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From the Forum: Constructed Gender?
May 20, 2003
by Myria

Recently the idea of gender-as-construct has been raised several times here. Often referred to as "enculturation", the idea is that not only is your social gender role a matter of sociology, but your inner gender identity is as well. From that some theorize that your sexuality itself is extrapolated and is itself a construct and not an inherent component. Enculturation theory is an important part of many branches of modern feminist thought and, if true, enculturation theory has a number of exceedingly important and wide-ranging implications. Unfortunately for enculturation proponents, there is a rather major problem with the theory, one they are generally either ignorant of or choose to ignore for convenience sake.

The scientific father of the gender-as-construct idea was Dr. John Money. Now retired, Dr. Money was a New Zealand born and Harvard educated psychologist who came to prominence at John Hopkins where he eventually ran the Psychohormonal Research Unit and co-founded the influential John Hopkins GIC (Gender Identity Clinic). Once considered the world's foremost expert on sexology and credited by many (incorrectly, in my opinion) as having coined the term "gender identity" to describe one's inner perception of one's self as man or woman, it's hard to overestimate the effect he had on how gender was viewed psychologically and clinically and that effect continues in large measure to this day.

Approximately one out of every 2,000 births results in some degree of mixed or malformed genitalia - what is today referred to as Intersexuality or simply "IS" (I should note here that not all forms of intersexuality result in malformed genitalia). There are a number of different causes for intersexuality - everything from genetics to environmental factors - and it manifests in any number of ways. At its simplest an infant might have an enlarged penis-like clitoris or a small ("micro-") clitoris-like penis but otherwise be "normal". At it's most complicated an infant's body may not be able to produce and/or utilize (id est, occurring on the conversion and/or receptor and/or transcription level) an entire class or simply one hormone.

Starting in the late eighteen hundreds and into the early nineteen hundreds were some of the first real efforts to study and, in some rare instances surgically and hormonally help, IS adults. Into the nineteen fifties - or, for that matter, even today - no one was entirely sure what, if anything, to do for obviously IS infants.

Among other things, the Psychohormonal Research Unit at John Hopkins studied IS individuals, especially infants. Dr. Money observed that IS infants born with identical physiologic symptoms were in some instances being raised as male and in other instances being raised as female. He concluded that it didn't matter how exactly a child was raised, they would become what they were raised as - gender identity, your sense of self as a man or a woman, was not something you were born with but instead something you learned.

At the time being functional sexually - what was referred to as "erotic functioning" - was considered of paramount importance to proper psycho-social development. In many, if not most, instances, "normal" sexual function would be difficult to impossible for the IS infants being studied. The technology of the day - and, for that matter, to this day - was such that creating a functional - cosmetically and, most often, orgasmically - neo-vagina surgically was a relatively easy matter. The state-of-the-art was crude then compared to today, but considered within acceptable limits. Creating a functional neo-phallus, however, was and is wholly beyond us. The best results of even today's state-of-the-art forearm flap phalloplasty creates questionable results (referred to by some as a "frankenpenis"), it was even worse then and not considered acceptable.

Dr. Money believed that infants were born psychosexually tabula rasa, their gender identity something they gained later from their parents and society. He believed he had proven this with his observations of IS children and he acted on this belief, creating a set of protocols that for the aforementioned practical reasons meant that IS children would be reassigned as female regardless of their chromosomal sex or any physiological sex indicators. He felt that this needed to be done as early as possible - the thirty month point being the cut off (why thirty months is not exactly clear) - and that the child should under no circumstances be told what was had been done to them. Many of these protocols, by the way, remain in force today.

Dr. Money's ideas went very much against the science of the day, which focused not on psycho-social aspects but instead on chromosomal/genetic and hormonal sources for gender identity. But given Dr. Money's charisma and force of personality, the apparent successes he was having, the prestige of John Hopkins, and the fact that he was presenting a simple solution to what had been a vexing emotional mine field, his ideas and protocols were accepted and became the norm with stunning rapidity. It soon became "common knowledge" that gender identity was something you learned, not were born with.

Dr. Milton "Mickey" Diamond was one of the few who questioned Dr. Money's theories and protocols. Dr. Diamond looked at the issue from a physiologic rather than psychologic point-of-view. Experiments Dr. Diamond had performed in animals showed that altering the hormonal environment of a developing fetus could have profound effects on said fetus' development and later behavior. This more than hinted at the brain being "sexed" at some point in development and that indicated a physiologic root for gender. If he was correct, then what Dr. Money was doing was misguided at best, an abomination at worst.

Fetal developmental physiology was at best at it's infancy at that time - it still is, really, though we know a lot more now than we did then. What Dr. Diamond was showing was the results of what is sometimes referred to as a "hormonal wash". Put simply, early on a fetus is neither male nor female, but is instead "null" and capable of being either. At a certain point in development a "hormonal wash" is generated by a feedback loop between the developing fetus and the mother. If that "wash" is androgenic the child develops into male, if it's estrogenic then female. The fetus' chromosomal make-up does not itself cause this differentiation, it merely controls the factors that do. At least in theory, intersexuals were by definition proof that sometimes this process doesn't go as planned.

One of the things Dr. Diamond was trying to show that was there was more than one "sexing" going on during development. The brain, being more complicated and developing at a slower rate than much of the rest of the body, was "sexed" at a different point. He believed, and later proved, that this resulted in actual physiologic differences in the brain - both animal and human. This was a potentially terminal flaw in the notion that gender identity was wholly learned.

