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The contributions of John Money: a personal view.


John Money has been a dominant voice in sexology sexology /sex·ol·o·gy/ (sek-sol´ah-je) the scientific study of sex and sexual relations.

sex·ol·o·gy
n.
The study of human sexual behavior.
 in the last part of the 20th century, breaking new ground in a wide variety of areas. In the process, he has been cantankerous can·tan·ker·ous  
adj.
1. Ill-tempered and quarrelsome; disagreeable: disliked her cantankerous landlord.

2.
, outspoken, and ever willing to do battle, but also original and thought provoking. This paper begins with an examination of science in general, moves on to psychology and sexology, and then examines Money's contributions to sexology in some detail. The latter are many and varied, including the development of the concept of gender, his theory of gender identity based on his work with intersex intersex /in·ter·sex/ (in´ter-seks)
1. hermaphrodite.

2. pseudohermaphrodite.

3. intersexuality.


female intersex  a female pseudohermaphrodite.
 individuals, the John-Joan case, and his importance in establishing transsexualism transsexualism

Self-identification with one sex by a person who has the external genitalia and secondary sexual characteristics of the other sex. Early in life, such a person adopts the behaviour characteristic of the opposite sex.
 as a diagnostic category and an academic discipline. Also important are his contributions to the development of the nomenclature of sexology, his importance to the sexology movement as a teacher, his significant research on large variety of sexual topics, his ability to convince government agencies that sex was deserving of funding, and his association with the Erickson Educational Foundation. He also was a significant figure in the development of the Society for the Scientific Study of Sexuality The Society for the Scientific Study of Sexuality, formed in 1957, claims to be "the oldest organization of professionals interested in the study of sexuality in the United States." It claims to have some 900 members and has a quarterly newsletter, Sexual Science.  (SSSS SSSS Staphylococcus scalded skin syndrome, see there ) and in raising the standard of its journal (The Journal of Sex Research), and therefore it is only fitting that an award he named after him. Though Money remains controversial, he has contributed significantly to the development of sexology as a discipline.

John Money is one of the great pioneers of American sexology in the last part of the 20th century. He should be included in the pantheon of pioneer researchers such as Alfred Kinsey Alfred Charles Kinsey (June 23, 1894 – August 25, 1956), was an American biologist and professor of entomology and zoology who in 1947 founded the Institute for Research in Sex, Gender and Reproduction at Indiana University, now called the Kinsey Institute for Research in , William Masters
William Masters should not be confused with Robert E. L. Masters, who also researched and wrote on the subject of sexology.
William Masters was also the birth name of musician Gordon Stretton.
, Virginia Johnson, and other individuals who changed the way Americans (and much of the world) thought about sexuality. Kinsey, the taxonomist, described the varieties of sexual behavior sexual behavior A person's sexual practices–ie, whether he/she engages in heterosexual or homosexual activity. See Sex life, Sexual life.  of Americans. Masters and Johnson Masters and Johnson, pioneering research team in the field of human sexuality, consisting of the gynecologist

William Howell Masters, 1915–2001, b. Cleveland, and the psychologist

Virginia Eshelman Johnson, 1925–, b.
 described the physiological process of orgasm and sexual response, and in the process founded modern sex therapy. Money, a psychologist, took the next step and constructed a theory of sexual development, emphasizing the interaction and interdependence of social psychological and biological factors. All four helped establish sexology as a science, but John Money was one of the first to put his research into a theoretical framework.

This is an important contribution. Just recently Wiederman and Whitley (2002) decried the lack of theory guiding sexuality research. They singled out the difficulty in integrating research and theory in a multidisciplinary field. Adding to the problem is the fact that few areas of research carry the emotional impact that sexuality does. There is always a justified fear of an emotional backlash to any challenge to traditional assumptions which have long centuries of belief behind them, particularly when many of the erroneous beliefs have also been incorporated into religious dogma. John Money has never been afraid of controversy and either willingly or unwillingly seemed to seek it out. This has been both a strength and a weakness.

