informatics of domination’ register, calculate, translate, and control the body (20). Whereas this instability of categories is associated with the oppression of certain groups, Haraway argues, it also offers an opportunity to tell different stories in order to reconstruct ‘the boundaries of daily life, in partial connection with others, in communication with all our parts’ (39). Popular plasticity discourse speaks this language. It translates culture into nature and nature into culture, giving rise to new ‘neurosocialities’ in which gendered norms may be challenged, transformed, or preserved (Schmitz 2012). Plasticity-based understandings of self and society may overturn biological determinism and sex essentialism, but they may also dovetail with claims of innate sexual difference. They may invoke the social and historical embeddedness of lived bodies, but they may also obscure such bonds by thematising individualism and free choice. In other words, a plasticity-based perspective may sustain a critical, feminist analysis as well as a post-feminist, neoliberal discourse. How, then, to develop and implement the one without inviting the other? What does it mean to think the gendered subject as a specifically neuroplastic subject? Uncovering to what extent, and in which ways, brain-based understandings of sex/gender are already shaped not just by biological determinism but also by plasticity-based claims and ideas, may be required to fully appreciate what is at

49 stake in these questions. In the chapters that follow, I will therefore examine if and how plasticity shapes ways of thinking about sex and gender in three different settings: education, parenting, and mental health.

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Chapter three Becoming a boy: brain sex in the classroom

‘If truth be told, one is not born, but becomes, a genius; and the feminine condition has, until now, rendered this becoming impossible.’ (De Beauvoir 2011 [1949], 152)

‘By virtually every measure, girls are thriving in school; it is boys who are .’ (Sommers 2000a)

Introduction

Since the 1990s, concerns have been rising across Western, industrialised nations about the state of men and boys (Epstein et al. 1998; Weaver-Hightower 2003). Countless magazine and newspaper articles, special websites, and blockbuster books with titles like The War on Men (Sommers 2000b), The End of Men (Rosin 2012), or The Demise of Guys (Zimbardo 2012) have raised the alarm about men rapidly becoming the disadvantaged sex. A major point of concern in this literature is the belief that boys are falling behind in school, earning lower grades than girls and dropping out more often before graduating (e.g. Gurian & Stevens 2005; Tyre 2006). This, in turn, has generated concerns about boys’ social adjustment: boys on the margins of the educational system are perceived as poorly adjusted and potentially dangerous. A Dutch teacher, for example, raised awareness about boys’ relative underachievement in school by drawing a direct link to terroristic ‘lone wolves’ like the ‘Unabomber’ Ted Kacynski and Anders Breivik (Haan 2011). This crisis in boys’ schooling is generally attributed to a feminised educational system— in which feminine traits like verbal fluency or sitting still are preconditions for success and female teachers provide a feminine role model—geared towards a modern, post-industrial economy that values ‘brains over brawn’ (Covert 2014). Boys are no longer allowed to be boys, the argument goes, so they disengage and become insecure, awkward, and violent. To turn the tide, advocates argue for urgent educational reform.

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We have been here before. At the turn of the twentieth century, the first feminist wave instigated similar concerns about the feminisation of boys and men. Feminism was blamed for creating a climate in which boys could no longer be boys. Experts called for educational reform to stop the feminisation of boys, and for the creation of homosocial spaces like the Boy Scouts (Kimmel 1996). The affirmation of traditional gender norms was backed up by biological theories of sex differences that ignored the potential impact of women’s social situation, including Galton’s claim that women’s smaller brains rendered them intellectually inferior (see Alaya 1977). Claims about sex differences in the brain are mobilised today as well to rationalise the boy crisis and to promote the rehabilitation of ‘natural’ masculinity. Best-selling boy advocates argue that boys and girls have different brains, which causes them to have different personalities, talents, and most of all needs (e.g. Gurian et al. 2010 [2001]; Sax 2008). They deem today’s educational systems ‘biologically disrespectful’, denying and disadvantaging male nature (Bruce Perry quoted in Tyre 2006). Much has been written about whether or not boys are actually in crisis, about the construction of masculinity in these debates, and about the role of brain-based biological determinism involved (e.g. Gilbert & Gilbert 1998; Francis & Skelton 2005; Griffin 2000; Rivers & Barnett 2006; ‘Sweden’ 2010; Titus 2004; Weaver-Hightower 2008). Few have paid attention, however, to the way in which plasticity-based arguments interact with hardwiring arguments in neuro-inspired boy crisis literature. The deterministic claim that boys and girls have male and female brains is an easy target for critique. As I discussed in Chapter 1, the theory that men and women have different brains is highly controversial. The claim that young boys and girls have different brains has received even less empirical support (e.g., Eliot 2011, 2013; OECD 2002; Rivers & Barnett 2011; Halpern et al. 2011). Nevertheless, the idea continues to prove appealing to teachers, parents, and governments across the world. I argue that analyses that focus purely on biological determinism do not fully appreciate the success of the message that ‘boys and girls learn differently’ (Gurian et al. 2010 [2001]). Attending to how hardwiring- and plasticity-based arguments interplay, I yield a more insightful understanding of how brain-based boy advocacy literature resonates with the current post-feminist, neoliberal climate. In this climate, introduced above, preoccupations with individual freedom, self-management, and optimisation coexist with a revival of sex essentialism, whereby fixed biological sex differences are represented as benign and useful (Gill 2007). I argue that the brain-based boy advocacy from authors like Michael Gurian and Leonard Sax succeeds because they thematise freedom and determinism simultaneously. They do so by framing sex differences in the brain as primarily sex differences in plasticity. In this

52 account, fixed biological sex differences appear, at least superficially, not as limitations but rather as a recipe for unlimited success and equality. Upon closer inspection, however, it is clear that this account is anything but empowering. This chapter is structured as follows. After briefly reviewing the main factors that gave rise to the international boy-crisis discourse, I will discuss the interplay of plasticity- and hardwiring-based arguments in the work of Michael Gurian and other neuro-inspired boy advocates. I will pay specific attention to the notion of risk and to the significance of male socialisation, highlighting how this literature claims that ‘boys will be boys’ but that, at the same time, proper socialisation is crucial. Without it, boys become a danger to themselves and to others. I will use Basil Bernstein’s (1977) notion of implicit or invisible pedagogy to make sense of this perspective on ‘nurturing the nature’ of children. Finally, as an illustration of my analysis, I will recount how boy advocates’ brain-based claims have influenced the educational discourse in the Netherlands, with a particular interest to how assertions of natural sex differences have merged with a strong focus on individual differences.

The rise of the boy crisis

What incited the latest international panic about boys’ educational and social adjustment? At least three factors have contributed to the visibility and credibility of the current boy crisis.

Backlash against feminism First, critics have interpreted the boy crisis as a backlash against the emancipation of women (Mills, Francis & Skelton 2009; Weaver-Hightower 2003). In the early 1990s, a number of books and reports drew attention to the dynamics of gender in educational settings, focusing on the adverse influence of gender stereotypes on girls’ education, self-esteem, and health (e.g. American Association of University Women 1992; Orenstein 1994). Subsequent studies, however, showed that differences in self-esteem were less dramatic than initially claimed (Kling et al. 1999; Major et al. 1999). In addition, critics argued that, while girls indeed lagged behind in science and maths, boys were worse off in school in all other respects (Kleinfeld 1998; Sommers 2000b). Sommers, for example, argued in her article ‘The War Against Boys’ (2000a) that feminist scholars who raised concerns about the effect of gender inequality on girls’ educational and social adjustment misrepresented their case. Boys, not girls, were the ones being short-changed by the educational system. Sommers asserted that the ‘manufactured

53 crisis of diminished girls’ promoted by ‘partisans of girls’ had some positive outcomes for girls, but that this effect was outweighed by the resulting ‘climate of disapproval’ of boys (2000a). An international ‘moral panic’ about the failure of boys ensued (Smith 2003). The prime suspect of boys’ underachievement was the purported feminisation of our educational systems: boys were supposedly penalised for expressing their natural energy in a system that now demanded and rewarded traits for which girls supposedly excelled (e.g. sitting still and paying attention, emphasis on language). The disparity jeopardised their academic success as well as their general health and happiness. The most outspoken boy advocates, like Sommer, portrayed this situation as a battle of the sexes, with a direct trade-off between girls’ success and boys’ failure. This representation of the situation suggests that girls’ progress is unfair and undeserving (Weaver-Hightower 2003), which strengthens the case that the boy crisis is indeed, at least partly, a backlash against women’s emancipation.

The marketisation of education The marketisation of education, which has been unfolding across industrialised nations for the past decades, has been a second catalyst of the current boy crisis. As cognitive labour became more vital to modern economies, national and international competition in scholastic performance became more important. Rankings of standardised test scores, such as the triennial Programme for International Student Assessment (PISA) reports published by the Organisation for Economic Co-Operation and Development (OECD), have been introduced to make this performance visible, comparable, and accountable. This quantification of scholastic performance calibrated educational systems for competition and optimisation, thus stimulating schools to function according to market-based principles. It is in this context that the relative underachievement of boys has been observed and problematized (Ivinson 2014). In the UK, for example, anxieties about boys’ educational success followed in the wake of the introduction of national school league tables in the early 1990s. These tables were published for parents to make an informed choice about their children’s education, thereby stimulating competition amongst schools. As Ivinson has noted, this statistical approach to educational success served to make some (but not other) group differences visible and salient by providing group-based comparisons, including overviews of sex differences. Statistics in this regard have provided ammunition for boy advocates. This statistical approach towards boys’ and girls’ success quickly superseded qualitative analyses of how gender relations affect school experiences, to the effect of ‘reif[ying] representations of the learner’ (2014, 156). For Ivinson, the boy crisis is in truth an ‘epistemological crisis’, a

54 regression of gender theory, where masculinity is now once again understood as an unstoppable natural force that teachers must recognise and foster, rather than as a social phenomenon that they might question or redirect (164). Faced with school curricula valuing brains over brawn, in reflection of the recession of industries relying on physical labour in western nations, boy advocates are compelled to rework and reaffirm masculinity as a natural resource. Analyses of gender as a historical, sociocultural phenomenon have thus been traded for comparisons based on sex as a biological category.

Educational neuroscience Since the turn of the century, increasing faith has been invested in the potential of brain science to innovate education. The emerging field of ‘’, also known as the Mind, Brain and Education movement, aims to ‘to join biology, cognitive science, development, and education in order to create a sound grounding of education in research’ (Fischer 2009, 3). Central to this aim are understandings of plasticity, both in the sense of learning processes and of brain maturation. The underlying premise of educational neuroscience is that the neurosciences can revolutionise our understanding of how children learn, yielding innovative and highly effective teaching strategies. The ultimate goal of neuroeducators is to individualise education completely: ‘if every student were given a neurological evaluation, educators would have powerful clues as to the best way to personalize learning’ (Jensen quoted in Layton 2015). Despite concerns that such translations are ‘a bridge too far’ (Bruer 1997; De Vos 2015), the field has been positively bourgeoning. Alongside academic research, a large commercial industry of (purportedly) brain-based programmes and guides has flourished. Many of these popular resources are built around neuromyths, especially the myth that there is a range of ‘learning styles’ according to which students can be categorized (e.g. verbal versus visual processing, or left-brain versus right-brain dominance). The claim that learning is improved when teaching styles are matched to individual learning styles has been widely debunked (e.g. OECD 2002; Pashler, McDaniel, Rohrer & Bjork 2008), yet its influence on educational practices appears unabated.21 The belief that boys and girls have different learning styles can be seen as a specific version of this myth. It is widely promoted as the rationale for, and solution to, the boy crisis. International bestsellers like The Minds of Boys (Gurian & Stevens 2005) and Boys Adrift (Sax

21. A recent survey shows that in the UK, for example, 98% of teachers have encountered a learning- style based programme in their school, and 93% believe that such programmes would indeed improve learning (Dekker, Lee, Howard-Jones & Jolles 2012).

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2007) all make a similar case: boys are born with different brains from girls, and therefore they have a different learning style. As such, they require different teaching strategies. In books like these, neuroscience is celebrated as the source of knowledge that trumps all other forms of knowledge. For example, Michael Gurian and Kathy Stevens write in The Minds of Boys:

The social thinkers of the 1950s, 1960s, and 1970s did not have PET scans, MRIs, SPECT scans, and other biological research tools available to them. They had to make assumptions about how children learn without any real scientific evidence. … They had to overemphasize the power of nurture in because they didn’t have a way to study the actual nature of male and female. (2005, 42, my emphasis)

In the regressive move that Ivinson (2014) calls an epistemological crisis, a rich body of scholarship exploring the dynamics of gender in the classroom is nullified as misguided, pseudoscientific guesswork. Instead, neurobiology is introduced as the best and only lens through which to understand the dynamics of masculinity and in the classroom (Busso & Pollack 2015). One of the solutions offered by boy advocates to the purported boy crisis is to educate boys and girls with different methods, preferably in single-sex classrooms. Michael Gurian and Leonard Sax, both based in the US, are two of the most well-known and influential proponents of single-sex schooling. Gurian, who is not trained as a neuroscientist, has authored a range of books instructing parents and teachers about the different ways in which boys and girls learn (e.g. Gurian et al. 2010 [2001]; Gurian, Stevens & Daniels 2010). In addition, he applies brain sex theory to relationships and corporate settings (Gurian 2003; Gurian & Annis 2008). His books are translated into many languages, and he is a regular contributor to a range of high- profile media outlets. He co-founded the Gurian Institute, which offers training seminars, mediates funding for educators, sets up single-sex education pilots, and studies their efficacy. It boasts to have trained over 60,000 teachers from 2,500 schools (‘Success Stories’). Leonard Sax, who holds a PhD in psychology and an MD, has a similar profile. He has authored a number of books advising parents and teachers about boys’ and girls’ specific needs, using neuroscientific arguments as a rationale. He speaks and publishes on the subject internationally,

56 offers workshops for parents and teachers, and has co-founded an institute to promote single- sex education, the National Association for Choice and Education (NACE).22 The arguments that these and similar advocates make for single-sex classrooms are twofold. First, as I have made clear by now, there is the claim that boys and girls have different brains and therefore need different pedagogic approaches. A second and related rationale is that gender stereotypes in single-sex classrooms would play a smaller role than in co-ed classrooms. Without the other sex present, boys and girls would not intimidate each other, and both boys and girls would be less concerned with what others think of them. As the NACE website states:

Girls in single-sex educational settings are more likely to take classes in math, science, and information technology, especially when teachers have received appropriate training. Boys in single-gender classrooms—led (once again) by teachers with training in how to lead such classrooms—are much more likely to pursue interests in art, music, drama, and foreign languages. Both girls and boys have more freedom to explore their own interests and abilities than in the coed classroom. (‘Introduction’)

The advocacy is paying off: single-sex education is on the rise in the US. According to NACE, only about a dozen schools in the US offered single-sex education in 2002 when the organisation was founded. In the same year, the No Child Left Behind Act called on the US Department of Education to reconsider the prohibition of single-sex education under Title IX, which regulates sex discrimination (Paige 2002). In 2006, this legislation was altered to allow schools to set up single-sex classrooms (US Department of Education 2006). Between 2011 and 2012, over 500 schools in the US offered separate education for boys and girls (‘Single-Sex’). In 2014, the number had risen to 850 (Anderson 2015). And the influence of Gurian and Sax goes beyond US borders. Educators have implemented their views across the world. In the Netherlands, as I will elaborate below, single-sex education is out of the question, yet Gurian’s views on the education of boys and girls have been disseminated to teachers through a series of state-financed publications. This success is achieved in spite of numerous critiques. These critiques target a number of aspects of the boy crisis literature. First, critics have argued that boys are not in crisis at all, and that the rhetoric of boy-crisis advocates merely serves to naturalise and reaffirm male

22. The organisation was originally called the National Association for the Advancement of Single Sex Public Education (NAASPE), a name ‘deliberately patterned after the National Association for the Advancement of Colored People (NAACP)’ (see http://www.4schoolchoice.org/).

57 privilege (e.g. Barnett & Rivers 2006; Mills 2003; Williams 2011). Second, as I have already mentioned, there is little support for the claim that boys’ and girls’ brain are so different as to warrant different educational approaches. As Eliot phrases it in a recent review, ‘the only evidence that “boys and girls learn differently” boils down to a tautology: they perform differently in school, therefore, they must learn differently’ (2013, 375). In addition, the evidence that children perform better in single-sex classrooms is very mixed, showing no definite support for the claim (Bigler & Signorella 2011; Pahlke, Hyde & Allison 2014). If anything, gender-stereotypical behaviour seems to increase rather than decrease in single-sex settings (discussed in Halpern et al. 2011). Instead, boys and girls equally benefit from other, shared interventions like smaller classrooms, more competent teachers, and increased funding (Martin 2007). Finally, critiques have addressed how social categories that intersect with sex/gender, particularly social class and race/ethnicity, are treated in the boy-crisis literature (e.g. Gillborn & Gibbs 1996; Griffin 2000; Kimmel 2010; McCready 2012). Many have commented on how boy advocacy tends to marginalise these categories by focusing on sex/gender differences, and have emphasised the importance of clarifying the question ‘which boys?’. The notion of brain sex is instrumental to this homogenisation of boys: as I have argued in detail in the previous chapter, it obscures within-group variation and between-group overlap, making sex differences seem dichotomous. And, it would follow, if all boys have a male brain, then they all have the same problems. As Kimmel (2010) has argued,

differences among boys—by race, or class, for example—do not typically fall within the radar of the cultural critics who would rescue boys. These differences are incidental because, in their eyes, all boys are the same. A crude biologism pervades much of the dire warnings about the fate of boys in school, one that flattens all differences among boys, and exaggerates the differences between boys and . (26)

At the same time however, single-sex schooling is often presented as a means to improve the educational experiences of low-income boys and ethnic minority boys in particular. This is a longstanding and controversial idea. Whereas some have claimed that segregated classrooms can indeed function as a critical ‘counterspace’ (Terry et al. 2013), others have argued that single-sex schooling policies do not succeed in tackling poverty and racism, and reinforce not only gender stereotypes but also racialised stereotypes like that of the hypersexual black male (see Williams 2004; Goodkind 2013):

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In the urban setting, single-sex education tempts school administrators to focus on the interests of black boys to the detriment of black girls. It repeats in racialized form the familiar idea that girls are the cause of boys’ lack of educational success and that boys must be kept free of distraction. (Balkin 2002, 10)

Together, these critiques suggest that the real crisis we have been facing since the beginning of this century is the reaffirmation of sex essentialism in the service of foreclosing any critical interrogation of hegemonic masculinity and its intersection with other social categories. In popular culture and in politics, the wealth of academic work engaging with the dynamics of masculinities in relation to race/ethnicity, sexuality, queerness, and other perspectives is drowned out by the loud voices of ‘backlash blockbusters’ (Mills 2003). Although I rehearse key aspects, I am not specifically interested in the truth value of the claims made by Gurian, Sax, and other neuro-inspired boy advocates in this chapter, nor in offering alternative accounts of boys’ experiences in the classroom (many others have already done so). Instead, I am interested in how these authors mobilise (pseudo-)neuroscientific arguments to rationalise the boy crisis, to cater to the anxieties about the state of masculinity by reaffirming natural sex differences, and to appeal to notions of individuality and freedom– all the same time.

‘Boys and girls learn differently’

‘Thirty years of politically correct insistence that gender doesn’t matter has had the ironic and unintended effect of reinforcing gender stereotypes’, Sax claims (2008). His goal is to achieve gender equality: equal chances for boys and girls to achieve their full potential. Importantly, Sax stresses, this potential is the same for boys and girls; only the means through which it can be realised is different. ‘There are no differences in what girls and boys can learn’, the NACE website insists, ‘But there are big differences in the best way to teach them’ (‘Learning Style’). Likewise, Gurian states that, ‘It is not the differences between male and female but rather disrespect for the natural strengths of each gender that is a root cause of oppression’ (2007, 124). He, too, professes that gender equity can be achieved if we understand natural sex differences and adapt our education accordingly: ‘both [male and female] brains can get better at all intelligences with proper stimulation’ (Gurian et al. 2010 [2001], 52). When differences in cognitive skills like abstract cognition and language are discussed, they are mainly approached in terms of learning styles rather than in terms of aptitude. Both Sax and

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Gurian, for example, maintain that the gender gap in maths skills can be minimised if girls are taught maths in a concrete manner (using real objects to manipulate or using stories), whereas boys do best learning maths from the blackboard. Similarly, they argue boys can become more apt at reading and writing when lessons involve sensory stimulation and acting out stories (Gurian & Stevens 2005, 152-154) and when ‘boy friendly’ questions are asked (‘what would you do?’ instead of ‘how would you feel?’) (Sax 2007, 41-42). In the framework provided by Sax and Gurian, allusions to gender equality and equal potential are thus combined with an emphasis on the immutability of biological sex differences in the brain. Gurian, for example, states his position as follows:

the gender of the human brain is not plastic … It is as hard-wired into the brain as a person’s genetic personality. … Our educational system has bought into the idea of “over- all neural plasticity.” Because of this mythical concept of the brain as a magical, changing device, very few academic institutions train teachers in the neural sciences of gender. (Gurian & Stevens 2005, 60)

As this statement indicates, Gurian resolutely rejects the possibility that sex differences in the brain are plastic. However, he and Sax also mobilise plasticity to their advantage by portraying sex differences in the brain as differences in learning style (as sex differences in plasticity). In this account, brain sex is not so much about form or ways of being, but much rather about process or ways of becoming. The sky is the limit for both boys and girls, yet the way in which they should reach for this limit differs. So, above all, male and female brains are represented here as two different ways of becoming a unique individual. This particular understanding of brain sex allows boy advocates to move in two directions at once. On the one hand, it modernises neurosexism by emphasising that gender roles are flexible and that children can do and be anything they want to. On the other hand, it remains conservative by emphasising that masculinity is natural and that boys will therefore always be boys. As such, it fits very well in the contemporary climate of neoliberal post- feminism, as I have discussed it in the general introduction. In this climate, or in Gill’s (2007) term ‘sensibility’, themes of freedom, choice, and optimisation are merged quite effortlessly with claims of fixed biological sex differences. On the one hand, a clear natural order is postulated, but on the other, men and women are represented as free and flexible agents within this order. In a world where everything can be turned into a resource, their natural traits are no longer restrictions but rather useful and pleasurable truths about the self that can be used to their

60 benefit. Similarly, in the work of Gurian, Sax, and other boy advocates, brain differences become a recipe for personal optimisation; follow it, and a child can become whatever it wants. A central part of this argument is the ‘maturity gap’: ‘one of the most pronounced brain- based gaps males and females ever experience’ and ‘one of the most profoundly disabling features of contemporary classroom life’ (Gurian et al. 2010 [2001], 62). Because girls’ brains mature at a faster rate, Gurian argues, boys appear defective by contrast. Compared to girls of the same age, boys have less emotional control, take more risks, and get into trouble more often. However, given enough time, boys will end up where girls are. Again, the central idea is that boys and girls have unlimited future potential, but their trajectories are different. Indeed, sex differences in the rate of brain maturation are rather well established, especially during puberty. The brain’s developmental trajectory around this age follows an inverted U shape, the peak of which appears to occur, on average, a few years earlier in females (e.g. Lenroot et al. 2007). The significance of this sex difference in terms of behaviour, however, is still poorly understood (Giedd et al. 2012). A ‘dual systems model’ of the teenage brain has been proposed which posits that brain areas associated with the processing of socioemotional rewards mature at a faster rate than areas associated with cognitive control, resulting in impulsive and risky behaviour (Steinberg 2010). Even though the ‘adolescent brain’ has become a major item of interest over the past decade, theories linking brain maturation to behavioural impulsivity and instability in teens have been criticised for exaggerating adolescents’ propensity for risky behaviour, for treating adolescents’ brains as disembodied entities, and for ignoring alternative predictors of risky behaviour like poverty (e.g. Bessant 2008, 2012; Kelly 2012; Koffman 2015; Males 2009; Sercombe 2014). Gumy (2014) has addressed claims about sex differences in teenage brain discourses, noting that in this area of research, ‘[t]he category of sex tends to obscure, even absorb that of gender, hence causes a reduction of the social complexity at the individual level’ (268). When we want to understand the experiences of children in education or in other contexts, it is crucial to attend to this social complexity. This does not mean that the brain should not have a place in explanations of differences between boys and girls, but it does mean that our understanding of children’s brain development has to become more complex and more contextualised. For example, we might ask to what extent the sex difference in brain maturation is contingent on certain aspects of the developmental environment. As it is now, brain maturation during adolescent is typically regarded as a more or less autonomous process, unaffected by experience. The implication of this is that any sex difference in brain maturation would be pre-programmed at birth.

