In 1964, after a gruesome accident, a little
boy named John became a little girl named Joan in a surgical procedure which
made headlines. Reported by sexologist Dr. John Money of the Johns
Hopkins Medical School, the procedure known as "gender
reassignment" was hailed as a marvel of modern medicine and an example
of the pliability of sexual identity.
But now, more than thirty years later, a
report published last month in the Archives of Pediatric and Adolescent
Medicine which continues the story of John/Joan indicates that
researchers may have been completely wrong, that an individual's
identification as male or female is formed before birth and is immune to
both psychology and surgery.
It all started when a botched surgical
procedure to repair the foreskin of eight month-old "John" (whose
name has been changed to preserve his anonymity) literally destroyed his
penis. His horrified parents brought him to the Johns Hopkins Hospital,
where surgeons decided that, due to the difficulty of reconstructing the
male genitalia, the best course of action would be a "gender
reassignment." John was castrated and sex-change surgery followed. It
was decided that John would henceforth be "Joan," and would be
raised as a girl alongside his twin brother.
This was the account as published in 1973.
The unfortunate case of John/Joan was widely received as proof that gender
identification was pliable, that a child has no definite ties to being male
or female before being socialized into the world of Barbie and G.I. Joe.
Time magazine said that the case "provides strong support...that
conventional patterns of masculine and feminine behavior can be altered. It
also casts doubt on the theory that major sex differences, psychological as
well as anatomical, are immutably set by the genes at conception." It
became a textbook example and was the standard procedure for similarly
mangled children, as well as for children suffering from severely deformed
genitals for decades.
However, the story didn't end there. See,
it seems that the gender reassignment didn't stick.
According to last month's report by Dr.
Keith Sigmundson of the Ministry of Health in Victoria, British Columbia and
Dr. Milton Diamond of the University of Hawaii - Manoa (who actually
served as a consultant to the British Broadcasting Company in its coverage
of the story in the late 1960's and 1970's), no matter how much Joan's
parents tried, she simply refused to be a girl. She rebelled at wearing
dresses and preferred her brother's toys over her own dolls. When her mother
tried to get her to pretend to put on makeup, she instead imitated her
father shaving. She would even insist on urinating standing up, regardless
of the mechanical difficulties involved. Socially, Joan shunned girls and
actively sought out male friends while her peers teased her mercilessly,
calling her "cave man" and "gorilla."
Around age 9, Joan began to suspect that
something wasn't right. "There were little things from early on,"
the patient recalls in last month's report. "I began to see how
different I felt from what I was supposed to be. But I didn't know what it
meant. I thought I was a freak or something...I looked at myself and said I
don't like this type of clothing, I don't like the types of toys I was
always being given. I liked hanging around with the guys and climbing trees
and stuff like that and girls don't like any of that stuff. I looked in the
mirror and [saw] my shoulders were so wide. I mean, there [was] nothing
feminine about me. I was skinny, but other than that, nothing. But that was
how I figured it out, but I didn't want to admit it. I figured I didn't want
to wind up opening a can of worms."
That can of worms was finally opened after
Joan began receiving estrogen treatment and grew breasts. Her discomfort
grew, and by the age of 14 she was considering suicide. After she confessed
to her endocrinologist that she suspected she was a boy, the team who had
been following her case decided that the best course of action might be a
re-re-assignment back to male. Joan embraced the idea, and by the age of 16
had undergone a mastectomy and phallus reconstruction. Finally, in a tearful
conversation with her father, Joan learned the truth about her original
gender.
The family, by this time a little leery of
the experts suggestions, decided to reject their suggestions that it would
be easier for "John" to move and start a new life elsewhere.
Suprisingly, classmates rallied around the teenager, accepting him in ways
that they had never accepted Joan. Some girls who had taunted him as a child
even developed crushes on him.
John took full advantage of the situation,
buying a windowless van equipped with a bar and bed and embracing his new
identity. By the age of 25 he had married and adopted his wife's children
(due to the castration, he is unable to father children himself), and is now
a healthy and stable individual. And yes, he is capable of having
intercourse and orgasm, though his wife is more interested in sex than he
is. About the events of his childhood, John is "still bitter, of
course, and who wouldn't be," Dr. Diamond said, "but he's got a
great sense of humor, and his head is on straight."
The case holds strong implications for
other children like John. In particular, for the 1 out of every 100,000
babies born with seriously deformed genitals, surgeons will now think twice
before arbitrarily deciding to make the child female. According to Dr.
William Reiner of the Johns Hopkins Hospital, who wrote a companion
editorial to the recent report, "The question this case doesn't answer
but lends data to is: What is the origin of gender identity? How do we know
we are a boy? And when do we know it?"
"John, in spite of being raised as a
girl and being treated with hormones and estrogen, said 'Forget it. I'm a
boy.'"
Citation: The Johns
Hopkins News-Letter; 28 March 1997 <http://www.jhu.edu/~newslett/03-28-97/Science/>
