As Nature Made Him: The Boy Who was Raised as a Girl.

As Nature Made Him: The Boy Who was Raised as a Girl. By John Colapinto. New York: HarperCollins, 2000, 288 pages. Cloth, $26.00.

Reviewed by Kate Nicolai, Ph.D., Department of Psychology, Rockhurst University, 1100 Rockhurst Road, Kansas City, MO 64110-2561; e-mail: [e-mail]

As a sexuality educator in an undergraduate psychology program, I continually keep my eyes and ears open for material that will engage students in novel ways and foster a deeper appreciation for the myriad dimensions along which sexuality is experienced and expressed in people's lives. Colapinto's As Nature Made Him: The Boy Who Was Raised As A Girl is the fascinating, heart-wrenching story of David Reimer, who, as a result of a botched circumcision and subsequent castration, was raised as a girl named Brenda until the age of 15. After reading Colapinto's book, I am convinced that it holds enormous pedagogical value as a supplemental text in any course related to sexuality or gender.

The book brings to life, in a highly engaging manner, a variety of content areas typically covered in sexuality/gender courses, such as prenatal sexual differentiation, the significance of gender identity to child and adolescent social development, the effects of hormones on the development of secondary sexual characteristics during puberty, sexual diversity and intersexuality, and the sociocultural meanings of sex and gender. Although the book's relevance to these content areas is certainly one reason I plan to assign As Nature Made Him to students in my course on the psychology of sexual behavior, its potential use as a vehicle to stimulate critical thinking and evaluation of sexuality information and research is most outstanding. My review focuses on aspects of the book that I believe might serve this objective.

Educators who assign this book to their students should thoroughly discuss the importance of critically evaluating sexuality information (for some guidance see Wiederman, 2001), beginning with the idea that not all sources and types of information are equally valid or credible. For example, there are obvious differences in the quality of evidence found in the well-researched case study that is reviewed by journal or book editors versus the testimonial "cases" that students will have undoubtedly seen on any number of television talk shows. More relevant to the evaluation of As Nature Made Him as a source of information is the fact that publishers of scholarly journals and publishers of books for mass consumption employ different criteria in their respective determinations of whether a work will go to press. This is not to suggest that these differing sets of criteria necessarily lead to published information that is more or less credible, just that the publishers' aims are not the same.

An initial question that could be posed to students is whether the author is credible and unbiased in his reporting of the case and events that surrounded it. Colapinto is not a sexuality researcher or clinician, and does not claim to be. To my knowledge, he had never published anything related to gender identity development or intersexuality before he investigated the John/Joan case (as it was known at the time) for Rolling Stone magazine. The fact that Colapinto is a journalistic, rather than a scientific, investigator could prompt classroom discussion about the potential strengths and limits of his unique perspective on the case. For instance, students might suggest that because Colapinto does not have a scholarly or clinical background in the field of sexuality, he could have missed important nuances of the case that a sexologist would not have overlooked. On the other hand, because Colapinto's background is not in sexology, it may be that he was able to report on the case more objectively, since he would be less likely to be closely aligned with any particular paradigm that could bias his approach to the case.

Critical evaluation of any investigation, whether scientific or journalistic, requires an examination of the methods used to gather information. Essentially, As Nature Made Him is a case study; students should be encouraged to identify components of solid case study methodology, discuss strengths and limitations of this method of research, and evaluate Colopinto's work on these bases. For example, a good case study integrates information from many diverse sources that are deemed credible. In this regard, As Nature Made Him is impressive. In my opinion, one of the most remarkable aspects of the book is the quality and credibility of the information the author presents on the case.

Colapinto takes great pains to assure readers that As Nature Made Him is indeed a work of nonfiction, in its totality. In the Author's Note preceding the first chapter, Colapinto writes that "[n]o dialogue or scenes have been invented for the purposes of `narrative flow,' `atmosphere,' or any other quasi-novelistic purpose" (p. ix). Further, he states that any dialogue that is presented--and the book is chock-full of dialogue--is taken verbatim from transcripts of taped psychological interviews (including conversations between David Reimer and John Money), from written notes of interview/therapy sessions (provided by several psychologists who treated Reimer at various points in his childhood and adolescence), and from statements provided by family members, friends, physicians, and teachers who were witnesses to particular events in Reimer's life.

The fact that Colapinto obviously did his homework in terms of gathering information from many credible sources does not mean, however, that As Nature Made Him is devoid of subjective bias. As students evaluate the strength of Colapinto's work, they might appreciate that while the author certainly presents the facts of the case in a way that instills a good deal of confidence in his credibility, Colapinto is, after all, telling a story he hopes will captivate and elicit emotion in his readers.

To illustrate, other than Brenda/David Reimer, the primary figures in the book are researchers John Money (also the clinician who treated Brenda) and Milton Diamond, who over the course of their scholarly careers took distinctly different views about the origins of sexual identity development. Colapinto provides enough detailed, factual information to give students a good understanding of Money's and Diamond's respective scholarly positions, and a necessary context to appreciate events relevant to the case (including what is described as an ongoing, intense, and at times very public, conflict between the two).

It is in Colapinto's exploration of Money's and Diamond's respective characters that As Nature Made Him reads more like a juicy novel than an objective report. John Money is portrayed as a truly chilling figure whose unabashed hubris is matched only by his Machiavellian need for power, control, and recognition. He is introduced early in the book as a "suavely charismatic individual ... with the long, elegantly cut features of a matinee idol" (p. 18). Diamond, on the other hand, is depicted as a very objective, reasonable, almost mild-mannered scientist whose responses to Money range from puzzlement to mild irritation. The extent to which these characterizations are entirely accurate I cannot say. In any case, students will not need to read between the lines to identify the "good guy" and the (very) "bad guy" in As Nature Made Him.