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As I have argued in the previous chapter, when investigating the influence of social factors on sex differences in the brain, it is important not to take these brain differences or differences in experience for granted. Mapping gendered experiences onto the brain risks essentialism when these experiences are conceptualised as two distinct, homogenous patterns shared by all girls and all boys. In reality, the experience of being a girl or being a boy is highly variable and co-dependent on other aspects of one’s embodied identity. In The Brain’s Body, Pitts-Taylor (2016) also draws attention to this issue:

Efforts to depict brains as biosocial also rely on [an] effort to fix persons in social categories, statistical aggregates, or populations that can be mapped onto the brain. The resultant neural phenotypes may resist biological determinism, but they do not automatically resolve the attendant problems of reification and essentialism. The measurement of human difference through biosocial plasticity can require cuts that belie biosocial complexity and that (mis)construe the experience of individuals and groups as homogenous and predictable. (41)

She demonstrates this problem with an analysis of studies mapping the effects of poverty onto children’s brains. In this research programme, she argues, ‘the plastic, biosocial brain gains a class phenotype through biosocial reductionism’ (124) while questions of generalisations across individuals and across contexts are ignored. One of the most troubling consequences of this, she writes, is that these representations of poverty as a neural phenotype justify strategies of pre-emptive governance addressing ‘social problems that are entangled with race, gender, and class inequalities’ (39). This is also visible in the context of single-sex schooling. As I have discussed above, whereas brain-based arguments for single-sex schooling often essentialise masculinity, actual policies will often target poor and minority boys and thereby risk reifying and essentialising stereotypes at the intersection of gender, class, and ethnicity. The following chapters will further highlight how plasticity-based research approaches participate in the construction of certain groups as at-risk and risky, and as appropriate targets of intervention. Now, however, I want to return to the brain-based boy advocacy literature and address the specific role of socialisation in this body of work.

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Boys becoming boys

Interestingly, male socialisation—for and by men—does take centre stage in the work of Gurian and similar authors, but in a radically depoliticised and naturalised way. They represent brain sex as simultaneously immutable—something boys (and girls) simply have— and highly precarious. For these authors, boyhood does not morph safely into manhood without proper guidance and role modelling. Their nature must be properly nurtured: ‘To become a man, a boy must see a man’ (Sax 2007, 204). If socialisation fails, everyone is in trouble. With their slower rate of maturation and natural impulsivity, boys are considered both fragile and dangerous. ‘Boys are always at the edge of causing harm to themselves or others because they’re such physical risk-takers,’ says Gurian (1996); ‘If we don’t respect male hormones and brains … they will cause harm to themselves and others’. Likewise, Steven Biddulph, another boy advocate, writes that ‘being young and male is a condition so vulnerable, so prone to disaster’ (2010 [1998], 1). So, socialisation is understood as a crucial factor in boys’ lives, but what that socialisation should look like is fully circumscribed by his nature. Gurian stresses that his thinking does not oppose nature against nurture and does not amount to determinism, because his views of human nature do not limit behaviour. He uses crying as an example: one can teach boys not to cry, although that will not change their brains (Gurian & Annis 2008, 14-15). Yet, his whole argument revolves around the idea that nature must ultimately trump nurture. The main point of the campaign for boys is, after all, that any attempt to transcend male nature is harmful to boys and to society at large. Instead, male nature has to be recognised, respected, and fostered. Any decision not to let nature ‘run its course’ would be a dangerous ideological choice. ‘Armed with [brain] scans, [we] can press our educational culture to change not the boys but rather the myth of gender plasticity under which we labor against our sons’ natural energy and learning style’, Gurian (Gurian and Stevens 2005, 56) writes, calling upon society to ‘put to rest the idea that humans can, should, or need to reengineer the brain into whatever our recent educational institutions or ideologies want it to be’ (Ibid.). It is up to parents and teachers to recognise male nature and to nurture it to maturity, aided by the knowledge of neuroscientific experts. As Williams (2012) has noted, it is quite striking that boy advocates mobilise essentialist notions of male nature, since women are the ones who have historically been associated with nature and with the limits imposed by their bodies. Indeed, these advocates go to lengths to emphasise that neurologically speaking, boys are the fragile sex. Gurian (Gurian and Stevens 2005), for example, likens the male brain to ‘porcelain’ and the female brain to ‘steel’, arguing

63 that the male brain is relatively unstable and therefore more likely to be labelled ‘learning disordered’ (218). Biddulph, citing statistics of deaths, accidents, and suicides, writes that when it comes to their health, ‘boys are like a developing country’ (2010 [1998], 3). However, Williams (2012) writes, this reversal does not mean that boys have truly become the second sex. Instead, she argues, by preventing critical interrogation of male socialisation and naturalising hegemonic masculinity, this move reinforces male privilege (546). Indeed, in the boy-advocacy rhetoric, male fragility is asserted in order to get parents, teachers and doctors to rally around boys to reaffirm and protect their supposedly inherent masculinity, while girls are suggested to be fine on their own, thanks to their robust brains. Williams (2012) argues in her analysis that in the work of Gurian, girls in particular are represented as capable of becoming anything, thanks to their superior biology, whereas boys are represented as more limited by their biological characteristics. I agree that this focus is indeed apparent in Gurian’s work and similar literature. Yet at the same time, Gurian and others repeatedly emphasise that boys can become anything, they just need a different approach. As such, they straddle two apparently contradicting opinions: on the surface, they reaffirm traditional masculine traits and oppose the feminisation of boys, yet on a more subtle level, they also argue that boys can and probably should acquire traditionally feminine traits provided that these are learned in a masculine way. This uneasy combination of reaffirming and reinventing masculinity is precisely what, in my view, makes this genre so effective and appealing to parents and educators who are concerned about the future of boys, since it offers resistance against social and economic changes whist implying, on a more implicit level, that boys do stand a chance in an economy that values brains over brawn, if only parents and educators prepare them with appropriate methods.

Nurturing nature: Gurian’s invisible pedagogy

Gurian’s mobilisation of neuroscience combines stark determinism with explicit appeals to freedom. In his books, the brain is the seat of a child’s immutable ‘core nature’ as well as the source of flexibility, potential, choice, and risk. As Thornton (2011a) has noted, this combination is a hallmark of contemporary neuroculture: ‘Determinism and optimization are not mutually exclusive positions in popular neuroscience; rather, determinism is the flip side of optimization, and both play important roles in brain culture’ (51). Indeed, she argues, popular neuroscience owes its ‘rhetorical power’ precisely to this combination of the brain as both cause

64 and consequence of our actions (57). If the brain were not viewed as the seat of our identity, changing and protecting it would not be of such crucial importance (61-62). In Gurian’s writings, children’s male (or female) nature is always a given and in need of protection and sustenance. Parents and teachers are tasked with recognising this unique ‘core nature’ of a child and facilitating the unfolding of her or his hardwired personality. On the one hand, Gurian represents this unfolding as a more or less autonomous process. For example, in Nurture the Nature, he describes the synaptic activation and pruning in new-borns as wilful acts of a baby’s core nature: ‘our children’s brains make the choices they need to make, according to their own nature’ (2007, 88). On the other hand, he emphasises the work required of caregivers to guide this process:

Your child is not a blank slate—his or her brain cells for temperament and personality, for instance, are already in place; his or her genetic legacy and inherited potential are already in existence—but it’s by your hugging, holding, and talking to this child and caring for this child that you’ll be helping him or her activate this personality, legacy, and potential. (87-88)

In lieu of Gurian’s assertion that this knowledge is ‘liberating’ for parents (88), his views on pedagogy require an intensive parenting style. Intensive parenting has been identified by cultural scholars as an ideology that developed in the second half of the twentieth century, as parenting became increasingly focused and time-consuming, especially for mothers (e.g. Furedi 2001; Hays 1996; Nelson 2010). The focal point of this ideology is not obedience, but the child’s needs: ‘The logic of intensive parenting requires that parents interact with their child at virtually all waking moments, attending closely to the child’s needs and demands’ (Quirke 2006, 389). Even though this ideal of motherhood addresses women in general, it requires resources that many mothers cannot afford (Hays 1996; Fox 2001). As such, mothers who can afford to spend all their time and energy on their children may have more successful children not because intensive parenting pays off, but simply because they are already privileged in terms of social class/socioeconomic status. From the 1990s onward, brain-based parenting advice further intensified this ideology by framing early brain development as a critical period in which both risk and opportunity are enormous, and insisting on constant emotional and cognitive stimulation as a requirement for optimal developmental outcomes (Nadesan 2002; Wall 2004, 2010).

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Gurian’s work reflects this ideology perfectly. He advises parents to closely monitor their child for signs of her or his ‘core nature’, and to use the expert knowledge he offers to interpret these signs and choose the right course of action. He urges them to ‘constantly [look] in their [child’s] eyes and [say], “What does this girl need? What does this boy need?”’ (2007, 94). Developmental steps are to be taken only if the child seems ready (128), recalling that parents have to keep in mind that girls develop faster than boys. At the same time, parents are warned not to hover or to show anxiety: the child must not experience any pressure to be anything other than his or her unique self (131). The intensive monitoring that this ‘tailored care, from the inside out’ (5) requires must thus be as unobtrusive as possible. In his study of British nursery schools from the 1960s onwards, sociologist Basil Bernstein (1977) has elaborated on this ideal of nurturing children’s unique natures by way of intense but unobtrusive surveillance, which he terms implicit or invisible pedagogy. His main interest was in how pedagogic practices relay power relations, with specific attention to class inequalities. Tracing the emergence of a new middle class, characterised by the production and control of services and communications, Bernstein identified a shift from visible to invisible pedagogy. The former, associated with the old middle class that produces and controls goods, constitutes an explicit and overtly hierarchical relationship between the child and the teacher or parent. The latter is much more implicit and progressive, emphasising self-regulation and competence, and encouraging children’s diversity. Both the old and the new middle class believe that a child’s nature is fixed, but the new middle class ‘also hold that the type is capable of great variety’, allowing for ‘ambiguous personal identity and flexible role performances’ (113). In other words, the new middle class holds ‘a theory which points towards social mobility—toward a meritocracy’ (113). The meritocratic ideology is embodied by invisible pedagogy, which operates on the principle that ‘implicit nurture reveals unique nature’ (1977, 111). Importantly, even though this invisible pedagogy appears to offer the child more freedom of self-determination, it actually involves much more complex and far-reaching control mechanisms: it ‘encourages more of the socialised to become visible, his uniqueness to be made manifest. Such socialization is deeply penetrating, more total as the surveillance becomes more invisible’ (113). In this ‘contradictory exercise’, Roger Cox (2002) writes in Shaping Childhood, ‘The child (unknowingly) and the professional (with expert knowledge of the child’s innate propensities) enter into a complex, apparently non-hierarchical, non-evaluative relationship which steers the child towards its own unique destiny’ (191).

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Although the usefulness of Bernstein’s work for feminist scholarship has been contested (Arnot 2002), I find his elaboration of invisible pedagogy highly illuminating in relation to Gurian’s writings, which read like a manual in this ‘contradictory exercise’. He assures parents and teachers that children’s nature will shine through no matter what they do, yet at the same time he threatens that this nature will be deformed if not properly nurtured. Parents and teachers are strictly forbidden to interfere with a child’s inner self, yet they are required to engage with intensive monitoring and control in order to create the right setting or this self to unfold. The brain, in its dual role of source and receptacle, functions as a grounding device for these contradictions. As the seat of a child’s unique nature and the locus of risk and potential, the brain as Gurian represents it rationalises the logic of his invisible pedagogy and provides the tools for caregivers to carry out its imperative. Gurian offers up his expert knowledge about sex differences as a crucial tool to do so.23 Interestingly, whereas Gurian offers up his version of an invisible pedagogy as a solution to the boy crisis, Bernstein linked invisible pedagogy, with its weak classifications, precisely to girls’ success relative to boys: ‘girls are less likely to be negatively constrained by invisible pedagogies than visible pedagogies. Conversely, for boys, under an invisible pedagogy practice, girls become successful competitors and a threat’ (1990, 82). However, as Arnot has argued, the emancipatory effect of invisible pedagogy should not be overestimated: whereas its ideology granted mothers and female teachers unprecedented control over the transmission of symbolic property, she notes, these women had little to no influence over the content of the transmission for which they were now held responsible, as gender relations within the family and within the pedagogic profession remained unchanged. Working-class mothers and their children in particular were unable to profit. As Bernstein himself observed, the logic of invisible pedagogy is based on class-specific assumptions as the space, time, and effort involved are not available in all homes. As such, children from disadvantaged households will not be a good ‘fit’ in an educational system operating according to an invisible pedagogy. Similarly, even though Gurian claims that his books will help all boys and girls, the demands he imposes on parents are far from democratising, since not all parents can afford to spend all their time gazing into their child’s eyes to catch a glimpse of her or his soul. In this respect, Gurian risks further amplifying, rather than ameliorating, inequalities in education.

23. Gurian’s occasional remark that even though sex differences are significant, there are exceptions to the rule (e.g. ‘bridge brains’, which are in between male and female brains), only seems to heighten fears of imposing the wrong kind of socialisation, further necessitating detailed expert knowledge about how to recognise and regulate children’s nature.

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Reaching for excellence: Gurian in the Netherlands

In the final section of this chapter, I want to supplement my analysis of brain-based boy advocacy with a description of the Dutch context. In the Netherlands, concerns with international competition in scholastic achievement contributed to the visibility and salience of sex differences in educational success as it did in other countries, yet policies initially focused on optimising the potential of the individual student. While concerns over the boy crisis were mounting in other countries, Dutch policy considered differentiating between boys and girls as unnecessary or even counterproductive to the establishment of an ambitious learning culture. At the same time, however, a series of state-financed publications disseminated the ideas of Gurian and other neuro-inspired boy advocates to teachers. Over time, this brain-based perspective allowed the concern with the individual, unique student to merge with a focus on sex differences. In the Netherlands, sex-segregated education was formally ended with the ‘Mammoth Act’ reform of 1968. This law was intended to make secondary education more meritocratic, increasing social mobility. During the 1970s and 1980s, campaigns were launched with the aim of increasing girls’ educational participation. Girls made great strides: in 2006, a report commissioned by the Dutch Ministry of Education, Culture, and Science (OCW, ‘onderwijs, cultuur en wetenschap’) showed that girls, as a group, had surpassed boys in terms of attaining ‘successful school careers’ (Van Langen & Driessen 2006). The focus of the report was mainly on non-cognitive skills, in which girls showed the most advantage. At the same time, girls still lagged behind in maths and science and they were still vastly underrepresented in technical areas in tertiary education. However, following international developments, the media picked up on the disadvantages of boys, concerned that Dutch boys might also be in crisis (e.g. NRC 2008; Obbink 2009). In the wake of these first rumblings, concerns were also raised about maintaining the excellent position of Dutch students in international rankings. The PISA rankings of 2010 showed that even though Dutch students performed very well compared to other OECD countries (OECD 2010), their achievements threatened to stagnate. In response, the OCW presented a plan to make both primary and secondary education more ambitious and more results-oriented. Two action plans were developed, ‘Basis voor Presteren’ (‘Basis for Achieving’, Netherlands 2011a) and ‘Beter Presteren’ (‘Achieving More’, Netherlands 2011b), calling for an explicit refocus on excellent students rather than weak ones. ‘Given the Dutch ambitions for economic growth and social development,’ one of the reports warned, ‘we cannot

68 afford’ the fact that other countries might surpass the Dutch students’ (Netherlands 2001b, 1; my translation). One of the interventions was to oblige schools to use the existing leerlingvolgsysteem (‘student tracking system’), which makes the school career of Dutch students easy to assess and compare. Dutch educational policy re-emphasised making use of each individual talent and on passend onderwijs/maatwerk (‘custom tailoring’) education. Since 2014, schools even have a ‘duty of care’ for each individual student, requiring them to provide an optimal environment for each individual child, focusing not on learning disabilities but on the possibilities of each single student. In the following years, several reports confirm the finding that Dutch girls perform better than boys in terms of non-cognitive skills and successful school careers, even though they are still behind in maths and science (Driessen & Van Langen 2010; Netherlands 2011d). The president of the Governing Council of Christian Schools argues for sex-segregated education in a national newspaper, but his suggestion appears to fall on deaf ears (Petovic 2011). The sector organisation for primary education responds that custom tailored education, focused on the individual student, should be preferred instead (ANP 2011). That same year, the minister of OCW states in a letter to the State that there is no reason for concern about Dutch boys, that she has no intentions of developing boy-specific policies, and that she expects boys to profit from the general interventions of the action plans for increased achievement (Netherlands 2011c). Meanwhile, an OCW-financed teacher guide, entitled ‘HijZijWijzer’ (‘HeSheGuide’), relies heavily on popular boy crisis literature, and instructs teachers that boys and girls have different genes, hormones, and brains (Janssen, Evers & Voskens 2010). Insight in these biological differences, the guide claims, is ‘a prerequisite to meeting boys’ and girls’ individual needs’ (9; my translation). It provides a long list of examples: girls are more focused on contact than boys (13); boys are specialists, whereas girls are generalists (20); girls are sensitive and empathetic whereas boys are aggressive and competitive (27); and so on. All these differences are linked to purportedly innate brain differences (e.g. more lateralisation in girls’ brains). Teachers are given some tips on how to handle boys and girls in the classroom; for example, boys need help with self-reflective whereas girls need help with being assertive (52-53). The report does not mention the fact that these claims are highly controversial. The OCW have commissioned two additional reports on what constitutes successful education for boys, resulting in another guide for teachers (handreiking), accessible online.24

24. The guide may be found at http://handreikingjongensmeisjes.slo.nl/.

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The first report contains a large section on typical boy characteristics (Maréchal-van Dijken et al. 2012). Like the ‘HijZijWijzer’, it relies heavily on popular literature like Gurian’s, supplemented by teachers’ anecdotes. ‘I see the traditional role pattern’, one teacher observes (20; my translation). The only explanation for this pattern offered in the report is brain sex theory, without a critical note. The rest of the report lists ‘best practices’ of successful teachers,25 all intended to facilitate boys’ natural differences. The second report is much more nuanced (Heemskerk et al. 2012). It observes two different approaches to the boy problem: a ‘nature’ approach and a ‘nurture’ approach. The authors do not take an explicit position, and note that schools do not do so, either. Approaching the problem pragmatically, the report observes, schools do notice gender differences, but try to relate to children as individuals. Most successful schools, therefore, have no specific approach for boys. The OCW’s second guide, which is an online site, summarises the two reports in the following ‘vision on dealing with differences’, which is worth quoting at length:

A clear view on the differences between boys and girls helps to meet the pedagogic and didactic needs of students. This does not entail a specific approach for boys. This would lead to undesirable limitations and stereotyping, and ignores the fact that variation within groups of boys and girls is large. However, insight in sex differences can contribute to a better handling of differences. Schools where boys perform relatively well, have no policies targeting boys specifically … What these schools do have, is ample attention for dealing with differences and room for an individual approach to students, which includes sex differences as a self-evident focus. Differences between boys and girls are noted, but dealt with on an individual level. … A teacher who is good for boys is also good for girls. (‘Visie op omgaan met verschillen’, my translation)

It is interesting to see how this advice veers from stressing sex differences to warning against stereotyping; foregrounding sexual difference and individual variation at the same time. The text thereby expresses both the desire to recognize the child’s unique core nature by using expert knowledge about brain sex, as well as the fear of imposing the wrong pre-conceived ideal on her or his unfolding self. Despite an initial opposition between an individual-based approach and a sex-based approach in the Dutch debate, the belief that boys and girls have different educational needs now resonates quite effortlessly with the focus on individual differences and

25. In the guide, teacher success was determined by male pupils’ ratings, and not their actual achievements.

70 custom tailored education: ‘The teacher is seen as responsible for an individual learner’s needs, embodied in their gendered brains’ (Titus 2004, 157; my emphasis). As I argued above, this relationship between sexual difference and individual variation is successfully grounded by the brain, which serves as the nexus of both determinism and optimisation. In 2013, the new minister of the OCW presented the new Cabinet’s outline of emancipation policy, putting the boy crisis squarely on the political agenda with a new focus area, entitled ‘Girl Success or Boy Problem’ (Netherlands 2013). This resulted in a new report: ‘De jongens tegen de meisjes’ (‘The boys against the girls’, ROA 2015), focused mainly on secondary education. Unlike what the title suggests, this report is quite nuanced. When it discusses brain differences as an important rationale for disparities between boys and girls in education, it acknowledges the impact of the environment on sex differences in the brain quite explicitly, unlike the other reports discussed in this section:

A warning about the nature of neuroscientific explanations for cognitive differences between boys and girls is in order. … [I]f boys and girls use different brain areas for a similar cognitive performance, that could be the result of a different development and not the cause. It is therefore of crucial importance to take into account previous experiences when discussing boy-girl differences. After all, it is the environment that determines to a large extent the changes in the microstructure of the brain which in turn determine further cognitive development. (Jolles & Keizer 2015, 43; my translation, references removed)

The above represents a hopeful development, opening the door to a more complex and adequate understanding of how and when sex matters in the brain by adding ‘the plasticity of sex differences’ to the vocabulary of boy-crisis advocacy. Hopefully, future developments in the field will also pay attention to the heterogeneity and intersectionality of gendered (and other) experiences.

