on the exact same day, at the exact same moment,

我希望大家設想一下， 兩對夫婦

each conceiving a baby, OK?

在1979年的年中

So two couples each conceiving one baby.

在相同的一天，相同的時刻

Now I don't want you to spend too much time imagining the conception,

每對懷上了一個孩子 -- 好。

because if you do, you're not going to listen to me,

那麼兩對夫婦各自都都懷上了一個孩子

so just imagine that for a moment.

但我不希望大家花太多時間去想像懷孕的進程,

And in this scenario, I want to imagine that, in one case,

因為如果你花太多時間去想它,

the sperm is carrying a Y chromosome,

你就不會聽我說下去。

meeting that X chromosome of the egg.

所以稍微想一下就好了。

And in the other case, the sperm is carrying an X chromosome,

那麼在這種情況下,

meeting the X chromosome of the egg.

我來設想一下，一種情況是

Both are viable; both take off.

攜帶者Y染色體的精子

We'll come back to these people later.

遇到攜帶者X染色體的卵子

So I wear two hats in most of what I do.

另一種情況

As the one hat, I do history of anatomy.

攜帶者X染色體的精子,

I'm a historian by training, and what I study in that case

遇到攜帶者X染色體的卵子。

is the way that people have dealt with anatomy --

兩種情況都可能

meaning human bodies, animal bodies --

我們之後再來看這兩對夫婦。

how they dealt with bodily fluids, concepts of bodies;

在我所從事的領域

how have they thought about bodies.

我擔任兩個角色。

The other hat that I've worn in my work is as an activist,

一個角色是,

as a patient advocate --

我做解剖身體結構學歷史研究。

or, as I sometimes say, as an impatient advocate --

我是個史學工作者,

for people who are patients of doctors.

我所研究的是

In that case, what I've worked with is people who have body types

人類對於身體結構的處理方法--

that challenge social norms.

即人類軀體，動物軀體--

So some of what I've worked on, for example,

他們如何處理非常態的軀體，概念上的軀體;

is people who are conjoined twins --

他們是如何認識軀體。

two people within one body.

另一個角色是

Some of what I've worked on is people who have dwarfism --

一名活動家

so people who are much shorter than typical.

作為一個為病人辯護人的角色--

And a lot of what I've worked on is people who have atypical sex --

或者說，像我有時候說的，是一個很急切的宣導者的角色--

so people who don't have the standard male or the standard female body types.

為了那些醫生的病人們。

And as a general term, we can use the term "intersex" for this.

那樣的話，在我工作中

Intersex comes in a lot of different forms.

所接觸到的是一些

I'll just give you a few examples of the types of ways you can have sex

挑戰著社會規範的人。

that isn't standard for male or female.

因此，我接觸到的，例如

So in one instance,

像連體嬰兒這樣的人,

you can have somebody who has an XY chromosomal basis,

兩個人共用一個身體。

and that SRY gene on the Y chromosome

還有一些是侏儒症患者,

tells the proto-gonads, which we all have in the fetal life,

他們比一般人要矮小的多。

to become testes.

另外，許多我接觸的人

So in the fetal life, those testes are pumping out testosterone.

的性別與眾不同 --

But because this individual lacks receptors to hear that testosterone,

即他們沒有很標準的男性特徵

the body doesn't react to the testosterone.

或者女性特的身體類型。

And this is a syndrome called androgen insensitivity syndrome.

總的來說，這個症狀可以被叫做雙性人。

So lots of levels of testosterone, but no reaction to it.

雙性可以有多種的形式。

As a consequence, the body develops more along the female typical path.

我來舉幾個例子

When the child is born, she looks like a girl.

來說明你可以具有

She is a girl, she is raised as a girl.

既不是標準的男性特徵也不是標準的女性特徵的類型。

And it's often not until she hits puberty and she's growing and developing breasts,

例子之一,

but she's not getting her period,

一個人可以擁有XY染色體,

that somebody figures out something's up here.

並且，在Y染色體上的SRY基因(雄性性別決定基因)

And they do some tests and figure out

刺激我們在胎兒時期都有的原始性腺

that, instead of having ovaries inside and a uterus,

變成睾丸。

she has testes inside, and she has a Y chromosome.

因此在胎兒時期，睾丸放出睾丸激素。

Now what's important to understand

但是這個個體缺少受體

is you may think of this person as really being male,

來接收睾丸激素,

but they're really not.

