As Nature Made Him (5 page)

While Money’s conclusions about the best approach to sexual matters merely raised eyebrows in the mid-1970s, they provoked outrage at the dawn of the more conservative 1980s, when Money ventured into areas of which even some of the most adventurous sexual explorers were leery. In 1986, Money published
Lovemaps
, an exhaustive study of such practices as sadomasochism, coprophilia, amputation fetishes, autostrangulation, and various other behaviors that he called, not perversions, but “paraphilias,” in an effort to destigmatize and decriminalize them. The topic of pedophilia became a particular interest, and one that Money took obvious delight in publicly espousing.

“A childhood sexual experience,” he explained to
Time
magazine in April 1980, “such as being the partner of a relative or of an older person, need not necessarily affect the child adversely.” He granted an interview to
Paidika
, a Dutch journal of pedophilia, which carries ads for the North American Man-Boy Love Association and other pro-pedophile groups. “If I were to see the case of a boy aged ten or twelve who’s intensely attracted toward a man in his twenties or thirties, and the relationship is totally mutual, and the bonding is genuinely totally mutual, then I would not call it pathological in any way,” he told the journal, and added, “It’s very important once a relationship has been established on such positive and affectionate grounds that it should not be broken up precipitously.” In 1987, Money wrote an admiring foreword to an unusual volume published in Denmark entitled
Boys and Their Contacts with Men
. By Dutch professor Theo Sandfort, the book presented what purported to be verbatim testimonials of boys as young as eleven years old rhapsodically describing the delights of sex with men as old as sixty. “For those born and educated after the year 2000,” Money wrote, “we will be their history, and they will be mystified by our self-important, moralistic ignorance of the principles of sexual and erotic development in childhood.” Money concluded his foreword with the proclamation “It is a very important book, and a very positive one.”

Money’s response to criticism for the public airing of such views was always to launch counterattacks of his own, ridiculing his critics for their adherence to an outmoded sexual Puritanism. In an autobiographical essay included in his 1985 book of collected writings,
Venuses Penuses
, Money dubbed himself a “missionary” of sex, proudly proclaiming, “It has not been as easy for society to change as it had been for me to find my own emancipation from the 20th-century legacy of fundamentalism and Victorianism in rural New Zealand.”

Money’s experimental, taboo-breaking attitude to sex found its echo in the way he pursued his professional research career. Eschewing the more trammeled byways of sex research, Money deliberately sought out exotic corners of the field. He found just such a relatively undiscovered realm of human sexuality in 1948, while in the first year of study for his Ph.D. in psychology at Harvard. In a tutorial called Fieldwork and Seminar in Clinical Psychology, Money was presented with the case of a fifteen-year-old genetic male born not with a penis, but with a tiny, nublike phallus resembling a clitoris. At puberty, the boy had developed breasts. It was Money’s first exposure to hermaphroditism—also known as intersexuality—a term of classification for a variety of birth anomalies of the internal and external sex organs. Often described in lay terms as a condition of being half-man, half-woman, the syndrome derives its name from a combination of the names of the Greek gods of love, Hermes and Aphrodite, and occurs as often as one in two thousand births (by some estimates). The symptoms vary from the extreme manifestation of a genetic female born with a penis-sized clitoris and fused labia resembling a scrotum, to a male whose genital resemblance to a girl at birth is so total that his true biological sex is not suspected until puberty when “she” fails to menstruate—to anything in between.

Money was fascinated by hermaphroditism and wrote his doctoral dissertation on the subject. Until then the syndrome had been studied almost solely from a biological perspective. Money approached it from a psychological angle, investigating the mental and emotional repercussions of growing up as anatomically neither boy nor girl. His thesis, entitled “Hermaphroditism: An Inquiry into the Nature of a Human Paradox,” was completed in 1952 and led to his invitation to join Johns Hopkins, where the world’s first and largest clinic for studying and treating intersexual conditions had been established. The clinic’s director, pioneering pediatric endocrinologist Lawson Wilkins, teamed Money with two married psychiatrists, Drs. Joan and John Hampson, to study the mental and emotional makeup of the intersexual patients treated in the clinic. The three researchers made up the newly created Psychohormonal Research Unit.