Conclusion

In this chapter, I have engaged with brain-based boy advocacy literature, focusing on the work of Michael Gurian. In my analysis, I have addressed the interplay of hardwiring- and plasticity-based arguments in these texts. This focus enabled me to highlight the way in which some authors thematise determinism and freedom at the same time. I suggest, here, that brain- based arguments for single-sex education cannot be fully addressed by a critique of biological

71 determinism. Rather, my discussion suggests that the success of these arguments lies in the combination of biological determinism with an explicit appeal to unlimited brain potential. By looking at the conceptualisation of brain sex in the work of Gurian and similar authors as a conceptualisation of sex differences in plasticity, I have highlighted the fact that brain sex as a natural, fixed property is not understood here as limiting the possibilities of boys and girls but precisely as a resource or recipe for individual optimisation. With this combination of biologically determined sex differences and limitless potential, these texts speak to a neoliberal, post-feminist sensibility (Gill 2007). By focusing on differences in learning style and maturation rates rather than on differences in aptitude per se, authors like Gurian affirm a natural order in which masculinity and femininity are eternal, homogenous and complementary, whilst accounting for recent shifts in gender roles. As such, they use a strategy similar to evolutionary psychologists, who argue that their claims are not biologically deterministic because they do not see behavioural output as fully determined by our evolved psychology but as contingent on environmental input (e.g. Confer et al. 2010). Of course, this evolved psychology itself is viewed as genetically determined. Likewise, in texts examined in this chapter, plasticity is conceptualised as intrinsic processes of learning and maturation which are themselves fixed and immutable. As such, sex differences in plasticity appear as hardwired. I have argued that a full account of boys’ and girls’ experiences in the classroom has to take into account the plasticity of sex differences. In other words, if boys and girls have different learning styles and/or brain maturation rates, then the question arises to which extent these differences are contingent on the developmental environment. However, I have also cautioned against projecting gender differences onto the brain without attending to their heterogeneous and intersectional nature. The texts that I have discussed in this chapter highlight the potential of boys as well as their fragility and dangerousness. Even though their natural masculinity is taken as a given, they are represented as needing intensive socialisation in order to reduce the risk they pose (for themselves and for others) and to optimise their development. This requires intensive yet invisible parenting, an ideology which is tightly bound up with class. In the next chapter, which focuses on the parental brain, I will address in more detail the expectations placed on parents by popular neurodiscourses that figure particular brains as at-risk and a risk.

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Chapter four Plastic parenting: a family portrait

‘It takes a village to raise a child’ (Nigerian proverb)

Introduction

In April 2015, Rebecca Saxe, Professor of at the Massachusetts Institute of Technology, laid down in a magnetic resonance imaging scanner with her sleeping child to create the first MRI image ever made of mother and child together. She shared the image Figure 2. MRI image of mother and child. Rebecca Saxe online, accompanied by a brief and Atsushi Takahashi / Department of Brain and Cognitive article in which she explained Sciences, MIT / Athinoula A. Martinos Imaging Center at the McGovern Institute for Brain Research) (2015) how she sees in this image a ‘venerable symbol of human love’:

I saw a very old image made new. The Mother and Child is a powerful symbol of love and innocence, beauty and fertility. Although these maternal values, and the women who embody them, may be venerated, they are usually viewed in opposition to other values: inquiry and intellect, progress and power. But I am a neuroscientist, and I worked to create this image; and I am also the mother in it, curled up inside the tube with my infant son. (Saxe 2015)

In an interview with another online source, Saxe further commented that:

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These brain scanners are extremely modern technology, only available here and now, to the wealthiest place and time in human history … [Yet] the image you see would look the same if it had been made on any continent or in any century, because the biology of human mothers and children you see in the picture has been the same for thousands, probably tens of thousands of years. (quoted in DiDomizio 2015)

With this image and her interpretation of it, Saxe both invokes motherhood as a universal, eternal, natural phenomenon and motherhood as a contingent, changing cultural practice. In this chapter, I am concerned with the way in which the brain of the infant and the brain of the parent, as phenomena emerging in developmental and , function at this intersection of the universal and the contingent, the biological and the social, the old and the new, simultaneously affirming and reinventing motherhood.26 The significance of Saxe’s image is that maternal love is not just symbolised by the closeness of the embrace and the tenderness of the kiss, but that this intimate bond is depicted as a bond between brains. In the twenty-first century, what counts as good parenting is often first and foremost considered brain-based parenting. In this discourse, raising a child well has become synonymous with optimizing brains, using expert knowledge about the infant brain and the parental brain. This expert knowledge has focused on brain plasticity as a key principle. The infant brain is represented as excessively impressionable, absorbing all blessings and all insults with life-long consequences. The maternal brain is also understood as going through a limited period of extensive plasticity, reorganizing itself to meet the child’s demands. Interestingly, as Thornton (2011b, 2014) has argued, and as I will discuss in more detail below, the popular discourse surrounding the notion of maternal plasticity has reinvented motherhood in a way that conjoins traditional notions of the mother as primary caregiver and domestic figure with the notions Saxe aims to invoke by depicting motherly love with state-of-the-art technology: power, professionalism, rationality. Recently, the paternal brain has been added to this family of plastic brains, demonstrating a transformation akin to that of its female counterpart. Here, I will paint a broader picture of this family of mother, father, and child, tracing how recent neuroscientific studies provoke both the affirmation and the subversion of the heteronormative nuclear family. Doing so, I will pay attention to the way in which the biologisation of parenting has proceeded hand-in-hand with

26. A part of this chapter has appeared, in an earlier version, in Tijdschrift voor Genderstudies. See Kleinherenbrink (2014).

74 the politicisation of parenting, as images of both infant brain and parental brain provide ‘a visible and calculable “space” for biopolitical knowledge and intervention’ (Thornton 2011b, 400), allowing experts to ‘measure’ adequate parenting and mandating governments to interfere when parents are at risk of being a risk for their child. In this chapter, I discuss how neuroplasticity, represented as a critical window of opportunity in the infant and in the parent, designates certain families as at-risk and as appropriate targets for intervention, and how it fosters an ideology of intensive parenting that responds to and further enacts social inequalities related to gender and class. However, at the same time I wish to make the case that emerging research on the plastic maternal and paternal brain can be read differently and mobilised to challenge the naturalised ideals of intensive parenting as good parenting, of the mother as the primary caregiver, and of the nuclear family as the optimal developmental environment.

‘Get it right in the early years’: the plastic infant brain

Let us start with another story. In 1909, 11-year-old William (‘Billy’) James Sidis enrolled at Harvard University as the youngest person in history to ever do so. After applying unsuccessfully at age 9, he was now accepted into a special program for extraordinarily gifted children. During his first year on campus, the ‘little lad in knickerbockers’ (Addington 1910, 693) astonished the Harvard Mathematical Club with a lecture on fourth-dimensional space. The press reportedly widely on the marvel of his intellect, which seemed not a gift from nature but rather the ‘wonderfully successful result of a scientific forcing experiment’ (New York Times 1909). Young Billy was the son of Boris Sidis, a medical psychologist with a keen interest in educational psychology. He was named after his father’s friend and mentor, the noted psychologist William James. In The Principles of Psychology¸ James had described the phenomenon of brain plasticity, noting the brain’s capacity to change as well as its tendency to resist change and to form habits. He described habit as the ‘fly-wheel of society’, keeping ‘different social strata from mixing’ by ensuring the formation of character at an early age (1890, 121). He argued mankind could capitalise on this principle by making sure only the most advantageous habits are laid down as early as possible (222). In later work, he described how adults, too, albeit with greater effort, could propel themselves to greater heights of excellence

75 and productivity by tapping into the hidden reservoir of mental energy that anyone possesses (1907)27. Boris Sidis applied these ideas in his clinical practice and in his own home, providing for his son ‘an education having as its chief purpose the training of the child to make facile, habitual, and profitable use of its hidden energies’ (Addington Bruce 1910, 692). Like James, Sidis was interested in the societal impact of habit formation and the possibility of accessing typically wasted mental reserves. In his book Philistine and Genius (1911), published shortly after James’s death, he argued that the educational system of his time, with its ‘mediocre teachers, department-store super-intendents, clerkly principals and deans with bookkeepers’ souls’ (54), turned children into ‘philistines’ with a ‘mob mentality’ by imposing discipline and routine on their minds. No wonder, he argued, that the world is riddled with crime, poverty, war, corruption, and disease. Against the philistine, he set up the figure of the genius: plastic of mind and independent of thought, drawn to beauty and truth rather than to authority and brute force. To cultivate ‘a strong, healthy, great race of genius’ (87), children’s mental potential had to be accessed and stimulated by providing constant novelty. ‘If you do not direct the energies in the right course’, he urged parents, ‘the child will waste them in the wrong direction’ (69). This training had to be commenced between the second and third year of a child’s life: ‘To delay is a mistake and a wrong to the child. We can at that early period awaken a love of knowledge which will persist through life’ (67-68). The press was keen to report any emerging evidence of Sidis junior having a breakdown or rebelling against his father (e.g. New York Times 1910, 1924, 1937). Ruling experts at the time held that intelligence was genetically determined, and that it should be left to unfold on its own accord (Kett 1978). It was considered unhealthy to attempt to accelerate cognitive development, and precocity was associated with negative outcomes: ‘“early ripe, early rot” was a slogan most frequently encountered’ (Terman 1954, 222). In a time where the state depended primarily on physical labour for its economic prosperity, concerns about promoting physical health took precedence over concerns with cognitive development (Vandenbroeck, Coussée & Bradt 2010).

27. James’s theory of hidden mental energy is possibly the source of the contemporary myth that we use only 10% of our brains, but other sources are also plausible (Beyerstein 1999). According to one recent poll, almost 50% of teachers in the UK and The Netherlands believe this myth to be true (Dekker, Lee, Howard-Jones & Jolles 2012). Popular plasticity-based representations of the brain as a muscle that can be bulked up can be seen as a variation of this myth: according to this discourse, we always use 100% of the brain but training can vastly expand our mental capacities.

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How different it is now. Had the Sidis family lived today, their theories would probably have been met with a lot more enthusiasm. In our increasingly information-based economy, optimising the cognitive development of children has become a major concern for both the state and for parents. During the 1990s, the ‘decade of the brain’, this concern gave rise to what Thornton (2011b) has called ‘the first three years movement’: a movement of scientific experts that translates neuroscientific findings into everyday parenting advise, emphasizing ‘both the centrality of the first three years for “wiring” and “molding” babies’ brains, and the supreme status of brain imaging and neuroscience as authoritative guides for early child development policy and practices’ (402). Even though most evidence for the importance of early experiences has actually come from the behavioural sciences, this movement relied heavily on neuroscientific arguments to maximise its appeal and authority (Bruer 1999, 2001). The notion of plasticity in particular has functioned as key principle: within this movement, the first three years of a child’s life have come to be understood as a critical, life-determining window of opportunity, during which parents can ‘make or break’ their child’s future. For example, the UK-based Wavetrust campaign writes in its report The 1001 Critical Days that during this period, ‘connections in the brain are created at a rate of one million per second! The earliest experiences shape a baby’s brain development and have a lifelong impact on that baby’s mental and emotional health’ (Leadsom et al. 2014). Similarly, the Australian Early Development Census informs parents that a baby’s brain develops so rapidly, that ‘if we get it right in the early years, we can expect to see children thrive throughout school and their adult lives’.28 Early-intervention advocates acknowledge life-long plasticity, but emphasise that there is a large difference in degree between plasticity during the early years and plasticity in later life.29 In addition, life-long plasticity is represented as contingent on early experiences that have to ‘activate the plasticity of the developing brain’ (Bonnier 2008, 853, my emphasis). In other words, the message given to parents is that ‘very early experiences alone produce lifetime potential’ (Nasesan 2002, 405; see also O’Connor & Joffe 2013; Wall 2010). As Nadesan has noted, this model of development

28. The Australian Government’s continuing mission in this regard is outlined at their website, https://www.aedc.gov.au/parents. 29. For example, the website of the Harvard University Center on the Developing Child states: ‘Just as a weak foundation compromises the quality and strength of a house, adverse experiences early in life can impair brain architecture, with negative effects lasting into adulthood’, which is accessible at the following link: http://developingchild.harvard.edu/science/key-concepts/brain-architecture/.

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objectifies and segregates time into fixed states. The first stage is early childhood … a spatialized zone fertile with possibility [which] must be scrutinized with the intent of identifying phenomena that contribute to outcomes measured in the second state, adulthood … This second and ‘dependent’ state [is represented in] ‘objective’ measures of ability and / or professional success. (Nadesan 2002, 413; see also Thornton 2011b)

This model is a prime example of what Schmitz (2012) has termed ‘modern neurodeterminism’, which fuses themes of malleability and permanence, and articulates the brain as both the result and the source of our experiences. It acknowledges the influence of environmental factors when looking back, but not when looking forward: ‘Brain materiality has to be essential at the point of intervention; otherwise it cannot be modulated, manipulated or controlled’ (262). Like James and Sidis, early-intervention advocates are concerned not just with the development of individual children but also with the future of the state and its citizenry. One of the key claims of the first-three-years movement is that structural social problems like poverty, crime, drug abuse, or teen pregnancy are best addressed during the infant years via interventions that ensure optimal emotional and cognitive development (Breuer 1999; Edwards, Gillies & Horsley, 2014; Kagan 1998; Thornton 2011b). This idea has successfully influenced policies in a number of countries (this is particularly well-documented in the UK: e.g. Edwards, Gillies & Horsley 2014; Gillies 2013; Lee 2011; O’Connor & Joffe 2013). However, the movement has also been met with considerable critique (for a more extensive recent review, see MacVarish, Lee & Lowe 2014). Some have challenged the scientific basis of its ‘infant determinism’ (Kagan 1998), arguing that the scientific evidence does not support the notion of a critical window of cognitive development in humans or the claim that an enriched environment can enhance brain development over and beyond a ‘good enough’ environment (e.g. Bruer 1999, 2001). Other critiques have focused on the impact of the early-intervention discourse, arguing that even though brain-based parenting advice appears neutral and objective, in fact it does prescribes which parenting practices count as good and moral, and when state intervention is legitimate (Gillies 2013; Kagan 1998). In particular, it has been noted how the movement, by representing the infant brain as ‘infinitely and permanently neurologically vulnerable to parental influence’ (Macvarish Lee & Lowe 2015, 248), further reinforces the ideology of intensive mothering that started to develop under the influence of post-World War II developmental psychology (Hays 1996, Furedi 2001). This ideology, as I have discussed in the previous chapter, compels mothers to ‘acquire detailed knowledge of what

78 the experts consider proper child development and then spend a good deal of time and money attempting to foster it’ (Hays 1996, 8). Yet these amounts of time and money are not available for poor mothers: the very mothers who are, most of all, expected to break the cycle of poverty by optimising their child’s brain. The first-three-years movement, however, adopts a neoliberal worldview in which such structural power inequalities recede into the background, and notions of self-monitoring, self- management and self-optimisation prevail (Thornton 2011b). Gillies, for example, has argued that the movement suggests ‘that we could all compete on a level playing field if only our mothers performed optimally’ (2013, 16). As such, poor mothers come to be associated with inadequate, even neglectful parenting, in need of state surveillance and intervention (Nadesan 2002, O’Connor & Joffe 2013). The result is that poor mothers are faced with increased interference and coercion and that their children are taken away from them more often, while the state can legitimately cut welfare spending (Edwards, Gillies & Horsley 2014; Gillies 2013; Wall 2004). As such, the early-intervention discourse responds to and enacts a gendered and class-specific social order. In this early-intervention discourse, then, parenting has become thoroughly politicised: family-life during the pre-school years has become a public concern as the first-three-years movement ‘places parents at the centre of the policy stage but simultaneously demotes and marginalizes them’ (Macvarish, Lee & Lowe 2015, 248). In other words, parents are made personally responsible for a host of structural, social problems (whereby the parents most affected by those problems have to shoulder the most responsibility), but with the same gesture, the state gains the mandate to step in and take control. Ultimately, the parents themselves— tasked with the impossible challenge of managing all risks in their child’s lives, and therefore inevitably incapable30—have become the biggest risk factor in their child’s life (Fox 2009; Furedi 2001; Lee, Macvarish & Lowe 2010).

30. In this respect, it may be useful to think of parenthood as it is constructed in early-intervention discourse as enacting not a neoliberal subject but rather what Isin (2004) has termed the ‘neurotic subject’ who ‘is less understood as a rational, calculating and competent subject who can evaluate alternatives with relative success to avoid or eliminate risks and more as someone who is anxious, under stress and increasingly insecure and is asked to manage its neurosis’ (2004, 225). The neurotic citizen, more affective than cognitive, is a figure ‘whose anxieties and insecurities are objects of government not in order to cure or eliminate such states, but to manage them’ (Ibid.). In other words, the neurotic subject is not so much governed through freedom but rather through fear and her or his conduct is not calibrated via calculated, profit-oriented decisions, but rather through symbolic acts and rituals that soothe and reassure its anxiety. It is true that, as Thornton (2011b) notes, the early-intervention discourse ‘[uses] images of infants’ brains to constitute maternal emotion as a visible and calculable “space” for biopolitical knowledge and intervention’ (400), but there is no way for individual parents to actually oversee and quantify the risks imposed on their child’s brain and to act on this assessment in any rational way. This is also evident in Nadesan’s (2002) description of educational toys for young children that were popular in the 1990s. Noting that neuroscience is unable to explain—let alone predict—child development to the extent promised by

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It is in this context of risk, and of the parent as risk factor, that I want to consider the parental brain in the next sections of this chapter. In time, brain-based parenting has come to refer not only to knowing and optimising the infant brain, but also to knowing, using and optimising the parental brain (e.g. Hughes & Baylin 2012). Research has focused on the neurobiological changes taking place in mothers and fathers, in order to identify the parenting networks that facilitate and motivate bonding and caregiving (for reviews, see Numan & Insel 2003; Pereira & Ferreira 2016; Swain 2008). These changes include hormonal and neuronal responses. Even though these two are intimately connected, my discussion will only address changes in the brain on maternal and paternal neuroplasticity (see Pitts-Taylor 2016 for a similar discussion focused on oxytocin). I will make the case that emerging research on maternal and paternal plasticity has the potential to challenge conventional understandings of mothering as a natural process, of the mother as the primary caregiver, and of the nuclear (i.e. heterosexual) family as the optimal developmental environment. However, by reading the maternal and paternal brain in the context of the first-three-years movement, it will also become clear that the parental brain as yet another critical plastic period contributes to the construction of parents- at-risk and parents-as-risk. My aim here is not to accept or reject the phenomenon of the plastic parental brain on empirical or political grounds, but rather to map the multiple connections and implications it generates.

‘Mothers are made, not born’: the plastic maternal brain

The neurobiology of maternal behaviour is increasingly becoming a topic of scientific interest. In this research program an interesting phenomenon has emerged: the plastic maternal brain. Studies have shown that structural and functional changes take place in the brains of new mothers during and after pregnancy, changes that are believed to facilitate the motivation and execution of maternal behaviour (e.g. in non-human animals: Featherstone, Fleming & Ivy 2000; Keyser-Marcus et al. 2001; Kinsley et al. 2006; in humans: Kim et al. 2010). These alterations have been linked to hormonal changes during pregnancy, parturition, and post-natal

parental advice literature she maintains that developmental toys ‘fill the void created by scientific uncertainty’, performing a ritual function: ‘As ritual objects, educational toys were implicitly held to protect children (at least symbolically) from the threats of a declining educational system and they were believed to demonstrate parental concern and involvement to the parents themselves’ (Nadesan 2002, 415). Instead of the empowered parent providing the child with a competitive edge over its peers through the consumption of educational videos and flashcards, then, the parent that is constructed by the early-development discourse is an anxious, inherently incompetent figure. In her recent book Brain Culture, Pykett (2015) takes up the neurotic subject as the emblematic figure of contemporary neurocultures.