身體不能對睾丸激素做出反應。

Females, like males,

這是一種叫做雄激素不敏感（睾丸女性化）綜合征。

have in our bodies something called the adrenal glands.

所以，雄激素的數量很大，但是不能引起反應。

They're in the back of our body.

因此，身體就會朝著

And the adrenal glands make androgens, which are a masculinizing hormone.

女性化的趨勢發展。

Most females like me -- I believe myself to be a typical female --

當嬰兒誕生時，她看起來像個女孩兒。

I don't actually know my chromosomal make-up,

她就是女孩兒，並且被當作小姑娘來撫養。

but I think I'm probably typical --

大多數情況，直到青春期

most females like me are actually androgen-sensitive.

她的胸部開始發育的時候,

We're making androgen, and we're responding to androgens.

她卻沒有經期,

The consequence is that somebody like me

於是被開始發現有一些不妥。

has actually had a brain exposed to more androgens

於是他們檢查發現

than the woman born with testes who has androgen insensitivity syndrome.

她並沒有發育卵巢和子宮,

So sex is really complicated --

實際上，在她身體內有睾丸，並且她攜帶著Y染色體。

it's not just that intersex people

現在，有一個重要問題需要說明的是

are in the middle of all the sex spectrum --

大家一定認為這個人實際上是個男孩兒,

in some ways, they can be all over the place.

但也並非如此。

Another example:

女孩, 像男孩同樣,

a few years ago I got a call from a man who was 19 years old,

在我們身體內有一個器官叫做腎上腺。

who was born a boy, raised a boy,

它在我們身體的後部。

had a girlfriend, had sex with his girlfriend,

負責分泌雄性激素,

had a life as a guy,

即一種雄性荷爾蒙。

and had just found out that he had ovaries and a uterus inside.

像我一樣的大多數女性--我相信我自己是個典型的女性--

What he had was an extreme form

我其實不太清楚我的染色體的組成

of a condition called congenital adrenal hyperplasia.

但是我想我應該是可以代表典型性的 --

He had XX chromosomes,

大多數像我一樣的女性實際上是雄激素敏感。

and in the womb, his adrenal glands were in such high gear

我們分泌雄性激素，並且對它有反應。

that it created, essentially, a masculine hormonal environment.

結果是，那些像我一樣的人,

And as a consequence, his genitals were masculinized,

大腦暴露在更多的雄性激素下

his brain was subject to the more typical masculine component of hormones.

而不是出生時就有睾丸

And he was born looking like a boy -- nobody suspected anything.

即雄性激素不敏感綜合征。

And it was only when he had reached the age of 19

所以說性別是個非常複雜的東西；不僅僅是那些雙性的人

that he began to have enough medical problems from menstruating internally,

即處在兩性之間的人 --

that doctors figured out that, in fact, he was female, internally.

在某些方面，這種人到處都是。

OK, so just one more quick example of a way you can have intersex.

還有一個例子:

Some people who have XX chromosomes develop what are called ovotestis,

幾年前，我接到一個19歲男子打來的電話,

which is when you have ovarian tissue with testicular tissue wrapped around it.

他生下來是個男孩，也被當作男孩來養,

And we're not exactly sure why that happens.

後來有了女朋友，也和女友發生了性關係,

So sex can come in lots of different varieties.

一直過著男孩的生活,

The reason that children with these kinds of bodies --

但最近，他發現自己體內有卵巢和子宮。

whether it's dwarfism, or it's conjoined twinning,

他所患的是一種極端形式的

or it's an intersex type --

叫做先天性腎上腺皮質增生症。

are often "normalized" by surgeons

他攜帶XX染色體

is not because it actually leaves them better off in terms of physical health.

並且在子宮內的時候,

In many cases, people are actually perfectly healthy.

他的腎上腺很活躍

The reason they're often subject to various kinds of surgeries

從而形成了一個男性荷爾蒙的環境。

is because they threaten our social categories.

結果就是，他發育了男性生殖器官,

Our system has been based typically on the idea

他的大腦接受了

that a particular kind of anatomy comes with a particular identity.

更多的典型的男性荷爾蒙的成分。

So we have the concept that what it means to be a woman

因此他生下來看起來像個男孩兒--根本沒人懷疑。

is to have a female identity;

只有當他長到19歲的時候

what it means to be a black person is, allegedly, to have an African anatomy

當他開始遇到生理問題的時候

in terms of your history.