Over the next six years, Money and the Hampsons studied some 131 intersexuals ranging in age from toddlers to adults. Money (who was lead investigator and author of the team’s published reports) claimed to observe a striking fact about intersexes who had been diagnosed with identical genital ambiguities and chromosomal makeups but raised in the opposite sex from one another: more than 95 percent of them reportedly fared equally well psychologically whether they had been raised as boys or girls. Money called these groupings of patients “matched pairs” and said they were proof that the primary factor determining an intersexual child’s gender identity was not biology, but rather the way the child was raised. He concluded that these children were born wholly undifferentiated in terms of their psychological sex and that they formed a conception of themselves as masculine or feminine solely through rearing.

This theory was the foundation on which Money based his recommendation to Johns Hopkins surgeons and endocrinologists that they could surgically and hormonally steer intersexual newborns into whichever sex, boy or girl, they wished. Such surgeries would range from cutting down enlarged clitorises on mildly intersexual girls to full sex reversal on intersexual boys born with undeveloped penises. These conversions to girlhood were foreordained by the state of surgical technology: it was easier for surgeons to construct a synthetic vagina than to create an artificial penis. Money’s only provisos were that such “sex assignments” and reassignments be done within the first two and a half years of life (after which time, Money theorized, a child’s psychosexual orientation ceased to be as malleable) and that once the sex had been decided upon, doctors and parents never waver in their decision lest they risk introducing fatal ambiguities into the child’s mind.

By providing a seemingly solid psychological foundation for such treatments, Money had offered physicians a relatively simple surgical solution to one of the most vexing and emotionally fraught conundrums in medicine: how to deal with the birth of an intersexual child. “One can hardly begin to imagine what it’s like for a parent when the first question—‘Is it a boy or a girl?’—results in a response from the physician that they’re just not sure,” says Dr. Fred Berlin. “John Money was one of those folks who, years ago, before this was even talked about, was out there doing his best trying to help families, trying to sort through what’s obviously a difficult circumstance.”

Money, however, was not interested chiefly in intersexes. As he stated as early as his Harvard thesis, he recognized the scientific worth of intersexes primarily as what he called “experiments of nature”—as a cohort of research subjects who could shed light on the question of sexual development in
normal
humans—who could, in fact, resolve one of the longest-running debates in science; namely, whether it is primarily nature or nurture that shapes our sexual sense of self. It was in his first published papers at Johns Hopkins that Money generalized the theory of psychosexual neutrality at birth from hermaphrodites to include
all
children, even those born without genital irregularity.

“From the sum total of hermaphroditic evidence,” he wrote in 1955, “the conclusion that emerges is that sexual behavior and orientation as male or female does not have an innate, instinctive basis. In place of a theory of instinctive masculinity or femininity which is innate, the evidence of hermaphroditism lends support to a conception that, psychologically, sexuality is undifferentiated at birth and that it becomes differentiated as masculine or feminine in the course of the various experiences of growing up.” In short, Money was advancing a view that human beings form a sense of themselves as boy or girl according to whether they are dressed in blue or pink, given a masculine or feminine name, clothed in pants or dresses, given guns or Barbies to play with. Many years later, Money would describe how he arrived at some of his more radical theories about human sexual behavior. “I frequently find myself toying with concepts and working out potential hypotheses,” he mused. “It is like playing a game of science fiction.”