80 interactions like lactation (see Russell, Douglas & Ingram 2001; Brunton & Russell 2008). Together, these experiences ‘[fashion] a more complex organ that can accommodate an increasingly demanding environment’ (Kinsley et al. 1999, 137). These changes do not only induce specific maternal behaviours, like pup retrieval and nest building in the case of rats, but are also believed to increase the mother’s general cognitive abilities including hippocampal- dependent memory and learning (Kinsley et al. 1999; Pawluski, Walker & Galea 2006a; Pawluski et al. 2006). This benefits a mother’s caretaking abilities, but also generalises to other tasks. For example, experiments have demonstrated that rats with maternal experience perform better in a maze than maternally inexperienced female rats (e.g. Love et al. 2005). These reorganisations appear to have long-lasting results: ‘once a mother, always a mother’ (Pereira & Ferreira 2016, 76). Importantly, these changes do not seem to be fully determined by the physical experiences of pregnancy, parturition, and lactation. Adoptive mothers undergo behavioural and neurobiological changes that are highly similar to birth mothers through interacting with their foster offspring. Early studies by Rosenblatt, for example, have shown that non-pregnant female rats will show adequate maternal behaviour after being exposed to pups for a few days (Rosenblatt 1967, 1975; see also Orpen & Fleming 1987). The available evidence suggests that this behavioural change is accompanied by neurobiological changes similar to (albeit not entirely the same as) those in maternal rats (e.g. Felton et al. 1998; Kalinichev et al. 2000). Similarly, studies in humans have shown that the quality of maternal behaviour and mother- infant bonding is similar for adoptive mothers and birth mothers (e.g. Singer et al. 1985, Suwalsky et al. 2008), suggesting that ‘a hormonally primed mother is not essential for normal infant development’ (Numan & Insel 2003, 318). Two recent EEG studies have suggested that adoptive mothers display similar brain activity as birth mothers when observing their children (Grasso et al. 2009; Hernández-González et al. 2016). Together, the studies suggest that the maternalisation of the brain is not necessarily an automatic, purely physical occurrence, but that the mother’s (subjective) experiences affect her neurobiology as well and can constitute an alternative route to a similar result. By highlighting the reciprocal nature of the mother-infant relationship as well as the subsidiary role of pregnancy, delivery, and breastfeeding, this research program has started to suggest that ‘mothers are made, not born’ (Society for Neuroscience 2014). Maternal behaviour is no longer viewed as an innate, instinctive trait possessed by all females alike, but rather as a set of interactions emerging from a complex interplay of genetic, hormonal, neuronal, cognitive, emotional, and behavioural factors (Pereira & Ferreira 2016). In other words,

81 maternal behaviour is increasingly understood as a biosocial phenomenon that involves the material body as much as it involves subjective experiences. This frames motherhood as set of varying, individual experiences rather than a single, universal experience. The nature of maternal behaviour and of the mother-infant bond has been a fundamental concern of feminist scholarship and activism. Since its beginnings, the has produced numerous and widely varying perspectives on motherhood that claim, celebrate, reject, and reinvent it (both within and outside of heterosexual couplings) at different moments in time. Many have examined women’s naturalised role as mothers in relation to their oppression and isolation in the domestic sphere, critiquing representations of maternity as a universal part of female nature. This large body of scholarship has demonstrated, instead, that motherhood is: a historically, culturally, legally, economically, and politically embedded social institution; situated in power structures organizing not only gender but also class and race; and not (just) an identity or relationship but rather (also) a work (see Arendell 2000; Kawash 2011). Conventional understandings of the relationships between reproduction, motherhood, kinship, and the nuclear family were thus challenged by the feminist movement and also by the LGBT movement. These relationships were further challenged by the advance of assisted reproductive technologies: welcomed by feminists like De Beauvoir and Firestone as freeing women from the ‘tyranny of biology’ (Firestone 1970, 193), but regarded more critically by others as a set of disciplining technologies that medicalise women’s bodies (e.g. Sawicki 1999). As Grosz (1994) has pointed out, much of this feminist scholarship on motherhood has assumed a biologically determined, ahistorical body, separating this body from the social or psychological aspects of womanhood. Whereas egalitarian feminists have focused on transforming bodies (via technologies) and social constructionists have focused on transforming ideologies (via socialisation), she argues, both positions have neglected historical, lived bodies as ‘a cultural interweaving and production of nature’ (15-18). These are the bodies that Grosz insists feminist scholarship attends to, including their sexually specific differences that ‘may or may not be biological or universal. But whether biological or cultural, they are ineradicable’ (18). Here, I want to make the case that the recent neurobiological research on the maternal brain I discussed in this section provides a novel and potentially fruitful way of rethinking motherhood, one that considers this ‘embodied subjectivity’ or ‘psychical corporeality’ (22) of lived bodies. These studies highlight how embodied, interpersonal, and affective ties between mother and infant emerge from complex interactions of genes, brain structures, hormones, past and present subjective experiences, emotions, social interactions, and many other factors.

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As such, recent neurobiological studies invite us to consider maternal bodies as ‘neither brute nor passive’ (Grosz 1994, 18), as irreducibly fleshy but not pre-social, as deeply social but not purely ideological. They encounter motherhood as it emerges from the dynamic interaction of a complex range of factors that mutually constitute each other’s influence. Rather than a single, natural, or essential instinct or trait, motherhood then appears as multiply determined and ‘softly assembled’.31 Soft assemblies are robust yet dynamic outcomes with variable pathways, which are always embedded in a particular history, a particular environment, and a particular set of intentions and goals. Finally, these studies invite us to consider sexual differences, like the physical capacity of giving birth or breastfeeding, whilst demonstrating that these differences are by no means essential: giving birth is no prerequisite for what we call maternity in this context (whether a ‘female brain’ is a prerequisite is a question I address below; the answer will be that it is not). At least in theory, then, this research program provides one possible avenue for exploring ‘the ontological status of biology, the openness of organic processes to cultural intervention, transformation, or even production’ (23), and for challenging naturalised, essentialist notions of motherhood without having to bracket the material body. Even though I argue that the plastic maternal brain, as a phenomenon that is currently emerging from a specific scientific program, provides a figure or tool to rethink motherhood from a critical feminist perspective, this is of course not necessarily how research outcomes in this area are interpreted by scientists and taken up in popular discourses. In fact, many studies that explore individual differences in maternal behaviour do so to link maternal plasticity to post-partum depression and other risks to the wellbeing of mother and child, thus contrasting optimal or normal motherhood with at-risk or pathological motherhood (Hillerer et al. 2014). Efforts to understand ‘defectively assembled maternal brains’ (Kinsley & Amory-Meyer 2010, 710) in the interest of preventing ‘less than optimal mothering’ (Barrett & Fleming 2011, 369) can, of course, improve the lives of certain mothers, but they do not challenge the idea that there is a singular notion of normal or optimal mothering. Thornton’s analysis of the ‘entrepreneurialization of motherhood’ (2011b, 2014) points in a similar direction. Analysing public discussions of the plastic maternal brain, she shows that the notion that mothers are not born but made has already permeated popular culture, and that motherhood is increasingly understood in terms of empowerment, free choice, and authenticity: ‘The “good mother” is not a socially or biologically imposed norm to which women must

31. ‘Softly assembled’ is a term from dynamic systems theory that denotes systems with dynamically interacting, fluctuating components, in contrast with systems with fixed, immutable, static connections (Thelen & Smith 1994).

83 conform; rather, mothering is a limitless pursuit of the self and its values of enjoyment, happiness, and fulfilment’ (2011, 413). Despite this emphasis on freedom and choice, however, the notion of maternal neuroplasticity has given rise to a new socially prescribed ideal mother, a figure that Thornton calls ‘mommy economicus’ (2014). This ideal mother cultivates her maternal plasticity not only to optimise the development for her child, but also to enhance her own cognitive potential, which can be used at home but also at her paid job: ‘Because of the extraordinary plasticity of her brain, mommy economicus is agile, flexible, and adept at directly leveraging the customary practices of motherhood … for corporate profit and personal empowerment’ (2014, 273). As a result, motherhood is transformed into an entrepreneurial practice. Thornton’s ‘mommy economicus’ embodies not only a neoliberal but also a postfeminist ideal. Her sexual difference defines her not as a limiting factor but as a resource: ‘she cannot discard her gender and, in fact, her gender gives her a competitive edge in the workplace’ (273). There is another side of the coin, however: in the mommy brain story, to not cultivate the maternal brain in line with brain-based parenting advice is to risk damaging outcomes, for the mother herself but especially for her child. Thus mothers are,

obliged to vigilantly work on themselves, to build up and sustain their capital. This responsibility intensifies rather than replaces the tremendous responsibilities already placed on the mother in existing constructions of ideal maternity, such as caring for home and family and nurturing life. (281, my emphasis)

Thornton’s work shows how maternal plasticity, as it is taken up in popular parental advice, holds out to women the promise of having it all as well as the threat of imminent danger, thus compelling them to take up intensive, expert-led mothering practices. ‘[Moving] between notions of biological sexual difference (hormonally induced neuroplasticity) and the social practices of gender’ (281), this brain story establishes new connections between femininity, motherhood and paid work, but also reconstitutes familiar associations between women and domestic work and reaffirms an understanding of the female body as dangerous. In the end, Thornton writes, mommy economicus is but a ‘“vulnerable empowered woman”—a woman whose female biology poses a constant threat to her well-being and her identity’ (283, quoting Dubriwny 2012).32

32. Again, we might ask whether this new ideal figure of the mother is better understood as a neurotic subject rather than as a neoliberal subject (see Isin 2004). Thornton herself notes how much contemporary brain-

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The crucial issue highlighted by Thornton’s work is that—whereas the notion of maternal neuroplasticity can, as I have argued, open up ways of rethinking the relationships between sex, gender, and the brain from a critical feminist perspective—maternal neuroplasticity is equally capable of ‘adapting, updating, and assimilating ideologies that are seemingly incompatible with neoliberalism’ (2014, 286). Here, it enfolds an ideology of intensive parenting. As such, any feminist project that mobilises neuroplasticity as a tool to challenge biological determinism and essentialism must take into account the ways in which such a move might inadvertently promote modes of governmentality that entrench the very ideologies this project aims to expose and eradicate.

‘Both mom and dad, brain-wise’: the plastic paternal brain

A question that I have left unattended so far is to what extent maternal plasticity is bound to the female brain. I have already noted that adoptive mothers appear to go through psychological and biological changes similar to those observed in birth mothers. What, then, about the father? Some have linked maternal plasticity explicitly to the female brain, suggesting for example that ‘the female brain appears to have evolved to adapt and change in ways that promote procreation … [possibly] a hedge against the unpredictability of the male brain’ (Kinsley & Amory-Meyer 2011, 980). However, recent studies suggest that the neurobiology of fathering is not so different from that of mothering. In this section, I will discuss how paternal plasticity relates to maternal plasticity and to what extent it also challenges naturalised gender norms, kinship, and the heteronormative nuclear family. Again, to keep the discussion to the point, I will focus solely on brain plasticity, but it should be noted that hormones, including testosterone and oxytocin, play an important role in the neurobiology of fatherhood (for reviews, see Swain et al 2014a; Wynne-Edwards 2001). The first clues about the workings of the paternal brain have come from animal studies. It is well known that in a variety of species, males undergo certain behavioural changes when siring offspring; generally speaking, they become less aggressive and more nurturing (e.g. Vom Saal & Howard 1982; Vom Saal 1985). Insights into the neurobiological correlates of these behavioural changes have come from the research of Catherine Dulac, professor of molecular

based parenting advice focuses on affective rather than cognitive processes, emphasising the importance of authentic motivation and genuinely experienced maternal love, and the intense fear this advice generates: ‘women’s extraordinary powers of influence are tied to overwhelming anxieties about the potential limitless repercussions of even the smallest actions’ (2011b, 415).

85 and cellular biology at Harvard University. Interested in the neurobiological correlates of social behaviour, she and her colleagues set out to study the ways in which rats recognise each other as male, female, or infant, and how social behaviours such as mating, aggression, and caretaking are then generated. Noting that across species, males engage in female-typical behaviour and vice versa, they wondered about the neural mechanisms behind this behavioural flexibility. Earlier work had found that blocking male rats’ ability to detect a conspecific’s sex by impairing the chemoreceptive vomeronasal organ (VNO) caused them to mount male and female conspecifics indiscriminately, and to display less aggression. Repeating the procedure with female rats, Dulac and her colleagues found that VNO-deficient females engage in male-typical sexual behaviour and, when having pups, display less maternal behaviour (Kimchi, Xu & Dulac 2007). The authors conclude that, in spite of the prevailing model of brain dichotomy, their results point to ‘a new model of sexual dimorphism in which the effector circuits of both male and female behaviors exist in the brain of each sex’ (1013). In a follow-up study, Dulac further investigated how these different behaviours are regulated in both male and female rats (Wu et al. 2014). Here, evidence is found for two separate but connected neural pathways, one underlying aggression towards pups and one underlying parental behaviour, existing in both males and females, virgins and parents. Which pathway is activated and which is inhibited, either via a shared mechanism or independently, depends on a complex interaction of past experience (having mated or not), current stimuli (VNO detection) and hormonal factors. Sex is but one factor amongst many in these interactions. Taken together, these findings suggest that, at least in the rat, males and females have the same brain circuits associated with parenting.33 So, instead of two distinct brain forms, or even one continuum, a unisex or ‘bisexual’ brain comes to the fore (Crews 2012). Can this notion of a bisexual brain be extended to humans? A handful of recent studies have probed the human brain in search of the circuitry underlying paternal behaviour (Atzil et al. 2012; Abraham et al. 2014; De Pisapia et al. 2013; Kim et al. 2014; Kuo et al. 2012; Mascaro, Hackett & Rilling 2013; Mascaro, Hackett & Rilling 2014; Wittfoth-Schardt et al. 2012; for reviews, see Swain et al. 2014b; Feldman 2015). Most of these studies imaged the brains of fathers looking at images or listening to the recorded cries of their own children and unfamiliar children in order to specify the neural circuits involved in paternal responses. Overall, these studies point to a global ‘parental caregiving’ network (Feldman 2015) in the paternal brain involving areas associated with emotional regulation, motivation, social cognition, and

33. See also Lenschow et al. (2016): this similarity appears to extend even to brain areas representing the genitalia.

86 empathy. These areas are by and large the same as the ones found in mothers, but some subtle differences have also been identified. To my knowledge, only three studies directly compared mothers and fathers (Atzil et al. 2012; De Pisapia et al. 2013; Abraham et al. 2014). The first, using videos as a stimulus, found similar activation in areas associated with social cognition and empathy in mothers and fathers, but sex-specific correlations between hormone levels and brain activation (Atzil et al. 2012). A second study, comparing male and female parents and non-parents, found that women, independent of parental status, showed greater deactivation of brain areas associated with ‘mind wandering’ in response to the sound of hunger crying (De Pisapia et al. 2013). The third and most recent study is of particular interest, since it included parental role (primary versus secondary caregiver) as a variable (Abraham et al. 2014). Subjects were recruited from heterosexual and homosexual couples and divided into three groups: primary- caregiving heterosexual mothers (PC-mothers), secondary-caregiving heterosexual fathers (SC- fathers) and primary-caregiving homosexual fathers (PC-fathers). Videos were taken at home of the parents interacting with their child, demonstrating greater synchrony in the PC-mothers and the PC-fathers than in the SC-fathers. Before scanning the parents’ brains, two brain networks of interest were identified: an emotional processing network, regulating attention and reflexive responses, and a cortical mentalising network, regulating social understanding, theory of mind, and cognitive empathy (1). Both networks were activated in all three groups in response to video images of the parent-child interactions, but group differences were also identified in two brain areas. Compared to the SC-fathers, both the PC-mothers and the PC- fathers exhibited increased activation of the amygdala, part of the emotional network. Compared to the PC-mothers, both the PC-fathers and the SC-fathers demonstrated greater activation of the superior temporal sulcus (STS), part of the mentalising network. A functional connection between the amygdala and the STS was identified in the PC-father group only.34 In the PC-father group, no differences were found between biological and adoptive fathers, and the authors assumed no influence of sexual orientation. In line with Dulac’s findings discussed above, the authors conclude that these results point to the existence of a global parenting network in the human brain that is largely the same for both men and women: ‘assuming the role of a committed parent and engaging in active care of the young may trigger this global

34 Furthermore, parent-infant synchrony correlated with amygdala activation for the mothers and with STS activation for the fathers. Oxytocin levels were also assessed, yielding a correlation with activation of the emotional networks in mothers and of the mentalising network in fathers.

87 parental caregiving network in both men and women, in biological parents, and in those genetically unrelated to the child’ (Abraham et al. 2014, 4). I suggest that in research on the paternal brain, as in research on the maternal brain, findings emerge that challenge notions of the mother as the natural primary caregiver, of the nuclear family as the most natural and optimal family constellation, and of kinship as genetically rather than affectively embodied. As Feldman (2015) has pointed out, ‘it is not known … how conditions such as extended versus nuclear living, co-sleeping, grandparental care, or traditional versus egalitarian sex roles shape parents’ brain during this plastic period’ (393). These are fruitful directions for research on the ‘situated’ parental brain (396). The question then emerges to what extent it is still appropriate to designate behavioural or neurobiological phenomena as ‘maternal’ and ‘paternal’. If one does not need to give birth or be female35 in order to access the ‘maternal pathway’, then what makes it essentially maternal? Would it not be more appropriate to speak of a primary caregiving pathway and a secondary caregiving pathway, or refer to the pathways by their actual function (e.g. an emotional processing pathway)? This might seem like a trivial, semantic issue, but the effects of gendered terms can be quite real, as was evident in the press coverage of the study by Abraham et al. (2014). Even though the results of this study point to a global parenting network in the brain, the authors distinguish a maternal pathway and a paternal pathway. The maternal pathway is described as an ‘phylogenetically ancient’ emotional circuit, sensitised by the experience of pregnancy, birth and lactation (9795). The paternal pathway is described an evolutionarily more recent, alternative pathway, activated by care-giving behaviours independent of pregnancy and childbirth (Ibid.). These distinct pathways are then taken as a sign that ‘mothers’ and fathers’ brains evolved to complement each other in the joint effort of raising young infants’ despite the fact that men can recruit both pathways (5; see also Feldman 2015).36 The media coverage of this study focused mainly on the possible implications for debates in the US over whether or not gay couples should be allowed to adopt.37 A dominant frame in this coverage was that ‘biologically, gay couples are fit to be parents as straight couples

35. Or even feminine: masculinity and femininity were assessed in Abraham et al.’s study using the Ben Sex Role Inventory. No group difference between the SC-fathers and PC-fathers was found. 36. Whether women in secondary caregiving roles also recruit the ‘paternal pathway’ remains an open empirical question. 37. In Obergefell v Hodges (2015), the US Supreme Court affirmed the constitutionality of same-sex marriage throughout the US in the spring of 2015, a year after this study was published, making adoption through federally funded agencies easier for gay couples. However, gay couples seeking to adopt still face more roadblocks than heterosexual couples. For example, privately funded agencies and agencies with a religious signature may still refuse to work with same-sex couples.

88 are’ (Dockterman 2014) because their brains enable them to perform the traditional gender roles of both the mother and the father: ‘Down to the most fundamental biological responses, gay people parent the same way heterosexuals do’ (Fox 2014), ‘gay fathers … seemed to be both mom and dad, brain-wise’ (Begley 2014), and ‘The brains of homosexual fathers adapt to take on the roles of both motherhood and fatherhood’ (Smith 2014). So even though this study of the paternal brain successfully decouples men and women from their designated gender roles, it seems that the preservation of the terms ‘maternal’ and ‘paternal’ leaves the actual gender roles, and thereby the heteronormative logic of the nuclear family, unchallenged. As a result, gay fatherhood gains support by virtue of mimicking traditional family life. In the context of gay marriage activism, such ‘respectability politics’ have been criticised by queer scholars for privileging the already-privileged (i.e. white, middle-class gays and lesbians) and for reifying heteronormative family values and institutions rather than transforming these in the interest of greater equality and inclusivity (e.g. Duggan 2002; Ettelbrink 1992; Lenon 2005; Taylor 2009; Valverde 2006). Same-sex couples’ inclusion, here, excludes the needs and experiences of parents who do not or cannot emulate this ideal, and excludes the possibility that alternative family dynamics may also constitute an ‘optimal’ developmental environment for young children.

Interlude: train the gay away?

The finding that primary caregiving fathers show similar brain activity to mothers can be mobilised as an argument to extend gay rights and allow same-sex couples to adopt –with the caveats considered above. However, plasticity-based arguments can also be (ab)used to argue against gay rights. Consider this quote:

Intensive exercise, training or imagination changes the brain microstructure. We are not victims of our biology or the experiences which shape the detail of our brain. Anatomy is not destiny; change is always possible. The brain is plastic and is in a constant state of change. Indeed the question is rather: what change is not possible? We would not want to say that the structure of the brain you were born with has no effect. It has. It can be profound. But that structure can also be profoundly changed, and we don’t yet know the limits. They are probably sky-high. (Whitehead & Whitehead 2009, paragraph 18-19)

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Numerous brain training programs are marketed with optimistic celebrations of plasticity like this one. This particular quote, however, is part of an article that claims neuroplasticity vindicates sexual orientation conversion therapy (Whitehead & Whitehead 2009). Affiliated with the National Association for Research & Therapy of Homosexuality (NARTH), the authors Neil and Briar Whitehead advocate ‘the rights [sic] of gays to change their orientation if they wished’ (2013 [1999], 13). Central to their argument is a critique of brain organization theory– which they build on the same grounds as feminist critiques–and the assertion of an interactionist framework. They maintain that sexual orientation is not determined by genetic factors alone, nor by deliberate choice, but rather by individual, idiosyncratic responses to a range of unique life events (Whitehead 2011). ‘This is one situation where the postmodern is a reality,’ Neil Whitehead wrote in a submission to the New Zealand parliament in which he opposed the legalization of gay marriage; ‘Everyone has their own highly individualistic story. This is easily understood when we consider how very individual various formative sexual experiences are’ (2012, 2). By taking this position, the Whiteheads align themselves with the APA, which states that ‘no findings have emerged that permit scientists to conclude that sexual orientation is determined by any particular factor or factors. Many think that nature and nurture both play complex roles; most people experience little or no sense of choice about their sexual orientation’ (APA 2008, 4).38 Byne and Parsons (1993) write that ‘a semblance of’ such an interactionist approach to sexual orientation already started to emerge in the 1980s, when the notion of brain plasticity began to find some acceptance and both biological and social scientist had to admit that their favoured explanations could not tell the whole story (228). When LeVay reported evidence of differences between heterosexual and homosexual men in the INAH 3–a nucleus in the hypothalamus–in 1991, ‘this uneasy truce was disrupted’ and biological theories started to dominate the field–until recently (Ibid.). In his report, LeVay suggested that the differences he found are innate, yet he had to concede that his evidence ‘does not allow one to decide if the size of the INAH 3 in an individual is the cause or consequence of that individual’s sexual orientation’ (1036).39

38 In the 2013 edition of the NARTH’s Journal of Sexuality, the editor commends the APA for their position and expresses his regret that the general public tends to believe sexual orientation is innate: ‘much education is needed if the public is to come to understand with the APA that ‘nature and nurture both play complex roles’ in the development of [homosexuality’ (Sutton 2013, 4). He recommends the Whiteheads’ book My Genes Made Me Do It (2013 [1999]), reviewed in the same issue, as a good place to start. 39. Subsequent rat studies demonstrated that sexual behavior indeed affects brain morphology in the SDN-POA, an area in the rat brain that is considered homologous to the INAH 3 in humans (Prince et al. 1998; Woodson, Balleine & Gorski 2002). When Byne et al. replicated (2001) LeVay’s 1991 study, they favoured an explanation that incorporates environmental influences.