也就是說從體內出現月經起,

And so we have this terribly simplistic idea.

醫生指出，實際上他的內部是女性。

And when we're faced with a body

好，我們再來快看一個例子,

that actually presents us something quite different,

可能具有兩性特徵的例子。

it startles us in terms of those categorizations.

一些有XX染色體的人

So we have a lot of very romantic ideas in our culture about individualism.

會發育一種叫做卵睾的器官,

And our nation's really founded on a very romantic concept of individualism.

也就是當卵巢組織

You can imagine how startling then it is

被睾丸組織包裹起來的一種器官。

when you have children who are born who are two people inside of one body.

我們還不能確定它的成因。

Where I ran into the most heat from this most recently

所以說性別可以是很多種形式。

was last year when South African runner, Caster Semenya,

孩子們

had her sex called into question at the International Games in Berlin.

擁有這些身體特徵的--

I had a lot of journalists calling me, asking me,

不論是侏儒症，或者連體嬰兒

"Which is the test they're going to run

或者是雙性型的--

that will tell us whether or not Caster Semenya is male or female?"

經常被外科醫生要求變得和正常人一樣的原因

And I had to explain to the journalists there isn't such a test.

實際上不是因為那樣

In fact, we now know that sex is complicated enough

對身體健康比較好。

that we have to admit:

因為很多情況下，他們的身體其實都很健康。

Nature doesn't draw the line for us between male and female,

他們接受各種外科手術的原因

or between male and intersex and female and intersex;

是因為他們恐懼我們社會上對人的分類。

we actually draw that line on nature.

或者說社會體系已經有一個典型的認識

So what we have is a sort of situation where the farther our science goes,

也就是一個有特殊身體結構的人，伴隨著特殊的身份。

the more we have to admit to ourselves that these categories

因此，我們的概念就是最為一個女人

that we thought of as stable anatomical categories,

就必須有女性的特性;

that mapped very simply to stable identity categories

以此類推，一個黑人

are a lot more fuzzy than we thought.

就得具有在你的履歷中

And it's not just in terms of sex.

非洲人的身體結構特徵。

It's also in terms of race,

因此我們就有了這種過於簡單而糟糕的認識。

which turns out to be vastly more complicated

當我們面對一個

than our terminology has allowed.

某些方面是完全與眾不同的身體的時候,

As we look, we get into all sorts of uncomfortable areas.

那些把他們歸為另類的想法讓我們感到吃驚。

We look, for example, about the fact

應此我們的文化中有很多關於個人主義

that we share at least 95 percent of our DNA with chimpanzees.

不切實際的想法。

What are we to make of the fact

並且我們國家建立在一個非常不實際的個人主義的概念上。

that we differ from them only, really, by a few nucleotides?

好，你可以想像這會是多麼令人震驚,

And as we get farther and farther with our science,

倘若你有兩個孩子

we get more and more into a discomforted zone,

出生的時候是兩個身體生在一個身體中。

where we have to acknowledge that the simplistic categories we've had

我最近一次遇到這種情況是

are probably overly simplistic.

去年的時候，非洲田徑運動員，卡斯特爾·塞門亞,

So we're seeing this in all sorts of places in human life.

在柏林國際比賽中被質疑性別問題。

One of the places we're seeing it, for example,

許多記者給我打電話，問我:

in our culture, in the United States today,

「他們會用哪種檢測方法

is battles over the beginning of life and the end of life.

來向大家證明

We have difficult conversations

卡斯特爾·塞門亞是男還是女？」

about at what point we decide a body becomes a human,

於是我不得不跟他們解釋說，根本沒有檢測的方法。

such that it has a different right than a fetal life.

事實上，我們現在已經瞭解

We have very difficult conversations nowadays --

性別是非常複雜的,

probably not out in the open as much as within medicine --

我們不得不承認

about the question of when somebody's dead.

大自然根本就沒有一個明確的分界線來區分男性或女性,

In the past, our ancestors never had to struggle so much

或者男性和雙性以及女性和雙性;

with this question of when somebody was dead.

這條分界線實際上是我們自己畫的。

At most, they'd stick a feather on somebody's nose,

因此我們現在的情況是

and if it twitched, they didn't bury them yet.

科學越發展

If it stopped twitching, you bury them.

