In a comment on my last post on gender differences in children, Darleen urged me to read As Nature Made Him: The Boy Who Was Raised as a Girl, by John Colapinto. I had heard good things about the book before, but I hadn’t read it, so I added it to my list.
The book is about David Reimer, the man who was one of the most famous medical "cases" ever, a touchstone in the debates about gender identity and the roles of biology and culture. As an 8-month-old baby boy, his penis was totally destroyed in a freak circumcision accident. (Lesson one of the book: don’t let anyone circumcise your kids with an electrocautery machine.) Following the advice of Dr. John Money, a respected psychologist, the Reimers had the baby castrated and a rudimentary vagina created surgically and raised her as a girl, "Brenda." Brenda would have been a subject of scientific interest in any case, but the fact that she had an identical twin brother, Brian, turned her into close to the holy grail for researchers, an experimental case with a control. Dr. Money featured her in dozens of articles, arguing that her successful transformation into a normal girl was proof that nurture, not nature, was the dominant factor in determining gender identity.
Unfortunately for Dr. Money’s argument, John Colapinto shows that Brenda was a desperately unhappy little girl who rejected all traditionally girl-ish pursuits, in spite of her parents’ frantic efforts to make her conform to her new gender identity. She resisted all attempts to convince her to have the plastic surgery needed to complete her genital transformation, and as soon as she learned her true story, insisted on changing her name and living as a boy. He eventually had surgery to recreate male genitals, as well as a double mastectomy to remove the breasts that he had grown from taking female hormones. While David had a period of deep depression as a young man, today at the time the book was written, he is appeared to be content in his life, happily married and a father through adoption. [Edited to reflect the fact that he later committed suicide, as Fred informed me in his comment.]
The other major strand in the book is Colapinto’s damning portrait of Dr. Money. He makes a convincing case that Money consistently ignored the growing evidence that Brenda’s sex transformation was a disaster, because it was contradictory to his theory, continuing to cite the case as a success long past the point when such a claim was reasonable. Moreover, he suggests that Money’s treatment of Brenda was essentially sexual abuse, as he pushed the young girl to discuss her fantasies and even role play sexual situations with her brother. (Because Money totally refused to cooperate with the writing of the book, there is no attempt to portray his side of the story.)
So, it’s a fascinating human-interest story, and Colapinto does a good journalistic job of laying it out for the reader. But where does it leave us in the endless nature-nurture debate? While I enjoyed reading the book, at times I yearned for a more acute scientific guide, someone who would probe further into the contradictions of what we mean by gender, who didn’t take Brenda’s willingness to throw a punch and her desire to pee standing up as proof positive that she was meant to be male.
The one piece of solid scientific ground is that Money’s pure nurturist hypothesis seems to have been pretty much totally discredited, in part because of the case of David Reimer. The more we learn about fetal brain development and its sensitivity to a variety of environmental influences, the less reasonable it becomes to think that powerful hormones like estrogen and testosterone would have such fundamental effects on other aspects of fetal development, but none on the brain.
But I think it’s fair to say that we simply don’t have a theory of gender identity that really makes sense of — and listens to with respect — the experiences of both David Reimer and biologically normal transsexuals like Jennifer Boylan. We don’t even have a language to talk about gender identity that doesn’t fall back on such caricatures as ascribing all concern about appearance and relationships to femininity and all interest in mechanics and competition to masculinity. And without such a language, we spend a lot of time talking past each other.