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One thing that LeVay was absolutely sure of, was that regardless of its causes, ‘sexual orientation in humans is amenable to study at the biological level’ (Ibid.). In the press, he similarly stated that ‘what’s most important is that homosexuality is now a topic that can be studied in the laboratory as a problem in neurobiology, and not something that must be left to the psychiatrists or the psychologists’ (quoted in Perlman 1999, quoted in Halley 1994, 534n121). As such, independently of what he asserted about the cause of homosexuality40, LeVay already foreshadowed the work neuroplasticity would accomplish during the decade to come: to translate all social and biological factors into a common language, through which all of life can be measured, calculated, and controlled. It is this neurofication of sexual orientation that the Whiteheads use to their advantage when they enlist plasticity in their argument in favour of conversion therapy. Even though the initial development of a homosexual orientation is the result of many interacting factors and not a choice, they argue, it can be voluntarily altered later in life because the brain is plastic:

some research may eventually show real and replicable biochemical and micro-structural differences between homosexual and heterosexual brains, but … these will almost certainly prove to be primarily the result of long-term and frequent behaviors – training, if you like. … Because of brain plasticity it’s quite possible that homosexuals could become more heterosexual though intense persistent work could be needed, about equivalent to thoroughly mastering a new musical instrument. (2013 [1999], 154-55, 158)41

Conversion therapy has been widely repudiated as ineffective, harmful and stigmatizing (e.g. APA 2009), and there is no evidence to suggest that sexual orientation can be altered via brain training.42 Yet even if sexual orientation could be changed voluntarily, of course we must

40. For a recent critique, see Jordan-Young 2010. For an interesting rereading of LeVay’s data that uncovers ‘a neurological complexity that LeVay has been able to record but not fully elucidate’, see Wilson (2004, 62). 41. They make a similar claim with respect to transgender identities: ‘It is known that the brain changes physically in response to our behavior … Transsexual brain differences are therefore more likely to be the result of transsexual behavior, rather than its cause … There is thus no basis for special civil rights to be granted to transsexuals’ (Whitehead 2010, 7-8). 42. The Whiteheads refer to Doidge’s book The brain that changes itself (2007) as if it would back up their claim. They quote Doidge’s statement that ‘the human libido is not a hardwired invariable biological urge but can be curiously fickle, easily altered by our psychology and the history of our sexual encounters.’ (95). However, nowhere in his book does Doidge suggest that sexual orientation can be changed by willful action. Importantly, the claim that sexual orientation emerges from the interaction of biological and environmental factors does not necessarily imply that it can be changed at will. Van Anders, who recently proposed a dynamic framework of sexuality in which ‘change [is] potentially central rather than peripheral, irrelevant, or

91 ask what reason there is to believe it would necessary or desirable to change. The Whiteheads argue that even though ‘brains are not innately gay or straight’ (2013, 142), homosexuality is associated with poor (mental) health and dysfunctional family dynamics, and heterosexuality is therefore the preferable, healthy option. I am not interested here in debunking these reprehensible claims;43 I only wish to reflect on the way the Whiteheads use plasticity to bolster their opinions, which enacts ‘modern neurodeterminism’ (Schmitz 2012): by translating the factors that contributed to the development of a particular sexual orientation into one common language–that of the brain–they render these factors more or less irrelevant. What counts from that point on is that sexual orientation, as a property of a plastic brain, is (presumably) amenable to assessment and intervention. In the introduction, I quoted Schmitz and Höppner who wrote that ‘[plasticity] is the virus with which neurofeminism has inoculated neuroscientific discourse during the last decade’ (2014, 16). The Whiteheads use the same virus in an attempt to inoculate the gay rights movement, which has used the argument of immutability to seek legal rights and protection under U.S. law. This strategy relies on the assertion that sexual orientation is hardwired: ‘choice is the enemy of neural truth’ (Walters 2014, 99). Several scientists, legal scholars and ethicists have argued that the immutability argument is inadequate, unnecessary and even harmful (e.g. Diamond & Rosky 2016; Halley 1994; Murphy 1997). The Whiteheads’ claims are a case in point of how treacherous it can be to tie political or ethical decisions to scientific truth-claims. Another lesson to be learned here, one that is highly pertinent to this study, is how easily plasticity-based arguments can be abused when they are invoked to merely reverse cause and effect, and to combat biological determinism with an appeal to self-determination. Such arguments bypass two crucial questions: first, how much ownership or control does one actually have over their own body/brain to change it at will (hint: it is not 100%), and second, who or what can decide what kinds of life and love are desirable (hint: it is not neuroscience)?

aberrant’, compares sexuality to ageing: there is continuous development, but it cannot be willed, forced or imposed (2015, 1179). This makes clear that the relationship between fixity and change is not as simple as popular accounts of plasticity tend to assume. 43. In recent years, elevated levels of mental and physical problems amongst gay men have been ascribed to internalized homo-negativity and the stress (including discrimination and violence) they experience as a sexual minority (Meyer 1995, 2003).

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Fathers at risk and as risk

When contemplating the plastic paternal brain, it is pertinent to consider how plasticity designates specific male bodies as ‘at-risk’ and as appropriate targets for intervention. Despite an increasing politicisation of fatherhood during the past decades, fathers’ psychological functioning has been researched predominantly in terms of the impact they have on mother and child, rather than out of interest for their own experiences: ‘even assisting ill fathers focuses upon their children … the very experience of fathering with mental illness is nowhere to be found as a topic, issue or problem to be considered’ (Galasinski 2013, 21). In other words, fathers at risk are mainly approached as a risk for their families. It is in this context that the paternal brain has become an object of interest. Research is called for in order ‘to identify changes in the parental brain among at-risk fathers in order to construct more specific and early interventions to prevent the onset of postpartum mood disorders and to optimise environments for child development’ (Kim et al. 2014, 531). Identifying ‘biomarkers for risk, resilience and intervention’ (Swain et al. 2014a, 4) in the paternal brain is pursued for the ‘implications for the study of human attachment for fathers, the assessment of associated risks, and formulation of interventions to improve infant mental health’ (Swain et al. 2014b, 400). Getting fathers more involved in childcare is broadly seen as a positive goal that will enrich men’s lives and advance gender equality. Studies that challenge traditional gender roles by showing how men’s brains are just as suited to take care of a child as mothers’ brains can contribute to that goal. Whilst welcoming these studies, however, we should also consider what kind of subject positions are created and what kind of governmentality is enacted when paternal plasticity is mobilised primarily in the interest of identifying fathers as at-risk. Certainly, fathers are not targeted as much as mothers in popular, medical, and academic discussions about intensive parenting and early development, and several studies suggest that fathers are less impressed than mothers by anxiety-inducing expert advice (e.g. Shirani, Henwood & Coltart 2012; Owen et al. 2010; Wall 2010). It is doubtful that this will change dramatically in the near future. Yet, that does not take away the fact that studies of the paternal brain have not only the power to challenge heteronormativity and gender essentialism, but also the potential to legitimise and further entrench an ideology of individualised, intensive parenting.

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Conclusion

We may say that all man's struggles, religious, moral and economical, all the combats and conflicts that fill the history of mankind, can be traced finally to the nature and vigor of the desires, beliefs and strivings which have been cultivated by the social environment in the early life of the individual. (Sidis 1911, 3-4)

William James Sidis abandoned academia before he was 25 and ended up living a secluded life working clerical jobs, estranged from his parents (his father died shortly after he left Harvard) and in constant conflict with the press, until he died of a at age 46 (New York Times 1944; Wallace 1986). It appears that his education did not save him from misery.44 Perhaps for him (at least in the eyes of the press at the time), his parents were the biggest risk factor in his life precisely because they believed they could create the perfect intellectual and the perfect citizen. In any case, his story demonstrates that neither our personal nor our societal future is determined by the early development of our brain. In this chapter, I have discussed how the infant brain, the maternal brain, and the paternal brain have recently emerged as critical windows of plasticity: windows of risk and opportunity through which the future of a child may be gauged and controlled. Following Thornton (2011b, 2014) and other scholars who have critiqued the first-three-years movement and the intensive mothering ideology it promotes, I have made the case that it is crucial to attend to the ways in which neuroplasticity designates parents as at risk and as a risk, legitimises surveillance and intervention of specific (i.e. gendered, classes, racialised) populations, and yokes partially reinvented but nevertheless essentialist gender roles to neoliberal ideals. Yet at the same time, in a desire to establish ‘neurological intimacy’ (Wilson 1998, 417) instead of rejecting or bracketing the physical body, I have offered a different reading of the material and argued that recent studies of maternal and paternal plasticity can be a potent resource for a critical feminist project that aims to challenge gender essentialism, heteronormativity, and the ideal of the nuclear family by engaging the material, fleshy, lived body. My aim here was not necessarily to demonstrate that nature is inherently queer. Rather, what is at stake here is that recent neurobiological studies can be used to understand parental experiences as the deeply embodied outcome of intra-acting material and discursive variables.

44. It appears he did write quite prolifically, albeit pseudonymously, throughout his life. Dan Mahony has collected his work at www.sidis.net. Here, one can also find material contesting the image of Sidis as a ‘prodigious failure’ painted by the press.

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Depending on one’s personal histories, beliefs, goals, intentions, resources, restraints, and physiologies, these embodiments may or may not turn out to be queer. This perspective acknowledges the (sexual) differences a fleshy body can make, and simultaneously reiterates the importance of considering bodies as cultural products. Popular plasticity discourses that celebrate individualism and self-determination erase both the specificity of material bodies and the structural power inequalities that impinge on these bodies. Instead, I argue, we can and should use neuroplasticity as a way of paying attention to both.

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Chapter five Women’s mental health and the therapeutic promise of brain sex

‘There is no female mind. The brain is not an organ of sex. Might as well speak of a female liver’ (Gilman 1898, 149)

‘every cell has a sex’ (Wizemann & Pardue 2001, 4)

Introduction

Mental disorders are considered ‘the core health challenge of the 21st century’ (Wittchen et al. 2011, 670). Together with neurological diseases, they are estimated to comprise more than 10% of the global disease burden in terms of DALYs (Disability-Adjusted Life Years), a number that is only expected to increase in the near future.45 Besides causing considerable human suffering, these diseases pose an increasingly large financial burden: the global cost of mental health conditions was estimated at $2.5 trillion USD in 2010, with a projected cost of $6.0 trillion by 2030 (Bloom et al. 2011). Confronted with these numbers, it is no wonder that many speak of mental illnesses as a widespread epidemic (e.g. Angell 2011). Underdiagnosis represents part the problem: according to the WHO, ‘Less than half of those who meet diagnostic criteria for psychological disorders are identified by doctors. Patients, too, appear reluctant to seek professional help. Only 2 in every 5 people experiencing a mood, anxiety or substance use disorder seeking assistance in the year of the onset of the disorder’ (“Gender and Women’s Mental Health”). At other moments, this epidemic is portrayed as a largely fabricated effect of over- diagnosing and over-medicating health practices promoted by psychiatrists and the pharmaceutical industry. For example, when the American Psychiatric Association announced

45. Data from 2013, via http://vizhub.healthdata.org/gbd-compare/. The DALY is a metric that represents years of life lost due to disease, and is calculated as the sum of life years lost due to premature mortality and life years lost due to disability (see “Metrics”).

97 its most recent edition (2013) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Frances (who chaired the DSM-IV Task Force) wrote that the,

DSM-IV was an unwitting contributor to three false positive “epidemics.” Its publication coincided with high rates of attention deficit hyperactivity disorder, autistic disorder, and childhood bipolar disorders. Other factors contributed to these epidemics, particularly the ubiquitous marketing efforts of drug companies directed at doctors and the general public. … The proposals contained in the first draft of DSM-V could potentially set off at least eight new false positive epidemics of psychiatric disorder. In their efforts to innovate, the working groups could expand the territory of mental disorder and thin the ranks of the normal. (2010, c1168)

Rather than posing a contradiction, professionals considered under-recognition and over- recognition of mental disorders two sides of the same problem (PLOS Medicine Editors 2013). Both concerns point to the necessity of a better understanding of the nature and impact of mental disorders. Despite decades of research, major techno-scientific advances in genetics and neurobiology, and the development of a vast pharmaceutical market, most disorders remain poorly understood. Heterogeneous patient groups, high rates of comorbidity, and multifactorial aetiologies render the diagnostic landscapes of clinical psychology and highly complex, and limit our ability to recognise and treat (let alone prevent) mental disorders. One recent strategy to grasp this problem better is to conceptualise mental disorders explicitly as brain diseases. The definitions of the disorders listed in the DSM-5 and similar diagnostic handbooks have been based on symptomatology, allowing clinicians to make diagnoses without having to speculate about specific causes. Whilst these categories are reliable for diagnostic purposes, they have proven of very limited value when it comes to identifying biomarkers for disease and to predicting treatment outcomes (Charney et al. 2002). In what Walter (2013) has identified as ‘the third wave of biological psychiatry’ (2), researchers and clinicians invest in genetic and neuroscientific studies of mental health in order to remedy this problem. When the DSM-5 was developed, attempts were made to reflect the insights coming from these research areas better, but it proved too soon to do so (Walter 2013). In response, the US National Institute of Mental Health distanced itself from the DSM and launched the Research Domain Criteria (RDoC) project, which aimed to create a new classification system based on neuroscientific insights (Insel 2013). Instead of studying experiences of anxiety, for example, this new approach would study fear circuits in the brain. A number of practical and

98 philosophical problems confront such a neuroscientific approach to psychiatry, which are beyond the scope of this chapter (see Kanaan & McGuire 2011; Kirmayer & Crafa 2014; Walter 2013). Extending my previous examinations of sex and gender, in this chapter I am specifically interested in the convergence of two strategies: the ‘neurofication’ of mental disorders and the focus on sex and gender as determinants of health. From the moment mental disorders were first conceptualised, differences between men and women in terms of prevalence, age of onset, symptomatology, progress, and prognosis have been noted. An oft-cited statistic, for example, apprises that autism diagnoses in boys outpace diagnoses in girls fourfold (Fombonne 2009). Some evidence suggests that autism is expressed differently in girls than in boys (Thompson, Caruso & Ellerbeck 2003). Depression, on the other hand, remains twice as common in women than men, and its symptomatology also appears to vary with sex/gender (Nolen-Hoeksema 1990; Seedat et al. 2009). Explanations for such differences often seek to distinguish ‘artefactual’ factors from ‘real’ factors (e.g. Parker & Brotchie 2010). ‘Artefactual’ factors include the possibility that a clinician does not recognise autism in girls due to its strong association with boys, or the possibility that depressed women may be more willing to seek help for depression than men (Giarelli et al. 2010; Wilhelm & Parker 1994). ‘Real’ determinants include sociocultural roles and norms, psychological attributes, and biological factors, each of which can influence the development of pathology in sex/gender-specific ways. Even though models have been proposed for many disorders that attempt to integrate these different factors, like diathesis-stress models that consider the interaction of predispositional vulnerability with stressful experiences (e.g. Hyde, Mezulis & Abramson 2008), the different factors are often studied in isolation. In recent decades, biological factors have received the most interest. This is part of a broader movement that promotes the assessment of sex as a biological variable in medical and basic research in the interest of women’s health. This movement emerged in the 1990s, and has come to dominate the landscape of gender-sensitive healthcare (Eckman 1998; Epstein 2007; Richardson 2013). In this chapter, I examine how this biologisation of the women’s health movement, in conjunction with the biologisation of mental disorders in general, has imbued brain organisation theory with a significant therapeutic promise. After discussing the emergence and implications of the sex-based biology movement in more detail, I will examine how brain sex is used to explain sex/gender differences in the prevalence, course, and symptomatology of mental disorders. I will do so by considering past and present definitions and investigations of schizophrenia and autism. My concern here is twofold. First, I aim to highlight how brain sex,

99 understood as the result of pre-natal hormones exposure, reifies (sex/gender differences in) mental disorders and obscures the fact that not only the biological but also the social aspects of sex/gender have played an intimate role in definitions and redefinitions of these conditions. As such, a purely brain-based, sex-based approach obscures crucial information needed to understand the emergence of mental disorders. My second concern is how the brain-based, sex- based approach to mental disorders legitimises and expands the authority of brain organisation theory. Both issues point to the need for generating embodied, developmental models that consider the entanglement of sex and gender. I will then expand my discussion by considering not just how brains and brain health should be conceptualised but also what modes of subjectivities the very preoccupation with brains—hardwired or plastic—gives rise to. Using Rabinow’s (1996) concept of ‘biosociality’, Woodward’s (1999) notion of ‘statistical panic’, and Dubriwny’s (2012) view of the ‘vulnerable empowered woman’, I will examine how brain sex and brain plasticity are mobilised by women’s mental health organisations and brain health organisations in order to address and activate women. Together, these considerations suggest that envisioning a different future for the women’s health movement is at once a political, ontological, and epistemological challenge.

Mainstreaming sex as a biological variable

Current efforts to understand the nature of mental disorders by focussing on sex differences in the brain are part of a more general movement that promotes sex-based biological research in the interest of women’s health. As documented by Eckman (1998) and Epstein (2007), this movement emerged in the 1990s after the Society for Women’s Health Research (SWHR) started to campaign against women’s exclusion from medical research in the US. At the time, women were effectively excluded from medical studies after the US Food and Drug Administration (FDA) banned women of childbearing age from clinical trials in 1977 to protected them and their future children from exposure to potentially harmful drugs.46 In 1985, the Task Force on Women’s Health—an arm of the US Public Health Service—concluded that the FDA’s regulation threatened women’s health rather than protecting it, since drugs were approved for general use without prior testing on women. Under the influence of the SWHR’s

46. This rule was introduced in the wake of several cases in which foetuses were severely harmed by pharmaceutical drugs. Among the drugs implicated were thalidomide, a tranquiliser widely prescribed off-label to pregnant women for morning sickness, resulted in birth defects throughout the 1950s and early 1960s, and DES, a synthetic oestrogen prescribed against birth complications from the late 1930s onwards, caused vaginal cancer and reproductive complications in daughters.

100 advocacy, the National Institute of Health (NIH) founded its Office of Research on Women’s Health, and strengthened its policies to encourage researchers to include women and to analyse data by sex; the FDA reversed its guideline excluding women in 1993. Eckman (1998) detailed that these developments profoundly changed the landscape of women’s health advocacy, as the notion of women’s health went mainstream and was extended beyond strictly reproductive and obstetric issues. Sex was mobilised as a crucial consideration for all aspects of health and disease: ‘biological sex, now understood as residing throughout a woman’s body, has been constructed as the difference that most determines women’s health’ (141). In 1996, the SWHR requested the Institute of Medicine (IOM) to fund a Committee on Understanding the Biology of Sex and Gender Differences, which could validate the necessity of advancing research on sex differences in health and disease, referred to by the organisation as ‘sex-based biology’. This resulted in the landmark publication Exploring the Biological Contributions to Human Health: Does Sex Matter? (Wizemann & Pardue 2001). Evaluating scientific knowledge about the impact of sex on health and disease, this report answers the rhetorical question in its title with a resounding ‘yes’: sex ‘matters in ways that we did not expect. Undoubtedly, it also matters in ways that we have not begun to imagine’ (x). The report recommends that sex must be studied ‘from womb to tomb’ (5) ‘in all areas and at all levels of biomedical and health-related research’ (xix), because ‘every cell has a sex’ (4). In order to study sex properly, the report states, it must be separated from gender. The following definitions of sex and gender are recommended:

In the study of human subjects, the term sex should be used as a classification, generally as male or female, according to the reproductive organs and functions that derive from the chromosomal complement. In the study of human subjects, the term gender should be used to refer to a person’s self- representation as male or female, or how that person is responded to by social institutions on the basis of the individual’s gender presentation. In most studies of nonhuman animals the term sex should be used. (8)

Interestingly, the report takes note of two dissenting committee members:

Although such definitions [of sex and gender] are helpful, two committee members argued that they imply that the idea of biological difference suggests a predominance of physiology, with a subsequent fine-tuning by environment. Moreover, the two committee

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members were concerned that dividing biological and environmental events into separate spheres could make researchers less likely to ask solid mechanistic questions about, for example, how diet and mechanical stress affect bone development. (18)

The report advises in particular that research on sex differences in brain organisation and function are expanded, and foregrounds brain organisation theory as a useful framework for doing so. Again, the report mentions two committee members who raise concerns about the advocated research directions:

Two members of the committee argued that continuing to use the phrase organizational effect as an explanation [of the development of particular behaviours] could preclude experiments that might reveal the actual mechanisms by which hormones, genes, and a variety of postnatal experiences produce the sex and gender differences of interest. Two members of the committee believed that reliance on analyses that divide variance into main effects and smaller contributing effects sidetracks other biologically appropriate analysis, such as pursuing developmental understanding of the emergence of cognitive skills. It also does not enable researchers to see how experience and biology work together to produce difference. (95)

Instead of brain organization theory, the two members wish to advance a developmental systems approach which ‘examines the mutual construction of cognition by physiology and by experience during key periods of development’ (95), which reflects the same approach that I advocate in the beginning of this thesis. Epstein (2007) writes that this IOM report ‘conferred crucial legitimacy’ on the movement promoting sex-based biology (240). Unfortunately, it seems that the concerns of the two critical committee members have made no lasting impression on this movement. The interaction of sex and gender is often paid lip service, but very rarely pursued as a starting point for research. Instead, dividing sex and gender is widely promoted as best-practice. For example, the US NIH Office for Research on Women’s Health offers an online infographic entitled ‘how SEX and GENDER influence health and disease’.47 At the top, it states ‘While sex and gender are distinct concepts, their influence is inextricably linked.’ Nevertheless, the poster offers examples neatly classified into sex and gender influences. Amongst the phenomena labelled

47. The image is accessible at http://orwh.od.nih.gov/resources/sex-and-gender-infographic/index.asp.

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‘sex’ is the fact that ‘Women are twice as likely as men to experience depression, with some women experiencing mood symptoms related to hormone changes during puberty, pregnancy, and perimenopause’. A ‘gender’ dimension of depression, according to the infographic, is that ‘Women are more likely to admit to negative mood states and to seek treatment for mental health issues’. Similarly, the website of the Sex and Gender Women’s Health Collaborative, an organisation co-founded by the SWHR, offers an infographic entitled ‘What a difference an “X” makes’.48 It lists examples of sex differences in health outcomes, including the female preponderance in depression, to which it adds that ‘Estrogen receptors may be associated with higher risk for major depressive disorder’. Here, the association between women and depression is entirely defined in biological terms: it is the ‘difference an “X” makes’. As a final example, the Canadian Institute for Gender and Health, on its webpage titled ‘Shaping Science for a Healthier World’, emphasises that sex and gender are ‘interrelated and potentially inseparable’, yet it recommends a dichotomised understanding of sex and gender as the best working- hypothesis: ‘While putting simple boxes around something as complex and interconnected as sex and gender is not easy, doing so helps researchers to apply the two concepts consistently and distinguish between the many different mechanisms through which sex and gender shape our lives’ (Canada 2016). As I have argued in Chapters 1 and 2, studying sex as an independent, dichotomous variable in isolation from gender is a strategy rooted in biological determinism and essentialism. Such a method belies the fact that differences between males and females are typically small, with extensive between-group overlap and within-group variation, and that sex/gender interacts with other group characteristics. Moreover, differences between males and females emerge from interactions of biological and environmental factors, which should be specified if we wish to understand these differences. As Springer, Mager Stellman and Jordan-Young (2012) have written, ‘sex is not a biological mechanism and its use as a proxy for other measures does little to further the understanding of health-related research questions’ (1818). So even though the sex-based biology movement is often represented as continuous with the feminist women’s health movement from the 1970s and 1980s, it in fact disregards central feminist critiques that have examined the production of biomedical knowledge and the links between postulated

48. Another example of sex offered by the infographic is that ‘Women have less bone tissue than men and experience a rapid phase of bone loss due to hormonal changes at menopause.’ One is immediately reminded of Anne Fausto-Sterling’s treatment of osteoporosis in The Bare Bones of Sex (2005), in which she demonstrates that bone density is the result of multiple, dynamically interacting systems of physical and cultural factors. Indeed, for Fausto-Sterling, ‘osteoporosis is a condition that reveals all of the problems of defining sex apart from gender’ (1499).