That Colapinto possesses a journalist style which rivals that of the best novelist should not be held against him, of course; although there are times that the careful reader will be aware of the "set-up" followed by the "zinger" or "bombshell," Colapinto's approach does not rise to the level of manipulation. Still, students should be able to recognize that an author's writing style can provide useful information in evaluating both the objectives of the author and the overall credibility of the work.

In addition to evaluating As Nature Made Him as a source of sexuality information, educators can use the book as a catalyst for critical discussions about the relationships between theory, research, and clinical practice. Importantly, the book illuminates the fact that the sociopolitical zeitgeist exerts a tremendous influence not only on how research questions are answered and how those answers translate into policy and practice, but on the very questions that are asked. Perhaps the best illustration of these points can be made in the context of a classroom discussion of what is probably the most central question pondered by behavioral researchers in the last century: the so-called "nature versus nurture" question. Students will appreciate, perhaps for the first time, the immeasurable real-world significance of this question as they read how at least one researcher's answer to it forever altered the life of David Reimer.

On the basis of studies carried out at Johns Hopkins on the psychological adjustment of intersexual individuals who were raised in opposition to their chromosomal sex, John Money generalized his neutrality-at-birth theory to all infants. Educators might generate a classroom discussion about the extent to which this generalization was appropriate given Money's methods and findings. Colapinto points out that Money's theory, which was widely publicized in the media beginning in the mid-1960s, was embraced by both the feminist movement and the wider public.

To students in the behavioral sciences, Money's assertions that the right "training" during an early developmental window could virtually eliminate any genetic influences on the establishment of gender identity should have a very familiar ring. In the early 1920s, Watson, a well-known predecessor of behaviorist Skinner, made the following (now infamous) proclamation: "Give me a dozen healthy infants, well formed, and my own specified world to bring them up in ... [and] I can guarantee to take any one at random and train him to be ... doctor, lawyer, merchant, chief, and, yes, even beggarman and thief' (1924/1970, p. 104). The important point for students is this: rather than being radical, or even particularly novel, Money's theory of gender identity development was a predictable extension and application of behaviorist formulations--which strongly emphasized nurture (i.e., environmental influences) over nature (i.e., genetic and biological influences)--that continued to previl through the 1970s. Further, given the political appeal of the neutrality-at-birth theory, the media attention it received, and the subsequent celebrity of its major proponent, it is not surprising that when David Reimer suffered his life-changing accident, John Money--not Milton Diamond--was looked to for the solution.

A real strength of As Nature Made Him is its detailed descriptions of empirical studies, especially those conducted by Diamond. Concepts such as experimental controls and analogue designs are brought to life, and the book also provides students with an excellent framework for understanding the underlying logic of the famous twin study, one method used by researchers to tease out the relative contributions of nature and nurture. If, as a result of reading this book, students can grasp why a case such as this would be an undeniable boon to behavioral researchers, identify the limits of conclusions that could be drawn, and propose alterations to the design of the study that might strengthen both its internal and external validity, then the book has proved its worth as a pedagogical tool.

No critical examination of any study in sexuality (or in any other area, for that matter) can be complete until the ethical dimensions of that study have been explored. With regard to research and clinical ethics, As Nature Made Him provides enough material for weeks of discussion and debate in the classroom. However, I need to provide a note of caution and some advice to educators who use As Nature Made Him in their classrooms: Because the book contains what can only be described as truly horrifying depictions of sexuality research and therapy, I strongly suggest that instructors devote sufficient class time to present an accurate and balanced view of contemporary (and ethical) sex research and clinical practices. Without the benefit of this discussion, students who read As Nature Made Him could very well leave the course with some of their worst stereotypes of sex researchers and clinicians intact, if not strengthened.

Although the questionable ethics of Money's clinical/research practices will no doubt be of central interest to students, the book also raises the broader issue of how, to what extent, and even if medical and mental health professionals should intervene in the development of intersex children, adolescents, and adults. Near the end of the book, Colapinto introduces the Intersex Society of North America, describes its objections to the invasive medical treatment of intersexuality, and reports on the attempts of this advocacy group to be heard by the medical establishment. Students could easily locate more information about the ISNA on the Internet (www.ISNA.org), and share their findings in a discussion of these issues. Finally, As Nature Made Him provides a wealth of material related to research ethics in a broad sense, including how, when, and where research findings are published in scholarly journals and the manner in which these findings are disseminated to the general public. More than anything else in the book, the fascinating saga revolving around the politics of publication will enlighten students to the fact that science does not occur, and researchers do not do their work, in a vacuum.

In sum, I encourage those who teach sexuality or gender courses to consider including As Nature Made Him: The Boy Who Was Raised As a Girl as a supplemental text. It will engage students on many levels, promote a more sophisticated understanding of both the content and the process of sexuality research, and if they are adequately prepared, help them develop and apply skills that will allow them to critically evaluate sexuality information they will encounter long after they have completed the course.

REFERENCES

Watson, J.B. (1970). Behaviorism. New York: Norton. (Original work published 1924)

Wiederman, M. W. (2001). Understanding sexuality research. Belmont, CA: Wadsworth.