Cet article porte sur la discussion d’un cas d’intersexuation par le psychiatre Valentin Magnan et le chirurgien Samuel Pozzi, en 1911. Il met en évidence les problèmes épistémologiques et ontologiques que pose la divergence entre les dimensions organiques et psychosociales du sexe, et discute leur persistance dans la médecine contemporaine du genre.

L’exposé de Magnan et Pozzi fait l’objet d’une micro-analyse visant à restituer la logique interne, les présupposés théoriques et les implications métaphysiques des jugements cliniques.

L’observation de Magnan établit une symétrie entre le sexe organique défini par les gonades, et le sexe « psychique » identifié à l’instinct sexuel mais aussi à certaines caractéristiques psychologiques et morales. Le psychiatre suggère une mise en équivalence ontologique de ces deux dimensions du sexe, et propose une interprétation naturaliste de leur incongruence. Celle-ci illustre cependant l’impasse épistémologique qui résulte de l'identification du sexe  « psychique » à une propriété du cerveau. Pozzi évite cette impasse en proposant une théorie psychologique qui permet d’envisager le rôle de l’environnement social et des croyances du patient dans la formation de l’identité sexuée. Cette perspective confère au sexe « psychique » un statut ontologique ambigu, entre réalité et illusion.

Certains de ces problèmes se perpétuent aujourd’hui notamment dans les controverses sur la dysphorie de genre des adolescents.

Les limitations intrinsèques de l’expertise médicopsychologique appellent une réflexion de fond sur l’ontologie de l’identité sexuée.

This article explores the history of medical and psychological expertise on sex/gender identity by studying the presentation of a case of “hermaphroditism” given by the psychiatrist Valentin Magnan and the surgeon Samuel Pozzi in 1911. It examines how these authors dealt with the discrepancy between the organic and psychosocial dimensions of sex, and it highlights the epistemological and ontological problems that emerge. The article also discusses the continuing echoes in current controversies in gender medicine.

Our study consists of an in-depth analysis of a presentation given to the French Academy of Medicine regarding a case of “inversion du sens génital chez un pseudo-hermaphrodite féminin [sexual inversion in a female pseudo-hermaphrodite]”. We conducted a detailed analysis of the minutes of the presentation, with the aim of revealing the internal logic, theoretical presuppositions, and metaphysical implications of the clinical judgements made by Magnan and Pozzi. Our primary sources include other texts by Magnan and his contemporaries on homosexuality and “sexual perversion”. Historical and epistemological studies of sex, sexuality, and hermaphroditism are used as secondary sources. Our theoretical framework draws mainly on the epistemological concepts of Kuhn and Bachelard.

The clinical observations presented by Magnan opposed the patient's organic sex, which was, despite the presence of ambiguous genitalia, unambiguously female given the histology of the patient's gonads (ovaries), and the patient's psychological sex, which was defined as male based on both the patient's sexual attraction to women and the patient's psychological and moral characteristics. The psychiatrist's discourse suggested both symmetry and ontological equivalence between these two dimensions of sex. Overlooking the potential role of early gender assignment, education, and social environment on the patient's self-identification as male, Magnan proposed a naturalistic interpretation of the case, summed up by the expression “a male brain in a female body”. In his earlier writings on “sexual inversion”, Magnan frequently uses the above phrase and the reciprocal “female brain in a male body”, directly echoing Ulrichs’ famous “female soul in a male body”. However, in the context of the 1911 presentation, the use of this phrase appears to reflect an epistemological impasse, which results from the conjunction of the paradigms “hermaphroditism” and “sexual perversion”. In contrast, Pozzi avoided this impasse by proposing a theory that highlights the role of the patient's social environment and beliefs in the development of their sexual instinct and the formation of their identity. This theory draws on the psychological mechanism of suggestion as well as on Darwin's reflections on the domestication of animals. This perspective introduces an ontological hierarchy between organic sex and psychological sex, the latter being likened, in some cases at least, to a kind of illusion.

Our study contributes to the exploration of the historical distinction between sex and gender by revealing the gap between the views of Magnan and Pozzi and those of the pioneers of sexology and psychoanalysis. However, we have also highlighted some epistemological and ontological problems that still pervade contemporary gender medicine. In particular, these are to be found in the persistent opposition between essentialist and environmentalist approaches to gender identity, in debates around the place of medical diagnoses in gender reassignment, and in the controversies over the role of social contagion in adolescent gender dysphoria.

Medical and psychological expertise on gender remains embedded in an epistemological matrix inherited from the field of sexual medicine in the late nineteenth century. The resulting intrinsic limitations call for an in-depth reflection on the ontology of gender identity.