103 bodily differences and social inequalities (Dubriwny 2012; Eckman 1998; Epstein 2007; Richardson 2013). Its preoccupation with—indeed, its celebration of—sex as a binary, biological variable has eclipsed considerations of the social and material conditions that shape individual women’s lives in various ways, and with that the intersections or interdependencies of sex/gender, race/ethnicity, social class, age, and other pertinent categories. ‘Lost from this new body of women’s health’, Eckman (1998) writes, ‘is the understanding, hard fought for by the women’s health movement, that women’s bodies are also sites of societal struggles’ (152). Leaving behind issues surrounding agency and empowerment, the new movement delegates women to ‘a subject position that feminist critics of science have roundly critiqued: women as research object, albeit an object with more than reproductive organs’ (150). As a result, as Epstein (2007) writes, ‘where the earlier groups often sought to “demedicalize” women’s experiences, the new advocacy, often led by women inside medicine and science, seeks to extend scientific scrutiny of their bodies’ (247, citing Ruzek and Becker 1999). Despite critical responses from feminist scholars, the sex-based biology movement has come to determine the agenda of contemporary gender-sensitive healthcare. One of its latest successes is the NIH policy, announced in 2014, that obliges all NIH-funded investigators to include both male and female animals or tissues in their research and to include sex as a biological variable in their analyses. This policy aims to remedy the fact that even though the male-centred bias in clinical trials has diminished, biological research on non-human animals has continued to rely heavily on male animals and tissues, even in studies potentially relevant for diseases that affect women disproportionally (Lebron-Milad & Milad 2012; Beery & Zucker 2011). In their review, Zucker and Beery (2011) found that the largest disparities are in the fields of neuroscience and pharmacology, with ratios of studies using only male animals versus only female animals of 5.5:1 and 5:1, respectively. Two contradictory reasons appear to underlie this bias. The first is that sex matters a great deal: female animals are believed to introduce undesirable variability into a sample due to the oestrous cycle, making research bothersome (but see Mogil & Chanda 2005; Prendergast, Onishi & Zucker 2014). The second is that sex does not matter at all: results obtained with male animals and tissues are extrapolated to females without additional research. Both premises are disputed by the new NIH policy, which ‘require[s] applicants to report their plans for the balance of male and female cells and animals in preclinical studies in all future applications, unless sex-specific inclusion is unwarranted, based on rigorously defined exceptions’ (Clayton & Collins 2014, 283). By making mainstream the consideration of sex as a biological variable, the NIH aims to ‘[support] science that meets the highest standards of rigour’ (283). One area expected to benefit from this

104 intervention is neurological disease, like schizophrenia. ‘It is well known that many neurological conditions are sexually dimorphic’, Clayton and Collins write (283), which is reason to study sex differences at the most basic biological levels. Whilst including female animals and cells in research is certainly a welcome and important move, obliging researchers to report sex differences runs into the problems stated above. It promotes the dominant view that sex is a straightforward, dichotomous variable that is best understood by focussing on its main effects, rather than on its interactions in specific mechanisms. This makes it likely ‘that one mistake, treating males as the norm, will be replaced with another; namely, treating males and females as two distinct entities’ (Fine et al. 2014, paragraph 2), and that the contingency of sex differences on factors like strain, age, or prior experience will be disregarded (Joel & Yankelevitch-Yahav 2014). In addition, it is likely to further entrench the authority of controversial theories like brain organisation theory, thereby perpetuating the popular idea that ‘men are from Mars, women are from Venus’. It is to the application of brain organisation theory as a crucial lens to understanding (sex/gender differences in) mental health and disease to which I now turn.

The therapeutic promise of brain sex

Together with the increasing neurofication of mental disorders, the movement advancing sex as a key biological variable in all medical and premedical research imbues brain organisation theory with a significant therapeutic promise. Understanding ‘normal’ or healthy sex differences in the brain is strongly promoted as relevant, if not crucial, to clinical psychology and psychiatry (e.g. Cahill 2006; Ruigrok et al. 2014; McCarthy et al. 2012). Autism and schizophrenia are commonly referred to as conditions that would be particularly amenable to this therapeutic promise of brain organisation theory. Autism, with its conspicuous preponderance in males, is popularly understood as the result of having an extreme male brain (Baron-Cohen 2002; Baron-Cohen & Hammer 1997). Schizophrenia, characterised by more subtle and lesser-known sex differences, has been linked to a reversal of ‘normal’ sexual differentiation (Gur et al. 2004). In what follows, I will consider how in each of these cases, brain sex is invoked as a heuristic device that helps researchers to reduce heterogeneity within patient populations and to identify potential risk factors or mechanisms. I will place these theories in a historical perspective, since looking at the way by which these two disorders have been (re)defined in gendered terms over time better equips analysing the merits of contemporary brain sex

105 perspectives. I will argue brain sex is not an appropriate perspective for the elucidation of etiological pathways. Using brain sex to explain sex/gender differences in autism and schizophrenia obscures the potentially crucial influence of social factors in the development of pathology. Instead, an embodied model of development that takes into account the dynamic interaction of sex and gender is better suited to provide insight into the origin of sex differences in mental disorders, and to further our understanding of these disorders in general.

Schizophrenia Schizophrenia originates from dementia praecox, a condition first described by Emil Kraepelin (1856–1926). Kraepelin revolutionised modern psychiatry by replacing symptomatology-based classifications of mental disorders with his clinical nosology. For him, mental disorders were discrete, physical diseases, and each would have a specific, organic cause. To identify the nature of these diseases, he argued, psychiatrists had to look beyond superficial symptoms and focus on course and prognosis instead (1896). Different diseases could involve similar symptoms, but they would each have a distinctive pattern. Kraepelin defined dementia praecox in contrast to manic-depressive psychosis (1899). The manic-depressive psychosis replaced the older concepts of mania and melancholia, which were, at the time, already associated with femininity (Showalter 1985). Manic-depressive psychosis was defined in primarily emotional terms, whereas dementia praecox was associated with disturbed reasoning and thinking (Busfield 2002). Kraepelin noted that manic-depressive disorders affected women predominantly, whilst dementia praecox was somewhat more general in men, especially in certain subtypes and at younger ages (1919). Whereas male patients were characterised by an overall early onset,

the tendency of the female sex to attacks of dementia praecox, which on the average is somewhat less, experiences a certain increase in three different periods of life, before the fifteenth, between the twenty-fifth and thirty-fifth, and after the fortieth year. There will certainly be a temptation here to think of sexual development which is earlier in the woman, of the time of the work of reproduction and of the years of involution. (1919, 231)

On what grounds were these sex differences established? Were they indeed the logical outcome of sex differences in sexual development, or did perceptions of masculinity and femininity also factor into the definition of patient populations? Historian of science Lunbeck (1994) notes that

106 the emphasis Kraepelin placed on patterns, rather than on symptoms per se, meant that the diagnostic choice between dementia praecox or manic-depressive psychosis was partly determined by the clinician’s affective response to a patient. Manic-depressive patients were described as eliciting a friendly, amused response, whereas the dementia praecox patient was experienced as strange and repelling. This, she argues, ‘suggests that psychiatrists perceived something essentially male or female in the diseases themselves’, which was something ‘encoded into the very categories that ordered psychiatrists’ observations’ in the first place (148).49 When a difficult choice had to be made between one and the other diagnosis, Lunbeck shows, men were twice as likely to be diagnosed with dementia praecox than women. For women, the diagnosis could hinge on whether their symptoms were seen as erotic (psychosis) or simply foolish (dementia praecox). This circularity between diagnosis and perceptions of masculinity, femininity, and sexuality might very well have played a role in Kraepelin’s observation that patients with late-onset dementia praecox are predominantly women: as a woman approached an age at which she was not longer considered desirable by her doctors, her chances of being diagnosed with dementia praecox rather than manic-depression would rise considerably.50 In addition to the differences in prevalence and onset, Kraepelin also noted a sex difference in the ‘psychic peculiarities’ that dementia praecox patients exhibit from childhood onwards: male patients with dementia praecox tended to have been shy, quiet, and withdrawn, whereas female patients with the same disorder were reported to have been more irritable, excited, nervous, and wilful (136). This purported tendency towards gender nonconformity observed in dementia praecox patients became a phenomenon of great interest to psychiatrists, because it seemed to give them a clue about the possible causes of the disease. Physicians speculated about the possible role of endocrine disturbances, pointing out abnormal physical characteristics observed in psychotic patients. When theorising about the role of hormones, ‘physicians liberally mixed their assumptions about sex roles with their observations about hormonally based sex characteristics’ in order to draw the connections between hormonal functions, gender role, and mental disorder (Hirshbein 2010, 164).

49. The symptoms of the manic patient symbolised ‘an unbounded, out-of-control femininity’ (149) marked by a periodicity that ‘mimicked in a more marked form the natural periodicity of women’ (150); in contrast, the signs of dementia praecox resonated as ‘the extreme, pathological manifestations of men’s naturally more stable nature’ (Lunbeck 1994, 150). 50. Lunbeck recounts the story of a forty-year-old woman, singing and playing naked in her room after losing her lover, who was not perceived by her psychiatrist as displaying behaviour associated with mania: ‘[her] nudity had failed to attract’ (149).

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Meanwhile, psychoanalysts attempted to link the disease to psychosexual development, drawing connections with homosexuality (see Rosario 2002). Hirshbein (2010) notes that psychiatrists in the late nineteenth and early twentieth century did acknowledge the fact that the male and female role placed different demands on men and women. However, traditional gender roles were deemed natural, unchanging and healthy. Problems were thought to arise not from the roles themselves but from the failure to perform them through ‘neglect or through too enthusiastic adherence’ (159). Deviation from general health norms and deviation from gender norms were thus deeply enmeshed: gender nonconformity (whether cause by hormonal disruptions or not) was understood as both the cause and the sign of mental breakdown (162). Solutions, however, were not sought in social reform but in the restoration of femininity to women, and of masculinity to men. The Swiss psychiatrist Eugen Bleuler redefined dementia praecox in 1911 as ‘schizophrenia’ to signify that the splitting of psychic functions—and not dementia—was the primary characteristic of the disorder. Bleuler understood schizophrenia as a heterogeneous group of clinical presentations rather than one specific syndrome, which vastly expanded the diagnosis (Heckers 2011).51 With this new, broad definition, schizophrenia became one of the most important disorders after World War I instead of hysteria (Libbrecht 1994). Mitchell (2001) suggests that the ‘the massification of male hysteria’ during the war played a crucial role in this transition. The idea that men were collectively becoming hysterical (i.e. feminine) was ‘simply unpalatable to the medical community—or, more generally, to standard images of “maleness”’ (127). In response, enthusiasm about the diagnosis deteriorated in favour of schizophrenia. By absorbing hysteria, schizophrenia gradually attracted more female patients, until they outnumbered male patients by the 1960s (Mitchell 2001, 125; see also Chesler 1972). Mitchell (2001) writes that the ‘“neutered” schizophrenic’ thus replaced the female hysteric as the model patient of psychiatry (126). Showalter, however, has argued that schizophrenia carried gender-specific meaning despite its equal distribution across men and women, and that it was therefore specifically the schizophrenic woman who succeeded the hysteric (1985, 203). Even though female patients were not greater in number than male patients, they were much more frequently selected for ‘cures’ like electroshock and lobotomy, which were used from the

51. Despite being influenced by psychoanalysis, Bleuler (and his student Carl Jung) rejected the belief espoused by Sigmund Freud and Karl Abraham that there was a psychosexual aetiology to dementia praecox. Like Kraepelin, he believed that schizophrenia was an organic disease. However, he did insist on studying the psychodynamics of individual patient’s experiences (Maatz, Hoff & Angst 2015).

108 late 1930s onwards (205-210). These debilitating treatments, Showalter shows, were deemed particularly suitable for women because their mental capacities would not need to be fully functional in their role as housewives. Thus, the expected treatability of patients was directly linked to the gender role that was expected of them.52 Another link between women and schizophrenia, which developed in US-American psychiatry from the 1930s onwards, is the schizophrenogenic mother, who induces schizophrenia in her child. As Hartwell (1996) notes, the popularity of this figure constitutes a most peculiar moment in the history of schizophrenia, one that marked a time during which the disorder was not viewed in strictly biochemical terms. She traces the origin of this notion back to post-World War I United States, where gender relations had been uprooted by the war and women’s right to vote, and concerns over women’s femininity and men’s masculinity were met by the psychoanalysis movement with reaffirmations of a natural gender order (276). After World War II, the notion of the schizophrenogenic mother was widely adopted by US-American psychiatrists, who had begun to turn away from the Kraepelinian disease model under the influence of psychoanalysis, redefining disease and health as a continuum rather than a dichotomy and emphasising environmental rather than biological causes of dysfunction (Decker 2007).53 Hartwell describes the devastating double bind that this concept placed women in: mothers harbouring unfulfilled ambitions were deemed pathogenic, but so were mothers realising their ambitions by working outside of the home (1996, 280). As such, not only women’s behaviour, but their very desires became a source of danger: the only way to be a good mother was to make marriage and homemaking one’s genuine ambition. Again, we see the failure to live up to gender roles, and not gender roles themselves, as the source of mental disorder – only in this context, women risk not (just) their own health but also that of their child.54 By the late 1960’s, when schizophrenia was shown to have a genetic component, antipsychotic drugs were on the market, social attitudes towards women were changing under the influence of the Women’s Movement, and the antipsychiatry movement challenged the

52. In addition to these medical links between disease, treatment and femininity, Showalter identifies a genre of English women’s writings, chronicling women’s experiences with madness and institutionalisation between 1920 and the early 1960s. In these writings, populated by female schizophrenic protagonists, ‘schizophrenia became the bitter metaphor through which English women defined their cultural situation’ (210). 53. At that time, Bleuler’s work on schizophrenia was translated in English for the first time. His psychodynamic approach and expansive definition resonated with US-American psychiatrists. With the emergence of this more dynamic view of schizophrenia, the sharp divide between schizophrenia and health became less unbridgeable. It started to seem possible to prevent at least a number of subtypes of schizophrenia by implementing early interventions, and thereby to reduce the number of institutionalised patients. This motivated the search for the schizophrenogenic mother. 54. Interestingly, the studies of schizophrenogenic mothers Hartwell describes all focus on male patients.

109 legitimacy of diagnoses, the ‘schizophrenogenic mother concept was no longer politically or intellectually consistent with the spirit of the times’ (Hartwell 1996, 288).55 Psychiatry reaffirmed a neo-Kraepelinian, biological medical model, marginalising psychoanalysis (Decker 2007, 245). Then in the 1970s, CT (computer assisted tomography) and MRI became available, and the first modern brain scan studies of schizophrenic patients appeared (Johnstone et al. 1976; Smith et al. 1984). Studies of possible social causes of schizophrenia disappeared from the US-American literature, and previous evidence of social risk factors was forgotten or renounced (Jarvis 2007). When the DSM-III was published in 1980, it specified much narrower criteria for schizophrenia than the DSM-II had listed, and put a greater emphasis on affective disorder as a differential diagnosis (Compton & Guze 1995). As a result, about half the patients who met DSM-II criteria for schizophrenia no longer met the DSM-III criteria, a large proportion of whom now qualified for affective disorders (Silverstein et al. 1982). Most of these patients were women, and as a result the male predominance in schizophrenia increased markedly (Aleman, Kahn & Selten 2003; Lewine, Burbach & Meltzer 1984; Westermeyer and Harrow 1984). From this point onwards, schizophrenia has been studied mainly from genetic and neurobiological perspectives. Whereas Plum had dubbed schizophrenia the ‘graveyard of neuropathologists’ in 1972, by 1990 psychiatrists remarked that ‘To have forgotten that schizophrenia is a brain disease will go down as one of the great aberrations of twentieth century medicine’ (Ron & Harvey 1990). By that time, some brain abnormalities in schizophrenic patients had been established, but patient populations were still heterogeneous, and etiological factors remained elusive. Subtypes were proposed but failed to yield reliable subpopulations. Faced with these difficulties, some researchers focussed their attention on sex differences as a possible way of reducing heterogeneity and of identifying mechanisms through which schizophrenia develops.56 The hypothetical relationship between brain sex and schizophrenia

55. The validity of schizophrenia as a real disease was further questioned when, in the early 1970s, the psychologist David Rosenhan had a number of fake patients admitted in psychiatric hospitals. These actors told hospital staff they heard voices, and were all diagnosed with schizophrenia. Once admitted, the actors started acting normal and professed their health, yet they were detained and medicated for several weeks until they were released with the diagnosis ‘schizophrenia in remission’ (Rosenhan 1973). 56. During the 1990s, the first sex-based comparisons of neurobiological abnormalities in schizophrenia started to emerge. One of the most reliable brain abnormalities found in schizophrenic patients was a lateral ventricular enlargement (Chua & McKenna 1995). Subsequent studies of sex differences suggested that male patients were more prone to ventricular enlargement, but the overall evidence was inconsistent (Salem & Kring 1998). The corpus callosum, a popular brain sex difference at the time that has been debunked since (Fausto- Sterling 2000), was also investigated but also yielded inconsistent outcomes (Salem & Kring 1998). Despite these initial disappointments, researchers have remained convinced that sex differences in the brain are a crucial window onto the aetiology of schizophrenia (e.g. Castle 2000; Goldstein 2006).

110 was tightened by the growing belief that schizophrenia is a neurodevelopmental disorder, caused by subtle influences on brain development before or during birth, such as maternal influenza or obstetric complications (Harrison 1997, Marenco & Weinberger 2000). This led researchers to propose a close link between prenatal hormone exposure and sexual differentiation of the brain for the development of schizophrenia. For example, after finding sex-by-group interaction effects on the volumes of a number of cortical brain regions (schizophrenic women exhibited a reduction in anterior cingulate volume compared to healthy women), Goldstein and colleagues suggested that ‘factors that contribute to producing normal sexual dimorphisms may be the same factors that modulate brain abnormalities in schizophrenia’ (2002, 161-62). They restrict their discussion of possible factors to genetic and hormonal effects during the foetal and early postnatal period and activational effects of circulating hormones later in life, not considering the possibility that gender-specific life experiences might also play a role in the relationships between sex, brain, and disease. The proposed link between sexual differentiation of the brain and development of schizophrenia therefore hinges implicitly on the assumption that sex differences in the brain are either present or pre-programmed at birth. This assumption underlies other available studies of sex differences in the schizophrenic brain as well. Gur and colleagues (2004) found that the volumetric ratio of the orbitofrontal cortex to the amygdala (OAR) is typically higher in healthy women than in men, but that there is a significant sex-by-group interaction effect on this trait. For female patients, the OAR was lower than that of their healthy controls, and for male patients the OAR was higher than for healthy men. As such, the authors state that, ‘schizophrenia results in “feminizing” the men and “masculinizing” the women’ (615), but at different nodes. In women, the orbitofrontal cortex largely drove this difference; in men, the amygdala incited the effect. ‘Because the amygdala is formed early in neurodevelopment,’ the authors state, ‘reduced amygdala volume in men with schizophrenia might represent direct gene effect or an earlier neurodevelopmental insult’ (615). However, studies with non-human animals have established that the amygdala shows considerable structural plasticity (see McEwen et al. 2012). More research needs to be done on the human amygdala, but there is already some evidence that amygdala volume in humans can be affected by (early) experiences, including maternal depression (Lupien et al. 2011). This challenges the assumption that any ‘abnormal’ sexual differentiation in schizophrenic patients necessarily emerges at the beginning of life. Gur and colleagues link their observations in the brain to the idea that female patients exhibit more positive symptoms, whereas male patients exhibit more negative symptoms. This

111 sex difference in clinical presentation is widely espoused, yet meta-analyses show that this difference has not been replicated across studies.57 Gur and colleagues, however, did find a higher rate of avolition (but not other negative symptoms) for men and more severe delusion (and a non-significant increase in hallucinations) for women. Higher OAR was associated with more severe symptoms for men, but with less severe symptoms for women. The authors conclude that the ‘masculinization’ of the brains of female patients and the ‘feminization’ of the brains of male patients constitutes a compensatory process in response to the disease process (515). As an adaptation to the ‘schizophrenia as reduced sexual dimorphism’ hypothesis, Crespi and Badcock recently proposed a two-axis system to understand sex differences in schizophrenia as well as autism (2008). One axis is that of ‘normal’ sexual differentiation between male and female brains, the other is an axis of cognition determined by maternally or paternally expressed imprinted genes. They argue that autism involves a predominance of paternally expressed genes, which results in the underdevelopment of social cognition; whereas schizophrenia emerges from a predominance of maternally expressed genes, which leads to an overdevelopment of social cognition. As such, autism and schizophrenia are positioned on opposite ends of a cognitive continuum from mechanistic to mentalistic thinking. This axis, the authors argue, is partially but not wholly aligned with the male-female axis, which should explain the preponderance of males with autism and of females with positive-symptom schizophrenia. On this account, then, schizophrenia is the expression of an extremely maternal brain, which correlates with having a female brain. Again, this is a theory that represents the link between sex and schizophrenia as a purely biological and homogenous process (for other critiques, see Fitzgerald & Hawi 2008, Keller 2008, Langdon & Brock 2008).58

57. Although no studies find the opposite effect, a range of studies have found no significant differences (see Ochoa et al. 2012, Falkenburg & Tracy 2014). The content of delusions and hallucinations does appear to differ between men and women, but this might be explained by gender-specific experiences of trauma (Falkenburg & Tracy 2014, 64). In the study by Goldstein and colleagues (2002), there were no significant sex differences in positive and negative symptom ratings (but a non-significant trend towards more formal thought disorder and more hallucinations, both positive symptoms, in the men, as well as a non-significant trend towards more paranoid subtypes in the women). 58. Besides research on structural brain differences in schizophrenia, cognitive performance in schizophrenic patients has also been investigated. The results of this research have been highly inconsistent, in part due to poor design and low generalisability (e.g. Krysta et al. 2013; Mendrek & Mancini-Marïe 2015; Mesholam-Gateley et al. 2009). One of the most prominent researchers in this area is Mendrek, who in 2009 held a talk at the scientific day of the Chair on Sex, Gender and Mental Health of the Canadian Institute of Gender and Health entitled ‘Schizophrenia: Trapped in the brain of the wrong sex?’. Unlike what this intentionally provocative title suggests, Mendrek’s work makes clear that the evidence linking sex differences in the brain and prenatal hormone exposure to schizophrenia is inconsistent, and that the influence of sex on cognitive functioning and brain morphology in schizophrenia patients is not homogenous. That is, depending on the structure or function of interest, studies find similar, absent or opposite sex differences in schizophrenic samples compared to healthy controls (Guillem et al. 2009). Even though she takes the link between schizophrenia and in-utero sexual