In 1965 Dr. Diamond published a scathing critique of Dr. Money's theories. Among other things, he pointed out that basing notions of gender development for all humans based on the results of what were essentially human experiments on intersexual children suffered from any number of obvious problems. There were too many unknowns and too many variables. For Dr. Money's theories to be considered valid in a wider sense he would have to show that his technique could be successful in an otherwise developmentally normal child.

The universe has a perverse sense of humor. Against all odds, in 1967 Dr. Money got his chance to do exactly what Dr. Diamond had proposed.

On August 22, 1965 maternal twin boys were born to a couple in Canada. On August 27 both of the boys were to be circumcised. During the procedure the twin who came to be known as "John" (a pseudonym for obvious reasons, the other twin being called "Kevin") had his penis severely burned beyond any hope of repair.

The horrified parents eventually contacted Dr. Money, who must have seen this as a gift from the gods. Here was a chance to not only fulfill Dr. Diamond's challenge, but a genetically identical control was thrown into the mix for good measure. Dr. Money could not have hoped for a better test subject. At 22 months, well within Dr. Money's 30 month limit, "John" was surgically, and later hormonally, reassigned and became "Joan". "Joan" developed as a normal female, her brother as a normal male, and the whole thing was a rousing success proving once and for all that Dr. Money's ideas about sex and gender were correct. Today you can hardly pick up a psychology text that doesn't discuss the case of John/Joan, its success is the bedrock upon which the entire notion of gender identity as a social construct stands.

There's only one problem, it was all a lie.

Dr. Diamond continued his research into the physiologic differences between male and female brains and what that might mean as regarded sex, gender, gender identity, and sexuality. The more he looked into it the more he was convinced that Dr. Money was wrong, that there was indeed a physiologic basis for these things. What he observed in animal models, human brains, intersexuals, and transsexuals was not easily explained away by enculturation. The question was, did things really go as well with cases like John/Joan as Money and others said they did? The lack of any long-term follow-up was another of those obvious, science 101, holes in the theories that few save Diamond seemed much interested in exploring. Dr. Diamond had never stopped believing that Dr. Money's theories and protocols were severely hurting intersexual children, in 1991 he decided to prove it. He eventually tracked down the last psychologist known to have worked with "Joan" and, eventually, met "Joan" herself.

Or, as it turned out, himself. Joan, despite never knowing why (Dr. Money was quite strict about the importance of the child never being told what had been done to them), had rebelled from the very beginning. She had never accepted herself as a girl and had endless problems, was put through endless hell to try and make her one. Despite being told she was a girl and treated like one from the time she was less than two years old she never saw herself as one and acted and presented in ways that were obviously - obvious to everyone save Dr. Money, apparently - masculine. By 1979 Joan had been on female hormones for two years, they weren't helping matters any, and that this point she started taking things into her own hands. Dressing as androgynously or openly masculinely as she could and rebelling against any attempts to further feminize her. On March 14th, 1980 Joan was finally told the truth. Joan again became John at that point, changing his name, having his breast surgically removed, and undergoing phallopla

It's hard to imagine how there could have been any more difference between the reported "successful" case of John/Joan and the reality. In 1997 Dr. Diamond and Dr. Sigmundson (the last psychologist to have treated "Joan") published a paper outlining the real story. The firestorm created by their paper still hasn't quieted down today even though none of this should have come as any great shock to anyone. Two years prior the first and only long-term follow up study of reassigned intersexual children at John Hopkins had been done by Dr. Bill Reiner, a former pediatric urologist turned child psychologist. His study had shown that out of six such individuals all six were closer to male than their reassigned female roles and two had spontaneously (id est, without being told what had been done to them) switched sexes. Despite every attempt to make girls out of them, all six somehow knew they were boys and openly stated that. What had been done to them hadn't helped them, hadn't solved any problems real or perceived

If gender identity, one's sense of self as a man or woman, was something learned, constructed, enculturated, created by our respective societies for whatever reason and inculcated into children from birth, then Joan and the John Hopkins reassigned intersexuals should all be out there living and being accepted by others as happy and healthy women. Unfortunately for them, given the hell they were put through, this is not the case, and John Money's "proof" that gender identity is constructed, learned, in fact goes a very long ways towards proving the opposite when one looks at the real evidence, at the real long-term results, rather than simply at Dr. Money's at best optimistic and at worst outright lying assessment.

The John/Joan and similar cases provide strong evidence that gender identity is an innate and immutable core component of what and who each of us is and that it exists from birth. Social gender role, the outward expression of gender identity in a social context, is certainly mutable, but even there the John/Joan case provides evidence that the fundamentals of social gender role are indeed based on that collective basal gender identity. This is strong stuff and anyone wishing to claim that gender is constructed or mutable is going to have to come up with extremely strong counter-evidence. To date, none has been forthcoming.

I have great sympathy for John and great admiration for his ability to rise above what he was put through. I frankly think Dr. Money is a monster who belongs in jail and deserves a particularly nasty place in whatever hell there may be. But John's story, the real story, does give me hope in a somewhat odd way. I do not believe that feminist or others who would try and fundamentally change or destroy femininity or masculinity will, in the end, be any more successful in doing so on a macro scale than Dr. Money was successful in doing so on a micro scale. They may do a lot of damage in trying - they are doing a lot of damage in trying - but ultimately they will fail.

My apologies for the length of this. I've never been known for my brevity and this is a complicated subject with a long history - I've barely scratched the surface of it here.

Originally posted on the ifeminists.com discussion forum, May 15, 2003.

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