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 Walter O. Bockting, Ph.D., Coordinator of Transgender Services, Program in Human Sexuality, University of Minnesota Medical School, 1300 S. 2nd Street, #180, Minneapolis, MN 55454; e-mail: [e-mail].

John Colapinto won the National Magazine Award for Reporting with his account of the classic John/Joan case in Rolling Stone (Colapinto, 1997). It is not surprising then that he subsequently published a book on this real-life story from the scientific literature. The book is ripe for evolution into a screenplay following the recent success of the film Boys Don't Cry. However, it is the overdramatized subplot of professional rivalry between researchers John Money and Milton Diamond that mars an otherwise solid work of reporting.

As Nature Made Him tells the heartbreaking story of David Reimer. Born half of an identical twin, David suffered an accident during circumcision at the age of 8 months: his penis was burned off. In the months following this accident, David's parents agonized over how this would affect their child's life. They eventually consulted specialist John Money with whom they decided to reassign David as a girl and raise him as such (a decision that was consistent with the prevailing sex assignment procedures for children born with ambiguous genitalia). David's testicles were removed, and a vulva was created. The parents were instructed to unequivocally nurture his female gender role. Of course, his identical twin, Brian, was raised as a boy.

Though initial follow-up reports suggested that David had successfully adopted the female gender role, over time it became clear that something was wrong. She felt awkward in the female role and was socially isolated and troubled. At age 12, she reluctantly took female sex hormones as recommended to facilitate puberty. When her problems escalated, it was decided to tell David, then 14 years old, what she had never been told before: that she had been born male. In response, she reverted back to the male sex at once, taking masculinizing hormone shots and undergoing mastectomy and phalloplasty. Now, 20 years later, David lives as a man, happily married to a woman with three children from a previous relationship.

This book describes a dramatic case, yet it is about more than David's tragedy and resilience; it is also about the scientific debate and controversy that has surrounded this case. Without this perspective, the significance of the case cannot be fully understood.

In the 1950s psychologist John Money concluded, based on research with intersex patients, that both gender identity and role are undifferentiated at birth. If assigned before the age of 18 months, gender identity would largely be determined by social experience (nurture) regardless of biological sex (Money, Hampson, & Hampson, 1955a, 1956, 1957). Consistent with this conclusion, a policy was developed recommending early surgery to match the appearance of the external genitalia with the assigned sex for those children born with ambiguous genitalia (Money, Hampson, & Hampson, 1955b). Biologist Milton Diamond challenged the underlying assumptions of this policy and argued instead, based on new animal research at the time, that pre- and perinatal sex hormones have a determining influence on gender identity and role via sexual differentiation of the brain.

The case of David and his twin brother Brian is particularly relevant to this argument in that both shared the same prenatal environment, yet Brian was assigned the male role and David the female role before the age of 2. Initial reports of David's successful adaptation to the female gender role were heralded as offering strong support for Money's theory (Money, 1975; Money & Ehrhardt, 1972). Now, some 30 years later, long-term follow-up reports exposing David's struggle and revealing his re-reassignment to the male gender role are viewed as offering strong support for Diamond's theory (Diamond & Sigmundson, 1997a). The implications of the case are therefore not limited to the clinical management of infants with traumatized or ambiguous genitalia, but extend to the relative contribution of nature versus nurture in the development of gender identity and role.

I have mixed feelings about this book. I agree with the acknowledgment of the important theoretical and clinical implications of David's story, but I am troubled by the way this subject is approached and described: as a true Hollywood script, complete with villain (John Money) and hero (Milton Diamond). Colapinto portrays Money as opportunistic, manipulative, condescending, violent, and even perverse. He accomplishes this through insinuations and by taking Money's comments and actions out of context. Moreover, Colapinto's reporting of Money is selective; changes in Money's thinking over the years are downplayed. For example, after research showed that prenatal exposure to hormones influenced gender role behavior in humans, Money gave up the hypothesis of gender neutrality at birth and went on to articulate his interactional theory of psychosexual differentiation (Money & Ehrhardt, 1972). In stark contrast, Colapinto depicts Milton Diamond as nonpretentious, ethical, mild-mannered, and a family man, brave enough to take on the establishment (i.e., as embodied by Money). I happen to know both John Money and Milton Diamond, and very much respect each scholar in his own right. So, I will not add anything more to Colapinto's digression.

Notably, this book is written for the general public. David's story is a very important one and will fill readers with empathy, respect, and admiration for this man's life and dignity. The book does not, however, add much to the Rolling Stone article. Sexual scientists, scholars, and clinicians are better off reading the original report in the scientific literature (Diamond & Sigmundson, 1997a) and related commentaries (Diamond & Sigmundson, 1997b; Meyer-Bahlburg, 1998, 1999).

In his 1998 commentary, Meyer-Bahlburg alludes to the emerging "third gender" paradigm that is currently influencing the debate on sex assignment at birth. Advanced by pioneers in the transgender and intersex movements, this new paradigm provides room for individuals to define and affirm their identities outside of the binary conceptualization of male versus female (Bockting, 1999). By living their lives true to form, transgender and intersex persons confront Western culture's deep-seated fear of ambiguity. Although Colapinto acknowledges intersex activists' unique identities and their plea against early genital surgery, he ultimately fails to transcend both Money's and Diamond's points of view and misses the opportunity to lead the reader to a greater appreciation of the complexity and diversity of sex, gender, and sexual orientation.

REFERENCES

Bockting, W. O. (1999). From construction to context: Gender through the eyes of the transgendered. SIECUS Report, 28(1), 3-7.

Colapinto, J. (1997). The true story of John/Joan. Rolling Stone, 775, 54-97.

Diamond, M., & Sigmundson, H. K. (1997a). Sex reassignment at birth: Long-term review and clinical implications. Archives of Pediatrics and Adolescent Medicine, 151, 298-304.

Diamond, M., & Sigmundson, H. K. (1997b). Management of intersexuality: Guidelines for dealing with persons with ambiguous genitalia. Archives of Pediatrics and Adolescent Medicine, 151, 1046-1050.

Meyer-Bahlburg, H. F. L. (1998). Gender assignment in intersexuality. Journal of Psychology & Human Sexuality, 10(2), 1-21.

Meyer-Bahlburg, H. F. L. (1999). Gender assignment and reassignment in 46, XY pseudohermaphroditism and related conditions. The Journal of Clinical and Endocrinology & Metabolism, 84, 3455-3458.

Money, J. (1975). Ablatio penis: Normal male infant sex-reassigned as a girl. Archives of Sexual Behavior: 4, 65-71.

Money, J., & Ehrhardt, A. A. (1972). Man & woman, boy & girl: Differentiation and dimorphism of gender identity from conception to maturity. Baltimore: Johns Hopkins University Press.

Money, J., Hampson, J. G., & Hampson, J. L. (1955a). An examination of some basic sexual concepts: The evidence of human hermaphroditism. Bulletin of the Johns Hopkins Hospital, 97, 301-319.

Money, J., Hampson, J., & Hampson, J. L. (1955b). Hermaphroditism: Recommendations concerning assignment of sex, change of sex, and psychologic management. Bulletin of the Johns Hopkins Hospital, 97, 284-300.

Money, J., Hampson, J. G., & Hampson, J. L (1956). Sexual incongruities and psychopathology: The evidence of human hermaphroditism. Bulletin of the Johns Hopkins Hospital, 98, 43-57.

Money, J., Hampson, J. G., & Hampson, J. L (1957). Imprinting and the establishment of gender role. Archives of Neurology and Psychiatry, 77, 333-336.