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Meanwhile, what happened to research on sociocultural risk factors? Even though research in this area has been deprioritised, evidence has been mounting that sociocultural factors can increase the risk of schizophrenia, sometimes in gender-specific ways. Work by Lewine, for example, has shown that femininity, independent from being female, is a predictor of neuropsychological functioning across a number of domains (Lewine 2004; Lewine, Thurston-Snoha and Ardery 2006). In another study, it was found that socioeconomic status correlates with more severe symptoms in men, but with less severe symptoms in women, pointing to the role of class- and gender-specific social expectations placed on susceptible individuals (Parrott & Lewine 2005). Other preliminary evidence points to the possibility that positive and negative gender-related experiences, like sexual abuse, social support or care- giving responsibilities, affect the development of schizophrenia (reviewed in Falkenburg & Tracy 2014). Gender is not the only social category of relevance, however. There is evidence that ethnic minorities are more vulnerable to schizophrenia. In particular, migrants and their children are at elevated risks up to five times higher than in native-born populations (reviewed in Selten, Cantor-Graae & Kahn 2007). Recent incidence studies suggest that black male migrants in particular are at high risk of developing schizophrenia due to their minority position. A study of very-late onset schizophrenia-like psychosis (SLP) in African- and Caribbean-born elders in London, for example, found a strongly increased risk in this group (Mitter et al. 2005). This risk was disproportionately greater in men, which was attributed to their greater social isolation. In addition, the age of onset for SLP was notably lowered in the migrant women compared to British-born women, an affect possibly mediated by an overall increase in mortality in female migrants. Overall, sex differences in risk and age of onset for SLP that were observed in the British-born population disappeared in the migrant group.59 The observation that migration

differentiation of the brain very seriously, she has also stressed the entanglement of sex and gender and called for more research on the role of gender socialisation (Mendrek & Mancini-Marïe 2015). In addition, researchers have studied the role of hormones. Some evidence has emerged that oestrogen can act as a protective factor against schizophrenia in a number of ways, for example by lowering the risk of birth complications (Häfner 2003, Olsen et al. 2008). Endogenous oestrogen appears to be correlated with less severe symptoms in both men and women, and adjunctive oestrogen seems to alleviate symptoms somewhat (Da Silva & Ravindran 2015). However, the evidence is inconsistent and a number of studies have failed to replicate findings of lower circulating oestrogen levels in schizophrenic patients compared to controls (although no study reports to have found higher levels, see Da Silva & Ravindran 2015). 59. The interaction of gender and ethnicity not only affects an individual’s exposure to risk factors but also medical perceptions of what and who should count as schizophrenic—two related, but distinct phenomena. As Metzl (2010) shows in his book on race and schizophrenia, the disorder was described specifically as an expression of angry black masculinity in the 1960s and 1970s, coinciding with the Civil Rights Movement. His analysis shows that this connection between black masculinity and schizophrenia was forged by anxieties over racial power relations. Indeed, the history of schizophrenia is as racialised as it is gendered.

113 elevates the risk of schizophrenia (and might therefore correlate with ethnicity) was already made in a number of studies in the early twentieth century, but research on this topic was largely abandoned once it had been suggested that causality had to be understood in the opposite direction (i.e. schizophrenia increases chance of migration, see Selten & Cantor-Graae 2004). From the 1980s onwards, while US-American psychiatry turned towards neurobiological models, European researchers started looking into the effects of migration once more (Selten, Cantor-Graae & Kahn 2007, Jarvis 2007). Unfortunately, it is still eclipsed by the dominant tripartite frame of genetics, , and endocrinology, especially in US-American research (Nasser, Walders & Jenkins 2002, Jarvis 2007). The overview of the history of schizophrenia I have provided here is but a crude representation of a long and complicated history, but it should suffice to demonstrate the extent to which schizophrenia has been defined, contested, and redefined in gendered terms60. Not only have restrictive gender roles caused men and women to develop gender-specific dysfunctions, but perceptions of ideal femininity and masculinity have affected how patient populations are defined, how patients are selected for treatment, and how research questions about the aetiology of the disease are formulated. Such biases have not been restricted to biological approaches; as the notion of the schizophrenogenic mother shows, accounts of social causation are just as amenable to sexist perceptions as biological explanations. Nevertheless, the greatest concern that I currently deduce is posed by the neurobiological approach that mobilises brain sex theory as a tool to understand schizophrenia. This strategy takes sex differences in the prevalence, age of onset, and symptomatology of schizophrenia for granted (even though they are to this day subject of debate, see Eranti, MacCabe, Bundy & Murray 2013; Ochoa et al. 2012), and assumes that these differences can be fully explained by genetic, hormonal, and/or neurological mechanisms. In addition, it assumes that sex differences in the healthy brain are well-understood and uncontroversial, and that they are hardwired. These assumptions justify each other: naturalising sex/gender differences in the brain encourages the naturalisation of sex/gender differences in schizophrenia, and vice-versa. Consequently, not only is ‘normal’ sexual differentiation of the brain used to understand how schizophrenia develops; sex/gender differences in schizophrenia are also mobilised as an argument to justify

60. One important issue that I have not addressed here for the sake of brevity is the historical association between schizophrenia and gender identity. Elements of gender dysphoria in patients diagnosed with schizophrenia have been described since transsexualism was first considered as a psychiatric diagnosis (Hoenig & Kenna 1974), with some reports describing schizophrenic patients misdiagnosed as transsexual (e.g. Campo et al. 2001). It cannot be estimated how many transgender people have been misdiagnosed as schizophrenic throughout history. To this day, evidence of comorbidity between schizophrenia and gender dysphoria is contested, and the implications of a possible link unclear (Rajkumar 2014).

114 and promote more basic research on sex differences in the brain (e.g. Bao & Swaab 2010; Cahill 2006; Cosgrove, Mazure & Staley 2007; McCarthy et al. 2012). The problem is therefore not only that the deprioritisation of social factors stands in the way of fully understanding the nature of schizophrenia, but also that it legitimises a problematic understanding of sex differences in the brain. In the end, what is required for a better understanding of schizophrenia is more integrative research that allows us to understand the interaction of vulnerabilities that may arise at very early stages of development (which may or may not be distributed unevenly in relation to sex) with relevant environmental influences (which may or may not be distributed unevenly in relation to gender and its intersecting categories). To achieve such an integration, a diathesis- stress model of schizophrenia has been developed from the 1980s onwards (Neuchterlein & Dawson 1986; Walker & Diforio 1997). This dual-risk model proposes that stressors act on existing biological vulnerabilities through specific neurobiological mechanisms. As Jones and Fernyhough (2007) have argued, one limitation to the model has been ‘the assumption that psychosocial stressors, a notoriously subjective concept, form a homogeneous category with similar physiological effects’ (1172). This highlights the necessity of studying physiological processes in context, an altogether more appropriate and promising research direction than brain organisation theory provides.

Autism Like schizophrenia, autism has proven to be a heterogeneous category with heterogeneous aetiology. Previous editions of the DSM delineated subtypes, but research has not been able to link these to specific causes or pathways. In the DSM-5, the single umbrella term ‘autism spectrum disorder’ has replaced the subtypes. And like schizophrenia, autism has been studied mostly in relation to genetic, hormonal, and neurobiological factors, with a starring role for hardwired sex differences in the brain. When Bleuler (1911) redefined dementia praecox as ‘schizophrenia’, he specified four core symptoms: abnormal associations, abnormal affect, ambivalence, and autism. He defined autism as an active withdrawal from the outer world in favour of the object of inner life, and used the term as an alternative to Freud’s notion of autoeroticism (Bleuler 1911, 1951; Dalzell 2007). In 1943, US child psychiatrist Leo Kanner had reported on 11 children displaying ‘extreme autism, obsessiveness, stereotype and echolalia’ (248). Kanner argued that these symptoms are very similar to childhood schizophrenia, but also different in that the children have these symptoms from birth onwards, and display ‘an excellent, purposeful, and

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“intelligent” relation to objects’ (249). Kanner therefore maintained that he had observed a distinct syndrome. When considering the aetiology, he offered his observation that the parents of his subject group were cold, ‘strongly occupied with abstractions of a scientific, literary, or artistic nature’, and prone to unhappy marriages (Ibid.). However, Kanner argued in the end, since these children appear to be affected from birth onwards, it would be better to ‘assume that these children have come into the world with innate inability to form the usual, biologically provided affective contact with people, just as other children come into the world with innate physical or intellectual handicaps’ (Ibid.).61 At the same time, the Viennese psychiatrist Hans Asperger reported similar cases in Austria. Like Kanner, he argued that these cases represented a distinct childhood disorder, which he labelled ‘autistic psychopathy’ (1944).62 This disorder, he observes, is characterised by ‘severe and characteristic difficulties of social integration’, which is sometimes compensated by ‘a high level of original thought and experience’ which can ‘lead to exceptional achievements in later life’ (37). Gillis-Buck and Richardson note that observations of male prevalence shaped the diagnosis of autism from these early beginnings onwards (2014). Both Kanner and Asperger observed that their childhood syndromes affected boys much more often than girls. When medical professionals debated whether or not Kanner’s ‘early infantile autism’ should indeed be distinguished from childhood schizophrenia, ‘Sex difference was part of this debate, with the male prevalence of autism cited as evidence for two discrete disorders’ (4). ‘Infantile autism’ was eventually included in the DSM-III in 1980. In 1994, ‘Asperger’s disorder’ was added, creating a spectrum of autism from low to high functioning, before the DSM-5 merged them under the single header ‘Autistic Spectrum Disorder’ in 2013. These developments, Gillis-Buck and Richardson argue, have contributed to the current success of the ‘extreme male brain’ (EMB) theory of autism, which has been proposed by Baron-Cohen (Baron-Cohen & Hammer 1997, Baron-Cohen 2002). According to this view, sex differences in human cognition and emotion can be understood as a continuum with ‘empathizing’ on one end and ‘systemizing’ on the other. The ‘essential difference’ between male and female brains is that male brains are wired for systemising, whereas the female brain is predisposed towards empathising. These differences are supposedly hardwired from birth onwards. Baron-Cohen (2002) proposes that autism is the expression of an extremely masculinised brain: superior at systemising, yet very poor when it comes to empathising. This

61. Nevertheless, the concept of the ‘refrigerator mother’ would persist; see Nadesan (2005). 62. For a discussion of the differences between Kanner’s ‘early infantile autism’ and Asperger’s ‘autistic psychopathy’, see Van Krevelen (1971).

116 theory has received critique from a wide range of writers, including autistic bloggers, autism researchers, philosophers of mind, and gender scholars, who have argued that the extreme male brain hypothesis simplifies and misrepresents the nature of autism and that it relies on an out- dated, unsupported notion of hardwired brain sex (e.g. Rogers 2003; Levy 2004; Bumiller 2008; Cohen-Rottenberg 2009; Fine 2011; Grossi & Fine 2012; Krahn & Fenton 2012; Sample 2012). To put it shortly, in Baron-Cohen’s work, autism is used to provide a rationale for brain sex as much as brain sex is used to provide a rationale for autism. Nevertheless, the EMB theory has become very influential. Gillis-Buck and Richardson (2014) write that a male prevalence of 4:1 in autism is ubiquitously cited in research in service of constructing a ‘biomedical platform’ for basic sex- difference research. Analysing recent grant-funded research, they show that researchers have increasingly made their genetic, hormonal, or neurological research relevant to autism by citing this statistic, which enables them to profit from the large amount of funding available for autism research. However, they argue that this statistic is ‘empirically underdetermined’ (17). The male prevalence is significantly smaller in individuals with intellectual disabilities, and research on girls with autism is generally lacking. Similar to the neuroscientific studies of schizophrenia discussed above, studies citing the 4:1 statistic assume that the male prevalence in a relatively small subset of the autistic population ‘carries insight into the general aetiology of the condition’ and that ‘current diagnosis rates of males and females reflect organic facts about autism and not gender stereotypes in diagnostic practices’ (8). Consequently, they argue, the preoccupation with the 4:1 statistic provides a platform for brain sex studies and also marginalises a large (and arguably the most vulnerable) part of the population with autism, does little to encourage research on autism in girls, and entrenches the harmful gender stereotype that male brains are wired for systemising cognition. In a recent paper, Mottron and colleagues (2015) proposed an alternative to the EMB theory: the enhanced plasticity hypothesis. Building on recent work that suggests that aberrant plasticity underlies autism, Mottron has proposed a ‘Trigger-Threshold-Target’ model in which genetic mutations or environmental insults increase synaptic plasticity (Mottron et al. 2014). Depending on the individual’s unique threshold, this induces functional reallocations that result in mild or severe disabilities. According to Mottron, autism affects males more often and in different ways, because males and females display different plastic reactions in response to the same event, and because males’ overall threshold for a plastic reaction is lower (2015). The authors link these sex differences back to genetically and hormonally regulated prenatal and early postnatal development. While the enhanced plasticity hypothesis proposes a more

117 complex account of autistic development than the EMB theory, it also relies solely on a notion of congenital sex differences in the brain (specifically, sex differences in plasticity) to explain the male preponderance of autism. Whilst this makes autism more amenable to early intervention, it does not take into account the possibility that the sex disparity in autism itself may be, at least partly, contingent on environmental influences. Against this common view that males must be inherently more vulnerable to autism and that socialisation does not play a significant role in the male preponderance, Cheslack-Postava and Rebecca Jordan-Young (2012) have argued that ‘considering how social as well as biological forces might be acting to cause observed disparity may provide new insights into its etiology’ (1668). Taking the entanglement of sex and gender as their starting point, the authors propose a gendered embodiment model of autism spectrum disorders, in which gender is understood as a ‘pervasive developmental environment’ (2012). This model traces the developmental trajectories through which children with initial vulnerabilities, ‘any of which might be differentially distributed by (genetic) sex, nor not’ (1669), interact with gendered social processes (e.g. in the parent-infant interaction). As such, it opens up for investigation a realm of questions that is typically ignored in the research literature on autism.63

Statistical panic: the female brain at risk

My discussion of schizophrenia and autism has made clear that male-female differences in health outcomes are not clear-cut, and not necessarily reducible to biological causes. Nevertheless, the movement for sex-linked biology foregrounds sex as a biological variable as one of the main determinants of health. Epstein (2007) writes that this salience of sex as a medical category has not merely grown out of objective scientific observations, but has specific historical and ideological roots. He points out that socioeconomic status is one of the best predictors of health outcomes, yet it is not nearly awarded the same significance as sex is. The implications of such visibilities and invisibilities go beyond the realm of medical practice: ‘if social class were incorporated as a standard signifier, the political effects might be significant: because social class is not seen as a biological category, to call attention to differential health outcomes by class is to call attention to the effects of social inequality on health’ (144). The

63. Again, I have left aside the issue of gender identity. Recent studies have suggested a link between autism and gender dysphoria, but the available evidence is limited and the implications of such a link unclear (Van der Miesen, Hurley & de Vries 2016; Van Schalkwyk, Klingensmith & Volkmar 2015).

118 current focus on sex, as separate from gender, has the opposite effect: it shifts the attention away from social inequalities by attributing risk to immutable individual characteristics. Following Epstein (2007), I consider sex, as it is currently mobilised as a prominent medical category, as a ‘biosocial’ category. Biosociality a concept formulated by Rabinow (1996), who builds on Foucault’s notion of ‘biopower’ (1976) to give an account of the emergence of new identities and affiliations under the influence of the life sciences. Sex—as the sex-based biology movement defines it—is a biosocial category, because its emergence as a medical classification has transformed the way women’s bodies and their health are understood (from reproductive organs to sex in every cell, including the brain), thereby forming a new basis for affiliations between women (sharing susceptibilities for specific diseases). This process has been about inclusion as much as it has been about exclusion, as it gave rise to a normative view of ‘the’ woman, thus marginalising the needs of women who fall outside of this norm (Eckman 1998; Dubriwny 2012). Further, this transformation involved not only scientific processes but also ethical struggles, as knowing women’s physiological makeup has been equated with acknowledging women’s fundamental human rights; yet, at the same time, as discussed above, many aspects of women’s health have been depoliticised. Considering sex as a medical category in terms of biosociality suggests that the sex- based biology movement has not only increased medico-scientific objectification, inspection, and intervention regarding women’s bodies but also arguably changed women’s self- perception, affiliation, and conduct. At stake in challenging the contemporary discourse surrounding women’s health is thus not just what bodies/brains are but also what kinds of subject positions the very preoccupation with neurobiology brings about. This much was already suggested in my discussion of the sex-based biology movement at the beginning of this chapter, and I wish to develop this direction further before closing this chapter. I will, therefore, briefly examine the modes of subjectification to which consumer-oriented advocacy for women’s mental and brain health gives rise. In particular, I am interested in the role of the statistic. Above, I discussed the observation from Gillis-Buck and Richardson (2014) that statistics expressing sex/gender disparities in pathology are mobilised to create a biomedical platform for basic sex difference research. What kind of work do these statistics perform when they are used to address and activate women as health consumers and (prospective) patients? Consumer-oriented messages from the sex-based biology movement often rely on statistics to inspire concern. Take for example, the website of the Women’s Brain Health

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Initiative (WBHI),64 which is based in Toronto and has a branch in Florida. The aims of the WBHI include raising funds for research on female physiology in the interest of reducing age- related brain disorders, to educate women about the risks that affect them, and to inform women about the ways in which they can ‘detect, prevent, and manage [their] brain health’. The site offers many informative articles with news about women’s brain health, as well as numerous tips on how women can adjust their lifestyles to ward off age-related decline. These tips revolve mostly around eating healthy and staying physically, mentally, and socially active (adjustments, the Initiative posits, that owe their efficacy to the phenomenon of brain plasticity). The WBHI homepage greets its visitors with the message that ‘70% of Alzheimer’s sufferers will be women’, and that ‘all of your female employees are at risk’ of age-related brain disease. In the ‘about’ section, the website states that ‘It was frightening to learn that women suffer from depression, stroke and dementia twice as much as men and an astounding 70% of new Alzheimer’s patients will be women’. The prominence of such statistics expresses something fundamental about how risk, health and disease are conceptualised in daily life. As Greco (1993) has written over two decades ago, disease is no longer commonly understood as an interruption of a healthy state but rather as continuous with a person’s normal life (359). Rather than causes, this conceptualisation of health and pathology focuses on ‘a personal susceptibility which is logically prior to cause’ (359). To live, then, ‘is already and ever-increasingly to be at-risk’, and ‘to “prevent” becomes already to “cure” something’ (360). As a result, individuals are continuously compelled to work on their health. The website of the US Office for Women’s Health (OWH) expresses this conceptualisation of health, illness, and risk bluntly: ‘You don’t automatically have good mental health just because you don’t have mental health illness. You have to work to keep your mind healthy’. No longer directly connected to environmental or individual causes, risk can no longer be bodily experienced: ‘Neither health nor illnesses are states of being: they are states of knowledge; they are epistemic’ (Dumit 2012, 13). Hence, the requirement of the statistic, a crucial tool to calculate one’s risk and act accordingly. To further understand the work that statistics expressing health disparities do in this context, it is useful to consider them in relation to Woodward’s (1999) discussion of ‘statistical panic’. Woodward writes that the statistic is a language that pervades our culture, ‘one that continuously offers itself up as a way of understanding our lives and the world and condenses itself into a single figure’ (178). Constituting ‘a discourse of probability’ (179), the language

64. See http://womensbrainhealth.org/.

120 of statistics is fully detached from the material body; it tells nothing of the present except the risk we are currently at: ‘I have an eighty percent chance… you have a ten percent risk… … We are at risk, it seems, of anything and everything’ (179). The ubiquity of risk, Woodward contends, engenders ‘a structure of postmodern feeling that oscillates between urgency and boredom’ (193). That is, the constant confrontation with impending doom inspires both panic and cynicism. So for movements like the women’s health movement, statistics are a critical tool, but are insufficient alone:

In part the challenge for those activists is to convince others to understand the urgency implied in the tedious, quantitative language of the statistic. … Much public policy depends on mobilizing statistical panic … Statistical panic: fatally, we feel that a certain statistic, which is in fact based on an aggregate and is only a measure of probability, actually represents our very future. (185)

One way of making sure women experience health statistics as urgent and personal is to appeal to their gendered responsibilities. The WBHI website features a glossy online magazine entitled Mind over Matter (MOM), offering ‘insights into the latest research findings to combat brain ageing diseases and the tools you need to stay brain healthy longer’.65 The opening article, entitled ‘Good, better, best’, features Dr Brown, who discusses women’s priorities: ‘women taking care of themselves is not being selfish, it’s being selfless. It will ensure they stay healthy and able to take care of the people in their lives. The whole concept of creating time for yourself, making yourself a priority, is important not just for you but for your whole family’ (8). Other resources on women’s mental and neurological health likewise address women explicitly as caretakers. The US Office on Women’s Health (OWH), for example, explains the importance of women protecting their own mental health by monitoring and adjusting their nutrition, exercise, and stress levels by stating that ‘Your health is very important. you will not have a healthy body if you don’t also take care of you mind. People depend on you’ (US 2010). Similarly, the consumer guide Women’s Mental Health: What it Means to You (US 2009), published by the Women’s Mental Health Initiative (WMHI, overseen by the OWH), writes that ‘Other people depend on you and your well-being. Your mental health affects how you act with family and friends. It affects your work. Taking care of your mental health is important to

65. The interactive magazine is accessible at http://mindovermatter.womensbrains.webfactional.com/mind_over_matter_magazine/FLASH/index.ht ml.

