After a botched circumcision a little boy was made into a little girl. Sharon Krum reports on a case that has split the American psychiatric community in two
THE year was 1964; the place, Baltimore, United States. An eight-month-old baby boy underwent a radical sex change to become a baby girl. When his penis was mutilated following a botched circumcision, doctors advised his parents that gender reassignment would be the best chance for a normal life.
They loved their son, wanted the best for him. The idea appeared extreme, but the experts seemed confident. It was the Sixties and the world of psychology was abuzz with talk of a wild new theory about sex and gender. Biology, it contended, was no longer destiny. Girls and boys are not born, but made. We come into the world as a blank page and our parents can fashion our gender at will. Talk to him, dress him, condition him as a girl, they promised, and a girl he would be.
Newly convinced that psychology could turn their son into a daughter, the parents acquiesced to surgery creating a vagina. John became Joan.
“As soon as he had the surgery, the doctor said I should treat him as a girl, put him in girl’s clothes,” says his mother who, with John, made headlines this month with the publication of a follow-up study in the Archives of Paediatric and Adolescent Medicine. Conducted by Dr Milton Diamond, a professor of biology at the University of Hawaii, and psychiatrist Dr Keith Sigmundson at the Canadian Ministry of Health, it is the most detailed examination made public so far into the life of a boy raised as a girl. (John’s identity is suppressed.) A cause clbre in the American psychiatric community, it has deepened the rift between advocates of nature and nurture.
Initially, the reassignment was trumpeted a success. Professor John Money, a paediatric psychiatrist at Johns Hopkins University, wrote that turning John into Joan furnished strong scientific proof that we are all born gender-neutral. Adding to the excitement was Time magazine, which in 1973 declared that Joan “provides strong support that conventional patterns of masculine and feminine behaviour can be altered”. John/Joan became the new darling of the psychiatric world, proof that psychology had finally outmanoeuvred biology.
Yet by the age of five, his parents knew otherwise. “It was a disaster,” his mother says now. “I put this beautiful dress on him and he immediately tried to rip it off.” Joan also rejected Barbie, asked if she could shave like her father, insisted on urinating standing up and, when her twin brother refused to share, saved her pocket money to buy a toy gun.
Even hormone treatment did nothing to quell her instinct to act male. At 10, she wanted to climb trees. At 12, she hated her breasts and refused to wear a bra. At 14, she thought girls were sexy. Confused and depressed, Joan contemplated suicide.
“I thought I was a freak,” Joan admits in the study. Her unrelenting anxiety convinced her parents that the truth must out: they told her she’d been born a male. Incredibly, there was no anger, only relief. “All of a sudden, everything clicked. For the first time, things made sense and I understood who and what I was.” After a double mastectomy and surgery to refashion a penis, Joan again became John. As a female, his life had been hell; as a male, he says, aside from bitterness about his castration, he feels secure in his identity. Now he is married and father to three adopted children – living proof, he says, that boys will be boys and social engineering belongs in the dustbin.
“This individual could wear a dress, put on lipstick, but there was something in his thinking process which said: `This is not me’,” reports Diamond, who believes John’s case strongly suggests sexual identity is fixed in the brain, not the genitals.
“Despite everyone telling him he was a girl, and despite female hormones, his brain knew he was a male,” concurs Dr William Reiner of Johns Hopkins Hospital, who is currently studying seven male teens being raised as women. Already two have rejected their female identities.
“The case challenges our assumptions that social role-playing has a direct impact on a child,” says Dr Frank Farley, past president of the American Psychological Association. “Even without a penis, John was clearly a boy. I think this case demonstrates that gender is in the brain and the impact of John’s parents treating him as a girl was minimal.”
Though rare, cases like John’s have been ongoing in the US since the Fifties, when gender reassignment for babies born with ambiguous or damaged genitals came into vogue. Psychiatrists, led by Professor Money, developed strong beliefs that sexual orientation was dependent on the appearance of a penis or a vagina. So, he reasoned, in its absence, social conditioning and hormones could turn a boy into a girl, and vice versa.
“In the Sixties, psychologists were convinced we were not `hardwired’ in the brain for gender,” says psychotherapist Dr Emily Hancock, author of The Girl Within. “In fact, it wasn’t until recent studies of twins separated at birth that we learned so much of our identity is in our genes.” She says John’s case suggests irrefutably that boys are created in the womb. Playing with Barbie and wearing pink dresses can never, she says, undo the power of the XY chromosome.
Not everyone agrees. Dr Carole Lieberman, clinical professor of psychiatry at UCLA, says: “I don’t see this as a triumph for the nature over nurture theory. Gender is a combination of genes and conditioning. Identity is 50/50. This is an extreme case.” So where does the truth lie? Can boys be turned into girls and vice versa?
Hancock believes the jury will always be out. “What John’s case suggests is that conditioning can’t override genes, but nurture theorists won’t concede this because there is too much at stake.” At its core, she says, the debate is all political. “We like to believe that if we alter a child’s environment, we can change it. Look at the trend for adopting babies from abroad or from mothers with addictions. If you subscribe to the nurture theory, you can ignore genes and socialise the child to develop a certain way. But I think John shows that you can’t, and trying to alter genetic identity only leads to disaster.”