我們越要對我們本身承認

But today, we have a situation

這些性別的分類形式,

where we want to take vital organs out of beings

也就是我們認為很理所當然的身體結構學上的分類

and give them to other beings.

即過於簡單把人

And as a consequence,

分成了不同的性別群體分類

we have to struggle with this really difficult question

實際情況要比我們想像的模糊的多。

about who's dead,

並且這不僅僅是關於性別的問題。

and this leads us to a really difficult situation

也同樣是關於種族的問題,

where we don't have such simple categories as we've had before.

這個複雜程度

Now you might think that all this breaking-down of categories

遠不是我們的學術語言所能形容的。

would make somebody like me really happy.

如我們所見，我們涉及各種各樣艱難的領域。

I'm a political progressive, I defend people with unusual bodies,

我們來看一個例子，現實情況是

but I have to admit to you that it makes me nervous.

我們用95%的人類的DNA

Understanding that these categories

與大猩猩進行對比。

are really much more unstable than we thought makes me tense.

我們該如何領受事實上

It makes me tense from the point of view of thinking about democracy.

人類和大猩猩的DNA只是在一些核苷酸上有所不同?

So in order to tell you about that tension,

科技越是發展,

I have to first admit to you a huge fan of the Founding Fathers.

我們越會涉及到讓人苦惱的領域,

I know they were racists, I know they were sexist,

那些我們現在必須認識到的

but they were great.

曾經過於簡單化

I mean, they were so brave and so bold and so radical in what they did,

的生物分類領域。

that I find myself watching that cheesy musical "1776" every few years,

正因如此，我們正在審視著

and it's not because of the music, which is totally forgettable.

人類生活中的各個領域

It's because of what happened in 1776 with the Founding Fathers.

我們看到其中一個領域，舉個例子,

The Founding Fathers were, for my point of view,

當今美國的文化領域,

the original anatomical activists,

激烈爭辯著生命的起源和終結。

and this is why.

我們有一個艱難的討論

What they rejected was an anatomical concept

關於我們從什麼時候一個軀體成為了一個人,

and replaced it with another one

從而有了不同於胎兒的權利。

that was radical and beautiful and held us for 200 years.

我們當今有一個非常困難的爭論--

So as you all recall,

也許在外部不如在醫學界內爭論的激烈--

what our Founding Fathers were rejecting was a concept of monarchy,

是關於何時認定為人死亡的疑問。

and the monarchy was basically based on a very simplistic concept of anatomy.

過去，人死的時候,

The monarchs of the old world didn't have a concept of DNA,

我們的祖先從來不會過多的糾結於此。

but they did have a concept of birthright.

最多也就是把一個羽毛粘在人的鼻子下,

They had a concept of blue blood.

如果羽毛動了，旁人就不會把他們埋掉。

They had the idea that the people who would be in political power

如果羽毛不動，就會埋了他們。

should be in political power because of the blood being passed down

但是如今的情況都是

from grandfather to father to son and so forth.

我們希望把死者的器官

The Founding Fathers rejected that idea,

移植到其他人的身體上。

and they replaced it with a new anatomical concept,

結果就是

and that concept was "all men are created equal."

我們開始糾結在上面所提到的難題中

They leveled that playing field and decided the anatomy that mattered

關於到底是誰死了沒有。

was the commonality of anatomy, not the difference in anatomy,

這導致我們進入一個很困難的情況,

and that was a really radical thing to do.

這個情況不適用之前過於簡單的分類。

Now they were doing it in part

現在你也許會想，所有的這些正在崩潰的分類

because they were part of an Enlightenment system

也許會讓像我這樣的人感到高興。

where two things were growing up together.

我是一個在政治觀點上不斷進步的人，我維護那些身體異于常人的人,

And that was democracy growing up,

但是我必須承認，這種改變讓我感到不安。

but it was also science growing up at the same time.

知道這個群體生活的不穩定程度

And it's really clear, if you look at the history of the Founding Fathers,

要遠遠高過我們的想像令我感到緊張。

a lot of them were very interested in science,

我的緊張是來自

and they were interested in the concept of a naturalistic world.

於民主的觀點。

They were moving away from supernatural explanations,

所以，為了告訴大家這種緊張的程度,

and they were rejecting things like a supernatural concept of power,

我首先要承認，我是開國元勳的忠實擁躉。

where it transmitted because of a very vague concept of birthright.

我知道他們是種族主義者，他們是男性至上主義者,