121 the people around you’ (2). Whereas these resources acknowledge the fact that women’s gender role exposes them to stressors, they simultaneously urge women to stay healthy by carefully managing their lifestyle in order to optimally perform their gender role. As such, the visibility of women’s specific health needs is won at the price of de-politicisation: their health is addressed, but valued explicitly in relation to traditional feminine values. The desirability or necessity of those values is not put in question. This consumer-oriented material on women’s mental and brain health, then, gives rise to a female identity that Dubriwny (2012), in her analysis of today’s dominant women’s health discourse, has called ‘the vulnerable empowered woman’. This identity, Dubriwny argues throughout her book, is shaped by postfeminist and neoliberal ideologies and thereby ‘disarticulated’ from feminist politics (13). These ideologies govern the women’s health discourse ‘through a larger rhetoric of risk in which women are represented as part of an inherently at-risk group that must engage in a constant monitoring and management of risk’ (Ibid.). Within this discourse, women’s purported empowerment is merely the freedom to shop amongst a limited offering of lifestyle advices and treatments. Both biological determinism and plasticity-based arguments play a role in the emergence of the vulnerable empowered women. Research programs linking gender disparities in health to sex differences in the brain—understood as hardwired and dichotomous—give rise to a perception of risk as unequally distributed across male and female brains. Similarly, by offering up statistics that indicate gender disparities rather the percentage of women that actually develop a disease like Alzheimer’s, organisations like the WBHI implicate all women as a single group defined by a shared, inherent susceptibility of the female brain. This susceptibility places women in ‘a state that at some inevitable future time will be fulfilled as a state of disease or health’ (Woodward 1999, 196). The constitution of ‘women’ as a biosocial category thus takes place in reference to the notion of the female brain. However, the notion of biosociality also points to forms of authority and truth claims that compel individuals to work on themselves in the interest of their health. Crucially, a woman’s risk of actually developing a disease is not 100%, and therefore not fully determined by the sex of her brain. This state of uncertainty, communicated to her in the language of the statistic (in reference to her responsibilities as a woman to induce a sense of alarm), is what should compel her to monitor and manage her life in order to minimise her risk. And just as brain sex appears to be the material referent for the abstract statistics of susceptibility (‘the female brain has a 60% chance of…’), so brain plasticity appears as the material ground for the purported risk-lowering effects

122 of lifestyle adjustments (‘cognitive training boosts cognitive reserve, lowering the risk of … up to 20%’). In conclusion, then, the consumer-oriented material offered by women’s mental and brain health movements does not merely rely on biological determinism, but also mobilises plasticity as a property of already sexed brains in order to effect change. Again, it becomes apparent that plasticity is not necessarily antithetical to biological determinism. Conceptualised as a property of sexed brains, plasticity articulates the affinity between medical, postfeminist, and neoliberal paradigms, rationalising the affirmation of sex as a biological, dichotomous determinant of health alongside contemporary preoccupations with consumerism and empowerment.

Conclusion

In this chapter, I have discussed the emergence of sex-specific mental health care and the biologisation of mental illness, which, together, have imbued brain organisation theory with a significant therapeutic promise. I have argued that a brain-based, sex-based approach to mental illnesses, which relies on the notion of brain sex as heuristic device that helps us reduce heterogeneity in both symptomatology and aetiology, brackets out crucial information needed to understand the dynamics of mental (dys)functioning. In addition, the sex-based biology movement that currently dominates the women’s health discourse facilitates the expansion of a biomedical platform for brain organisation theory, thereby promoting controversial claims that naturalise harmful gender stereotypes (Gillis-Buck and Richardson 2014). Following Cheslack- Postava and Jordan-Young (2012), I argued that if we accept sex/gender as the most productive way of investigating a certain pathology (a debatable premise in itself), an embodied model that takes the entanglement of sex and gender as its starting point is likely to be the most accurate, informative, and ethical approach. After the US National Institute for Mental Health announced the RDoC project, director Thomas Insel wrote the following reflection on the problem of reification in the DSM versus the new RDoC approach:

nature does not define the disorders designated by our current diagnostic labels, all of which were devised by committees of clinicians who were voting on the symptoms. …

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While genes cut across the current diagnostic labels, neuroimaging often helps us to sub- divide groups. By studying patterns of brain activity at rest or with activation, we can begin to let the brain tell us the different forms of mood, anxiety, or psychotic disorders. (2012)

There is a suggestion in this comment that neuroscience can ‘carve nature at its joints’. This same suggestion is at work in studies that use brain sex to elucidate the nature of psychiatric disorders. In these studies, the reification of brain sex and of brain diseases go hand in hand. Following Haraway (1988) and Barad (2007), I consider scientific practices to be a fundamental part of what they aim to measure. That is, the boundaries between male and female, healthy and pathological, and nature and nurture are not materialised in brains and then ‘discovered’ in scientific practices. Rather, they materialise, or are enacted, in the relationship between brains, scanners, observers, and the technosocial conditions in which these and other relevant actors are embedded (including the gendered history of mental health described in this chapter). This is not to say that disorders are not real, or not biological. They are, but in a different sense than suggested by Insel’s words. That is, they are relational and cannot be understood in isolation from the ‘apparatus of bodily production’ (Haraway 1988: 595) that maps them. At stake in this discussion is not just the question what women’s brains are but also the question of what kinds of subject positions the very preoccupation with brains brings about. As Thornton (2011a) has written, life is not medicalised so much because individuals are ‘brainwashed to accept pharmaceutical remedies for common distress’ but rather because ‘they are conditioned to understand life as a calculable project that they are responsible for assessing and quantifying through neurobiological lenses’ (113). Plasticity-based arguments that insist on the entanglement of nature and culture may be used as a tool to bring back into view the social factors shaping women’s bodies and their health, and thereby contribute to the re- politicisation of women’s health. Yet, at the same time, plasticity-based visions of the subject contribute to the individualisation of risk and health management precisely by rendering risk a non-deterministic and manageable phenomenon that may be targeted at the level of the individual body. That is, in popular brain-based discourses, plastic brain anatomy does not equal destiny, but it does figure as the point where all risk factors can be translated into a common brain-based language, and therefore functions as the appropriate target of intervention. As a result, a reconsideration of what bodies are and how knowledge about bodies is produced in a biomedical context should not take place without a simultaneous consideration of who can and

124 must be responsible for these bodies. In other words, envisioning an alternative future for women’s health advocacy is an ‘ethico-onto-epistemological’ challenge (Barad 2007, 185).

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Conclusion

This study critically examines how sex and gender are imag(in)ed in the 21st century brain. It builds on feminist scholarship that has critiqued the claim that sex differences in the brain are hardwired and dichotomous. Specifically, it enters into a conversation with neurofeminist work that has advanced brain plasticity as a major challenge to brain organization theory and as a desirable and necessary alternative research direction. Noting the shared history between brain organization theory and the (re)discovery of neurogenesis, this study asks, amongst other questions, to which extent plasticity is already taken into account in scientific, political and popular representations of brain sex, and to which effects. A recurrent finding in this dissertation is that, across multiple contexts, plasticity is conceptualized as a property of sexed brains. As such, plasticity is acknowledged whilst brain sex is kept firmly behind a ‘neurobiological line of defense’ (Rubin 2009, 419) that separates the fixed from the flexible. In Chapter 1, I have discussed how studies of environmental enrichment and of oestrogen actions in the brain use brain sex to ground and organize observations of neuroplasticity. In Chapter 3, I have read the claim that ‘boys and girls learn differently’ (Gurian et al. 2010 [2001]) as a claim about sex differences in plasticity, which enabled me to account for the success of brain-based boy advocacy. In Chapter 4, I have discussed maternal and paternal plasticity, which have given rise to the notion of a ‘bisexual’ or unisex brain. The continued use of the terms ‘maternal’ and ‘paternal’, however, presents yet another incarnation of ‘sex differences in plasticity’. Finally, in Chapter 5, I have discussed how the female brain is constructed as inherently at-risk due to its hardwired sex, yet at the same time plastically responsive to lifestyle adjustments with which women are encouraged to pro-actively manage their brain health. In addition, this chapter briefly considered a recent claim that sex/gender differences in autism might be understood as the result of sex differences in plasticity (Mottron et al. 2015). Amidst the veritable hype plasticity has unleashed at the turn of the 21st century, the claim that sex differences are hardwired into the brain appears decidedly old-fashioned. The successful persistence of this claim could be attributed to the endurance of a traditional gender ideology that requires biological determinism as its foundation. However, the analyses provided in this dissertation suggests that the enlistment of plasticity as a property of male and female brains also contributes to the continued acceptance of brain organization theory. By incorporating plasticity, this theory appears—at least superficially—as less deterministic since

127 it locates sexual difference at the level of brain circuits rather than at the level of behaviour. By fusing themes of determinism and freedom, this conceptualization of brain sex affirms femininity and masculinity as natural essences, but it is also capable of accounting for recent shifts in gender roles. For example: arguments that explain women’s underrepresentation in STEM fields by pointing to innate differences in math aptitude (as Harvard University president Lawrence Summers has infamously done in 2005) cannot easily account for time- and location- dependent shifts in the gender math gap. Arguments that focus on sex differences in learning style or brain maturation, however, can account for such shifts by linking them to changes in educational practices, and are therefore more agile and robust. Furthermore, this study shows that this fusion of determinism and plasticity aligns neurosexism with a neoliberal, postfeminist sensibility (Gill 2007; McRobbie 204) which affirms sexual difference as a natural essence but also thematises gender equality and self- determination. In the name of empowerment, freedom and self-indulgence, this sensibility encourages women to intensively discipline themselves to attain a feminine ideal. Rather than being straightforwardly anti-feminist, then, post-feminism has an ambiguous relationship with feminism (McRobbie 2004). This suggests the relationship between neurosexism and feminism might be more ambivalent than it appears at first sight, too. This is especially apparent in the final chapter, which highlights how women’s health organizations promote the investigation of sex as a biological variable as the last frontier of the women’s rights movement. Here, brain organization research is firmly positioned as a feminist practice. How, then, to respond? In this thesis, I have argued that the pervasiveness of neurosexism demands a critical alternative perspective that does not reject neurobiological knowledge but instead seeks to establish ‘neurological intimacy’ (Wilson 1998, 417). I have also argued that a material-discursive approach will provide the best framework for doing so. Such an approach accounts for the sociocultural practices in which differences materialize— including knowledge-making practices—but also for the (sexual) differences a body can make, without positing an underlying essence. In this account, plasticity refers to the inseparable entanglement of matter and meaning. But can such a critical perspective be used to challenge neurobiological determinism without fostering norms, values and subjectivities that are antithetical to feminism? Can plasticity be considered an ethical metaphor and a right tool for feminism? At the outset of this study, I have stated that there is no definitive answer to this question. Concepts travel, and do different kinds of work in different contexts. Indeed, the plasticity of plasticity has asserted itself throughout this study: it may be used to challenge the ‘tale of two brains’ that represents

128 brain sex as dichotomous and hardwired, or it may precisely be incorporated by—and used as evidence for—this tale. It may invoke the generativity and resilience of the flesh, or it may suggest we have full ownership and control over the body. It may serve to draw attention to the historical and cultural embeddedness of bodies, or it may highlight individualism. It may be used to challenge naturalized norms and celebrate diversity, or it may be harnessed to identify individuals who are at risk of diverting from what is considered normal or healthy. What does it mean, then, to (re)think the sexed/gendered subject as a neuroplastic subject? Again, there seems to be no conclusive answer, but by mapping the ontological, epistemological, and ethical considerations that this question provokes, this dissertation has (or so I hope) provided a rich description of the stakes that are involved.

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Summary

The Politics of Plasticity: Sex and Gender in the 21st Century Brain

The Politics of Plasticity critically examines how sex and gender are imag(in)ed in the 21st century brain. At the beginning of this century, the idea that the brain is plastic—that its structure and function can change in response to stimulation or injury—began to replace the idea that adult brains are fixed. The claim that sex differences are hardwired into the brain, however, is still frequently endorsed. This study builds on feminist scholarship that has critiqued this claim, and that has argued for a reconsideration of the relationship between sex/gender and the brain through the lens of neuroplasticity. In this dissertation, I argue that plasticity can indeed be used to develop a critical, material-semiotic account of how sex/gender comes to matter in the brain. However, noting the neoliberal, post-feminist tendencies of popular plasticity discourses, which compel individuals to engage in intensive self-surveillance and self-management through narratives of empowerment and choice, I also ask what kinds of norms, values and subjectivities a plasticity-based approach might unintentionally foster. Is plasticity, then, the right tool for feminism to challenge neurobiological determinism? By mapping the ontological, epistemological, and ethical considerations that this question provokes, The Politics of Plasticity examines the stakes that are involved in (re)thinking the sexed/gendered subject as a neuroplastic subject. Chapter 1 reviews the critiques that have been raised against brain organization theory by feminist critics, highlighting how the claim that brain sex is dichotomous and hardwired is supported by particular, highly selective ways of generating, comparing and representing data. To challenge the claim that sex differences in the brain must be present or programmed at birth, I review evidence from a range of research areas that suggests post-natal influences indeed affect the sexual differentiation of the brain. I also discuss examples of research in which plasticity is studied as a property of male and female brains, arguing that plasticity can not only subvert but also corroborate brain organization theory. Drawing on feminist theories that challenge the divide between the biological and the social, Chapter 2 reads a classic experiment on sex differences in different environments (Juraska et al. 1985) as a ‘material-discursive phenomenon’ (Barad 2007) in which brain sex materializes in the intra-action of genes, environmental stimuli, and the technoscientific

131 apparatuses used to render them visible. Here, plasticity appears as a useful tool to theorize the entanglement of sex and gender. Noting the shared history between brain organization theory and the (re)discovery of neurogenesis, this study asks to which extent plasticity is already taken into account in scientific, political and popular representations of brain sex, and to which extent this results in the preservation, transformation, and/or subversion of gender norms. Chapter 3 addresses this question in the ‘boy crisis’—a concern over boys’ educational achievement that has been spreading internationally since the turn of the century. Reading the claim that boys and girls learn differently as an assertion of ‘sex differences in plasticity’, I highlight how neuro-inspired boy advocates successfully respond to a changing society by simultaneously reaffirming masculinity as a natural essence and thematising individuality and freedom. I furthermore discuss how the male brain, in this literature, is conceptualized as a source of potential and of risk that requires an ‘invisible pedagogy’ (Bernstein 1977). Finally, I consider the impact of these views on Dutch educational policy. In Chapter 4, I turn to the family. The infant brain, the maternal brain and—very recently—the paternal brain have all been conceptualized in scientific, political and popular discourses as limited windows of exceptional plasticity. In this chapter, I discuss how these representations foster an ideology of intensive parenting (Hays 1996) which responds to, and further enacts, social (gendered, classed) inequalities. As a result, certain parents are designated as at risk and a risk, and therefore as appropriate targets for intervention. However, I also make the case that research on the plastic parental brain can be read differently, namely, as a challenge to women’s naturalized role of the primary caregiver and to the ideal of the nuclear family as the optimal developmental environment. Chapter 5, finally, focuses on women’s mental and brain health. I discuss how the progressive neurofication of mental disorders, together with the emergence of a women’s health movement that promotes research on sex as a biological variable, has imbued brain organization therapy with a therapeutic promise. Using schizophrenia and autism as examples, I argue that the promotion of brain organization theory as a way of understanding, curing and preventing psychological and psychiatric disorders reifies both brain sex and (sex/gender differences in) mental disorders, and obscures crucial information. This chapter also considers how the mobilization of brain sex and brain plasticity in ‘consumer’-oriented material provided by women’s health organizations constructs women as inherently at-risk but simultaneously capable of (and thus responsible for) pro-actively managing their health.

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Samenvatting

De Politiek van Plasticiteit: Sekse en Gender in het Brein van de 21ste Eeuw

De Politiek van Plasticiteit is een kritische studie naar de wijze waarop sekse en gender worden ingebeeld (en afgebeeld) in het brein van de 21ste eeuw. Aan het begin van deze eeuw begon het idee dat het brein plastisch is (dat de structuur en functie van het brein kunnen veranderen onder invloed van stimulatie of beschadiging) het idee dat volwassen hersenen onveranderlijk zijn te vervangen. De claim dat sekseverschillen in de hersenen van nature vastliggen wordt echter nog veelal onderschreven. Deze studie bouwt voort op feministisch onderzoek dat deze claim heeft bekritiseerd en dat ervoor heeft gepleit dat de relatie tussen sekse/gender en het brein opnieuw wordt overdacht, ditmaal in het licht van neuroplasticiteit. In deze dissertatie beargumenteer ik dat plasticiteit inderdaad kan worden ingezet om een kritisch, ‘materieel-semiotisch’ perspectief te ontwikkelen op de wijze waarop sekse/gender ertoe komt te doen (materialiseert) in relatie tot het brein. Tegelijkertijd besteed ik aandacht aan de neoliberale, post-feministische toon van populaire discoursen omtrent plasticiteit, waarbij het individu onder het mom van ‘empowerment’ en keuzevrijheid intensief wordt gestimuleerd om zichzelf te monitoren en om haar eigen doen en laten te reguleren. Ik ga op zoek naar de normen, waarden en subjectposities die bedoeld of onbedoeld worden gestimuleerd door het begrip plasticiteit, om een antwoord te vinden op de vraag: is plasticiteit het juiste feministische gereedschap om in te zetten tegen neurobiologisch determinisme? De Politiek van Plasticiteit brengt de ontologische, epistemologische en ethische aspecten van deze vraag in kaart en onderzoekt daarmee wat er op het spel staat wanneer we het gesekste/gegenderde subject willen (her)beschouwen als een neuroplastisch subject. Hoofdstuk 1 verschaft een overzicht van de kritiek die is geleverd door feministische critici op het idee dat sekseverschillen in de hersenen dichotoom zijn en vastliggen. Ik laat zien hoe deze claim in stand wordt gehouden doordat data op een selectieve wijze wordt verzameld, vergeleken en weergegeven. In dit hoofdstuk geef ik tevens een overzicht van het nog schaarse onderzoek dat suggereert dat diverse factoren na de geboorte een rol spelen in de vorming van eventuele sekseverschillen in de hersenen, waarmee de claim wordt weersproken dat dergelijke verschillen per definitie al aanwezig dan wel geprogrammeerd zijn bij de geboorte. Tot slot bespreek ik onderzoek waarin plasticiteit wordt geconceptualiseerd als een eigenschap van

133 mannelijke en vrouwelijke hersenen. Hier wordt plasticiteit niet ingezet als bewijs tegen, maar juist als een argument voor de claim dat sekseverschillen in het brein zijn aangeboren. In hoofdstuk 2 beschouw ik een klassiek experiment, waarin sekseverschillen in de hersenen van de rat worden onderzocht in verschillende omgevingen (Juraska et al. 1985), aan de hand van feministische theorieën die het onderscheid tussen het biologische of materiële en het sociale of discursieve ter discussie stellen. Ik lees dit experiment als een ‘materieel- discursief fenomeen’ (Barad 2007), waarbij sekse/gender in het brein materialiseert in de ‘intra- actie’ (Ibid.) van genen, omgevingsfactoren en de gehele techno-wetenschappelijke inrichting waarmee verschillen zichtbaar worden gemaakt. Hier gebruik ik het concept plasticiteit als een middel om de onlosmakelijke verwevenheid van sekse en gender in beeld te brengen. De theorie dat sekseverschillen in de hersenen zijn aangeboren en de (her)ontdekking van neuroplasticiteit kennen een gedeelde geschiedenis. Deze studie stelt daarom de vraag in hoeverre het begrip plasticiteit al een rol speelt in wetenschappelijke, politieke en populaire representaties van sekse en gender in het brein, en in hoeverre bestaande gendernormen hierbij worden behouden, getransformeerd en/of doorbroken. In hoofdstuk 3 wordt deze vraag onderzocht in de context van de ‘jongenscrisis’. Sinds het begin van deze eeuw heerst in diverse landen bezorgdheid over de prestaties van jongens in het onderwijs. In dit kader wordt veelal beweerd dat jongens en meisjes vanwege hun verschillende hersenen een verschillende educatieve aanpak nodig hebben. In dit hoofdstuk verklaar ik de populariteit van deze bewering door deze te beschouwen als een uitspraak over sekseverschillen in plasticiteit. We zien dan namelijk hoe populaire auteurs, die (pseudo-)neurowetenschap gebruiken om voor sekse- specifiek onderwijs te pleiten, de claim dat masculiniteit een natuurlijke, uniforme essentie is weten te verenigen met de visie dat elk kind een uniek individu is dat in potentie tot alles in staat is. Ik bespreek de wijze waarop het mannelijke brein hier wordt geconceptualiseerd als een bron van risico en potentie die vraagt om een ‘onzichtbare pedagogie’ (Bernstein 1977). Tot slot beschouw ik kort hoe deze zienswijze het Nederlandse onderwijsbeleid beïnvloedt. In hoofdstuk 4 kijk ik naar de familie. Het babybrein, het moederbrein en (sinds kort) het vaderbrein worden in diverse wetenschappelijke, politieke en populaire discoursen gerepresenteerd in termen van een gelimiteerde periode van exceptionele plasticiteit. In dit hoofdstuk bespreek ik hoe deze specifieke representaties een ideologie van intensief ouderschap (Hays 1996) bevorderen. Binnen deze ideologie worden sociale ongelijkheden met betrekking tot onder andere gender en sociale klasse in stand gehouden. Deze ongelijkheden bepalen mede welke ouders worden beschouwd als onderdeel van een risicogroep, waarbij risico een dubbele betekenis heeft: risico voor de ouder en (vooral) risico van de ouder (voor het kind).

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Tegelijkertijd beargumenteer ik hier dat recent onderzoek naar plasticiteit in het brein van ouders ook juist kan worden gebruikt om traditionele normen, zoals het idee dat vrouwen van nature beter geschikt zijn als primaire verzorger dan mannen, te ontkrachten. Hoofdstuk 5, tot slot, behandelt de psychische gezondheid van vrouwen. Ik beschrijf hoe de toenemende ‘neuroficatie’ van psychologische stoornissen, tezamen met de opkomst van een vrouwengezondheidsbeweging die onderzoek naar sekse als een dichotome, biologische variabele promoot, een grote therapeutische belofte heeft meegegeven aan de claim dat hersenen mannelijk of vrouwelijk zijn en dat deze sekseverschillen in de natuur vastliggen. Onderzoek naar sekseverschillen in de hersenen wordt derhalve beschouwd als een noodzakelijke en veelbelovende manier om psychologische en psychiatrische stoornissen beter te begrijpen, te genezen en te voorkomen. Aan de hand van twee voorbeelden, schizofrenie en autisme, laat ik echter zien dat deze strategie cruciale informatie over de aard van sekseverschillen in de hersenen en over de aard van sekseverschillen in mentale gezondheid buiten beschouwing dreigt te laten. In dit hoofdstuk bespreek ik tevens de wijze waarop de notie van het vrouwelijk brein en de notie van neuroplasticiteit in samenspel worden ingezet om vrouwen bewust te maken van hun gezondheidsrisico’s en om hen verantwoordelijk te stellen voor het proactief managen van hun eigen gezondheid, waarbij ik de rol van gendernormen en gezondheidsstatistieken in beschouwing neem.

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