While Money’s theory of human newborns as total psychosexual blank slates may strike a contemporary reader as science fiction, such was not the case in the mid-1950s, when it was met with almost universal acceptance by clinicians and scientists—an acceptance not difficult to understand in the context of the time. Explanations for sex differences had been moving toward a nurturist view for decades. Prior to that, the pendulum had been pointing in the naturist direction—thanks to the discovery at the end of the nineteenth century of the so-called male and female hormones, testosterone and estrogen. The discovery of these chemical-based internal secretions had led biologists to proclaim the riddle of sex differences solved: testosterone was the masculinizing agent; estrogen, the feminizing. They confidently predicted that male homosexuals would be discovered to possess an excess of the “female” hormone in their bloodstream and a deficiency of the “male” hormone. Minute analysis of the urine and blood of adult homosexual men, however, revealed no such hormonal imbalances. Under the microscope, a straight and a gay man’s internal secretions are identical. Other experiments meant to show the hormonal basis of sexual identity also failed, and as the failures mounted, enthusiasm for a biological explanation of sexual differences gradually waned. Simultaneously, the first half of the twentieth century and the advent of Freud and modern psychology saw a rapid increase in social learning models for human behavior. Against this background, the Johns Hopkins team’s conclusions that sexual identity and orientation were solely shaped by parents and society fit perfectly into an intellectual zeitgeist in thrall to behaviorist theories. Nor did it detract from the papers’ reception that they carried the imprimatur of Johns Hopkins Hospital, one of the premier medical research institutions in the world.

The Johns Hopkins team’s 1955 intersex papers were proclaimed instant classics and won that year’s Hofheimer Prize from the American Psychiatric Association. The Hampsons soon left Johns Hopkins for Washington State University and by 1961 had drifted out of gender identity research. As a result, Money alone became heir to the award-winning papers’ reputation. And as sole director of the Psychohormonal Research Unit (after Lawson Wilkins’s death in 1962), he was also the lone beneficiary of the unit’s success. In 1963 Money was awarded a grant of $205,920 from the National Institutes of Health—a considerable sum in early-1960s dollars, but merely the first of several NIH grants that would sustain Money and his unit for the next thirty-five years. In 1965 he served as Mead Johnson visiting professor of pediatrics at the University of Buffalo Children’s Hospital, and was awarded the Children’s Hospital of Philadelphia Medal “for contributions to the study of the psychological development of children.” A year later he would begin to garner fame outside the academic realm when he finally succeeded in persuading Johns Hopkins to establish the clinic for the treatment and study of adult transexuals.

Money had been galvanized by transexualism since 1952, when the revelations about Christine Jorgensen first hit the press. In Jorgensen’s case, Money saw tantalizing proof of his theory that environment, not biology, determines psychological sex, for here was a person born with apparently normal male biological makeup and genitals whose inner sense of self had differentiated as female—in direct contradiction to his chromosomal, gonadal, hormonal, reproductive, and anatomic sex. What greater evidence could there be that gender identity is determined not by biology but by environment? Determined to study such individuals in the greatest number possible, Money set out to get Johns Hopkins into transexual research and treatment, which was still a repellent idea for the majority in the American medical establishment.

In his campaign to establish Johns Hopkins as the first hospital in America to embrace transexual surgeries, Money knew that he would first have to bring on board a respected medical man. (Money himself was a psychologist and did not possess a medical degree of any kind.) He turned first to Dr. Howard Jones, the Johns Hopkins gynecologist who had perfected the surgical techniques for sex assignment on Money’s infant intersexual subjects. “I can recall,” Jones says, “that for a number of months, maybe even years, John kept raising the question of whether we shouldn’t get into the transexual situation.” While Jones was interested in experimental medicine (he would eventually leave Johns Hopkins for the University of Virginia where he would found the nation’s first in vitro fertilization clinic), he was resistant to the idea of performing elective castrations and genital reconstruction on adults.

But Money was persistent. He turned for help to Dr. Harry Benjamin. The acknowledged grandfather of transexual study in America, Benjamin had for the previous ten years been quietly referring transexual patients to doctors in Casablanca and Morocco for sex change surgery. Money enlisted three of Benjamin’s postoperative transexuals to come to Johns Hopkins and meet with Jones and pediatric endocrinologist Milton Edgerton. Eventually Jones and Edgerton were convinced. “John finally marshaled enough evidence,” as Jones puts it, “to indicate that this was something that maybe should be done.” Fittingly enough, Money was given the job of naming the new clinic for adult transexual surgeries. He dubbed it the Gender Identity Clinic.