Transsexualism – Nature or Nurture?
Until recently the prevalent thinking regarding transsexualism has been to treat it as a mental disorder rather than as a natural variation. Transsexuals, the theory held, had a disorder which caused them to see their gender identity as reversed from their physical sex. No one was born a transsexual under this theory. Transsexuality somehow arose after birth, even though psychologists struggled unsuccessfully to explain how.
This kept the question of transsexualism squarely in the realm of psychology where it probably would have remained if no alternative biological explanation arose. Fortunately, such an alternative biological explanation did arise, playing out against the prevailing psychological consensus over the better part of the past five decades.
The leading figures representing the two sides of this debate were Dr. John Money, and Dr. Milton Diamond.
Undifferentiation versus Organization-Activation
John Money was a psychologist known for his research on intersexed patients. Through his research in the 1950’s he concluded that people were born without gender identity. Gender identity, he surmised, was impressed upon them as infants and fixed ever afterward. That is – if a child is raised as a boy, he will grow up to identify as male; and if the same child is raised as a girl, she will grow up to identify as female.
He extrapolated this into a general theory applicable to all people: men, women, and intersexed alike. This theory was called “psychosexual undifferentiation” or “psychosexual neutrality at birth.”
At around the same time scientists in fields of biology were studying the role of genetics and sex hormones on the reproductive behaviors of animals. This research found that the adult sexual behavior in the animal world could be established (i.e. organized) by prenatal hormones, and that behavior could later be activated by the same hormones. This came to be known as the organization-activation theory.
The disjunction between these two theories (Undifferentiation pointing primarily to a “nurture” explanation for gender identity while organization-activation leaned heavily upon “nature.”) was readily recognized at the time. However they were reconciled by a curiously Victorian spin. It was posited that Money’s theory identified a uniquely human trait – yet another feature separating mankind from the beasts. Animals may be vulnerable to pre-natal factors in determining adult sexual traits, but socialization and other cultural factors overrode such base instinct in humans.
Not all biologists were content with this reconcilliation. Milton Diamond, a graduate student in biology at the University of Kansas at the time, submitted a critique to a biology journal challenging Money’s theory of undifferentiation at birth. Diamond believed that the forces of organization and activation which held true for other mammals likely also applied to humans. He argued that real evidence of gender neutrality at birth suggested by Money’s theory was lacking from his sample of exclusively intersexed individuals. After all, where were the cases of individuals born without an intersexed condition who had been shown to accept infantile sexual reassignment?
The John/Joan Case
It is hard to overstate the importance of what came to be known as the “John/Joan Case,” in light of this background.
Not long after Money had been challenged by Diamond he was presented with an infant male patient who had, through a botched circumcision, lost his penis. The patient had an identical twin brother who’s genitalia remained intact. Money convinced the parents to allow genital reassignment surgery on their damaged son, arguing that he would have far better prospects for future success and happiness as a girl.
This appeared to be the perfect case to test Money’s theory. Here were twin boys, identical in genes, inter-uterine developmental conditions, raised by the same parents, in the same home, attending the same schools. The only difference was that one was raised as a boy, and the other raised as a girl. Money had instructed the parents never to mention the sexual reassignment to their daughter, so as far as she and her twin brother knew she had been female from birth.
Money oversaw the case for years, regularly publishing about the child’s development into a well-adjusted, happy, and feminine girl. He concluded that this success confirmed his theory of gender neutrality at birth. It was indeed possible to sexually reassign an infant born unambiguously male to be reared successfully as a normal girl.
The case was seized upon by popular media, and widely cited throughout the psychological and sociological texts which followed. It was heralded by feminists as vindication of their belief in gender as a purely social construct.
In the medical world, it lead to the normalization of surgical “correction” of ambiguous genitalia at birth among pediatricians. There was no longer any need to worry about underlying sexual identity – only external physical appearence. Sexual identity would take care of itself as the child grew up. Untold thousands of intersexed children received unrequested sexual reassignments at birth during the following decades.
This would also bring about consequences for transsexuals. John/Joan had established that gender was established by your upbringing. Transsexuals were claiming to possess gender identities in defiance of both their bodies and their upbringing. As this defied the prevailing theory, transsexuals were classified as suffering from a mental pathology. This theory held sway largely unchallenged into the late 1990’s.
Money’s theory may have held sway in the worlds of psychology and medicine, but independent research continued to raise questions. This was partially due to quietly emerging facts around the critical “John/Joan” case subject.
Money had reported that this case had been a success, and that the child had grown into a happy, well adjusted girl. Follow up research conducted by others found that this wasn’t so.
The child’s real name had been David Reimer, changed to Brenda upon the sexual reassignment. Brenda steadfastly refused to accept a female identity, leading to suicidal depression by her early teens. By the age of 14, Brenda assumed a male gender identity, reclaiming the name David. For years afterward David struggled to reclaim his male identity physically as well as socially.
Though the implications of this development directly challenged Money’s theory of undifferentiation at birth, Money showed little interest in following up on the case, and those who did discovered scant interest in their findings throughout the 80’s and into the 90’s.
This changed when, in 1997, Milton Diamond persuaded the now-adult David Reimer to go public with his story in the hopes that it may prevent other children from suffering his fate. This story was then popularized by a prominent article in Rolling Stone magazine.
This development sent shock waves throughout a medical world in which infant sexual reassignment had become far more common than was widely known by the general public. Money’s lack of followup and his surprising silence in light of the development spoke loudly about the soundness of his theory in light of the new evidence.
This thrust the organization-activation theory was back into the spotlight, leading to a relative explosion of research from the late 90’s through the current day. Next post, I’ll start to explore some of this research attempting to describe the mechanisms involved in organization-activation within humans, and how this relates to transsexuals, intersexed people, and everyone else.
A more detailed examination of the above complete with scholarly references is available in the article: “Clinical implications of the organizational and activational effects of hormones,” by Milton Diamond, published in the journal Hormones and Behavior in March 2009 (pdf link). Thanks to Dr. Veronica Drantz for the reference.