Making sexology a science is not an easy task. It can only be done by building on what each new discovery brings. As one who entered into sexual research through the history of medicine and science, I have always been very much aware of how science is continually updated with old theories being replaced by new. One of my early books, The Scientfic Revolution (Bullough, 1970), examined the radical transition in Western thought brought about by a shift from a geocentric ge·o·cen·tric  
adj.
1. Relating to, measured from, or with respect to the center of the earth.

2. Having the earth as a center.



ge
 to a heliocentric he·li·o·cen·tric   also he·li·o·cen·tri·cal
adj.
1. Of or relating to a reference system based at the center of the sun.

2. Having the sun as a center.
 universe in the 16th and 17th centuries. So challenging to the established order was this change that Galileo's books were on the papal index until the 20th century. We all know the names of scientists such as Copernicus and Galileo, Kepler and Newton, as well as others who were important in the advancement of science, but we tend to forget that we have gone far beyond them in our present day world of many systems within our universe, of the possibility of a big bang big bang

Model of the origin of the universe, which holds that it emerged from a state of extremely high temperature and density in an explosive expansion 10 billion–15 billion years ago.
 and the debate over whether the universe is expanding or contracting, and numerous other issues not contemplated by the early pioneers. As the comparatively recent discovery of DNA DNA: see nucleic acid.
DNA
 or deoxyribonucleic acid

One of two types of nucleic acid (the other is RNA); a complex organic compound found in all living cells and many viruses. It is the chemical substance of genes.
 emphasizes, science is continually reinventing itself. What one generation says might be modified by new discoveries or interpretations. This is a truism in sexology as well.

Changes in ideas come not just from new discoveries but also from looking at traditional assumptions with a fresh mind. It has long been evident to historians of mathematics, for example, that the plane geometry we were taught in middle school developed out of land-based surveying. What happens if we approach the subject from a different viewpoint and argue that the shortest distance between two points is not a straight line but a curved one as it is in space? Answering such a question led to the development of non-Euclidean geometry non-Euclidean geometry, branch of geometry in which the fifth postulate of Euclidean geometry, which allows one and only one line parallel to a given line through a given external point, is replaced by one of two alternative postulates. . The result is a totally new world view. Depending on which basic assumptions one works with, both geometries are equally valid and consistent. I believe John Money created a similar change by developing his concept of gender.

Sexuality issues are further complicated by the fact that the answers to questions rely both on biology and on the social and behavioral sciences behavioral sciences,
n.pl those sciences devoted to the study of human and animal behavior.
, and the latter are still in the developmental stage as a science compared to the former. Often, reading social and behavioral science behavioral science
n.
A scientific discipline, such as sociology, anthropology, or psychology, in which the actions and reactions of humans and animals are studied through observational and experimental methods.
 research is like the proverbial blind persons examining the elephant: Each is correct on a small detail but misses the whole picture. Theories are plentiful but difficult to test. In this sense, some of modern psychology, whose adherents are probably now the dominant voice in sex research, resembles the theorists in the heroic age the age when the heroes, or those called the children of the gods, are supposed to have lived.

See also: Heroic
 of medicine. During that period in medical history, there were many theories and not much hard data to support any of them except the claims of their practitioners that they cured their patients. There were Thomsonians, eclectics, hydropaths, homeopaths, naturopaths, and literally hundreds of others, almost all equally bad (Hoolihan, 2001). Many of these schools created a sexual mythology about masturbation, hysteria, impotence, and other ills that we have not yet entirely overcome. In fact, medicine in the past probably ought to be classified as more of an art and a trade than a science. It is good to remember that as late as the 18th century, Greek and Roman medical writers and their Arabic commentators remained the dominant force in medical thinking, although thanks to Vesalius and William Harvey and others, there was a better knowledge of anatomy and physiology. Even this new knowledge was called into question by physicians who wondered what help it gave them in curing their patients and as a result stuck to their old methods.

This real lack of scientific exploration in medicine until fairly recently is one of the issues that medical historians often discuss after they have had a few glasses of beer or harder liquor and are relaxing among themselves. The question, usually harshly stated, is this: When did professional medical practitioners cure more patients than they killed? Was professional medical knowledge any better than folk medicine folk medicine, methods of curing by means of healing objects, herbs, or animal parts; ceremony; conjuring, magic, or witchcraft; and other means apart from the formalized practice of medical science. ? It is not just a question for the cocktail hour but for serious discussion, since many of the standard treatments--such as bleeding to get rid of evil humors, starvation diets to starve the disease, massive amputations without sterile techniques which inevitably led to infection and often death, forbidding or condemning masturbation, and any number of other mistreatments and beliefs--we now look upon with horror. Most of us reluctantly have to conclude that it was only in the 20th century that medicine became more of a science than an art, and even then we have to admit that still today the art of medicine remains a very important part of medical practice since there is still so much we do not know.

What is true of medicine is even more true of the social and behavioral sciences in general. Psychology is now probably the most influential of the behavioral sciences in the sex field and in same specialties perhaps the most scientific. Still, over the 20th century it underwent an evolution, moving from structuralism structuralism, theory that uses culturally interconnected signs to reconstruct systems of relationships rather than studying isolated, material things in themselves. This method found wide use from the early 20th cent.  to functionalism functionalism, in art and architecture
functionalism, in art and architecture, an aesthetic doctrine developed in the early 20th cent. out of Louis Henry Sullivan's aphorism that form ever follows function.
 to behaviorism behaviorism, school of psychology which seeks to explain animal and human behavior entirely in terms of observable and measurable responses to environmental stimuli. Behaviorism was introduced (1913) by the American psychologist John B.  (Misiak & Sexton, 1966). J. B. Watson's behaviorism was modified by the operant operant /op·er·ant/ (op´er-ant) in psychology, any response that is not elicited by specific external stimuli but that recurs at a given rate in a particular set of circumstances.

op·er·ant
adj.
 behaviorism of B.F. Skinner. For a time, this was called the "new psychology," but it too was soon challenged, and Skinner boxes in child rearing ill retrospect seem a passing fad. His operant behaviorism was criticized by Carl Rogers Noun 1. Carl Rogers - United States psychologist who developed client-centered therapy (1902-1987)
Rogers
 for concentrating on the "externally observable behavior" and "ignoring the whole universe of inner meanings, of purposes, of the inner flow of experiencing present in the human world"(Misiak & Sexton, 1966, p. 344).

It seems to be a truism that any new generation looking at the theories of an older one often will challenge its predecessors, a perhaps necessary part of the development of a science where so much still remains unexplainable. As long as it remains so, new theories will appear, usually building on past ones but modifying and changing them.

In my lifetime there has been gestalt Gestalt (gəshtält`) [Ger.,=form], school of psychology that interprets phenomena as organized wholes rather than as aggregates of distinct parts, maintaining that the whole is greater than the sum of its parts. , humanistic, psychoanalytic, phenomenological, existential, interpersonal, and evolutionary psychology evolutionary psychology
n.
The study of the psychological adaptations of humans to the changing physical and social environment, especially of changes in brain structure, cognitive mechanisms, and behavioral differences among individuals.
. There are Freudians, Jungians, Adlerians, Ericksonians, and the list could go on, rivaling or exceeding the medical theorists of the past (Misiak & Sexton, 1966). Some attacks on theorists are more brutal than others. Bruno Bettleheim, for example, was denounced as a fraud, a liar, and a perverter per·vert  
tr.v. per·vert·ed, per·vert·ing, per·verts
1. To cause to turn away from what is right, proper, or good; corrupt.

2. To bring to a bad or worse condition; debase.

3.
 of children by the brother of one of his clients, although in the past 2 or 3 years there has been an attempt to rehabilitate him (Raines, 2002). Whether he should or can be rehabilitated is something we do need to ask. This is an important question, since Bettleheim has not been alone in the viciousness of attacks directed toward him. Cyril Burt, the British psychometrician famous for his study of identical twins identical twins
pl.n.
Twins derived from the same fertilized ovum that at an early stage of development becomes separated into independently growing cell aggregations, giving rise to two individuals of the same sex, identical genetic makeup, and
, was accused shortly after his death of making up data, fudging his results, and inventing coauthors (Gillie, 1976). It was not until 1988 and 1989 that two different investigators concluded that the attacks against Burt had been motivated by a mixture of professional and ideological antagonism and that no credible case for falsification falsification /fal·si·fi·ca·tion/ (fawl?si-fi-ka´shun) lying.

retrospective falsification  unconscious distortion of past experiences to conform to present emotional needs.
 of the data could be made (Fletcher, 1991; Joynson, 1989).

Sometimes treatments are rejected because of new data. The Masters and Johnson therapeutic treatment of impotency, for example, has more or less disappeared with the development of new drugs and new surgical solutions. On the other hand, Harry Benjanmin, who was denounced as a quack by many of his peers, is now eminently respected and has a professional society named after him. Some researchers remain controversial but much less so as their research and findings hold up. Alfred Kinsey has had some down periods because of congressional investigations, denunciations by a significant section of the clergy, attacks by some of his colleagues, a debunking de·bunk  
tr.v. de·bunked, de·bunk·ing, de·bunks
To expose or ridicule the falseness, sham, or exaggerated claims of: debunk a supposed miracle drug.
 biography (Jones, 1997), and an organized anti-Kinsey movement (Reisman & Eichel, 1990), but his reputation once again is on the rise, and the institute he founded remains a major force in sexological research. He probably will never be free from attack until his most virulent enemies die off, since they regard him as one of the main causes of the sexual revolution. Even though Kinsey's data has been used and misused by both supporters and opponents. I still find him an invaluable source.

All of this brings me to John Money, who as a pioneer issued challenges to both his colleagues and the public at large to rethink traditional assumptions. In the process he has been cantankerous, outspoken, and ever willing to do battle, but still original and thought provoking and unafraid of challenging the establishment. Being a trail blazer is a difficult role, since others who follow try to find new or easier paths or take different turns and come up with different conclusions. Some will challenge the "expert" just because his or her theories are so dominant. Other will build upon the work, examining it from a new and different perspective and deriving different conclusions. All of this has happened to Money, but none of this should lessen the accomplishments of Money the pioneer, since he like each of us was formed by the time and knowledge base of the world he lived in. Science, as I have to keep repeating, is a series of explorations for new answers to questions that the pioneers did not ask or did not foresee. Even a worse fate faces those path breakers whose concept becomes popular, so popular that they are often misinterpreted. Money has been not only misunderstood by many but also consciously or unconsciously misinterpreted both by his supporters and antagonists.

A good example is his conception of gender. In 1955, he adopted an old term, gender--long used in linguistic discourse to designate whether nouns are feminine, masculine, or neuter--to serve as an umbrella concept to distinguish femininity or womanliness wom·an·ly  
adj. wom·an·li·er, wom·an·li·est
1. Having qualities generally attributed to a woman.

2. Belonging to or representative of a woman; feminine: womanly attire.
 and masculinity or manliness from biological sex. In a sense, by adopting a new term to describe a variety of phenomena. Money opened a whole new field of research. He continued to expand the use of the concept by developing such terms as gender identity, defined as the total perception the individual has about his or her own gender, including a basic personal identity as a man or woman, boy or girl. He also held that his new gender category could he expanded to include a basis for making personal judgments about an individual's level of conformity to the social norms of masculinity and femininity, that is, to his or her gender role. Most people, he argued, are gender congruent meaning gender identity, gender role, and all of the symbolic manifestations of gender are harmonious--and they will not have a cross-gender sexual orientation sexual orientation
n.
The direction of one's sexual interest toward members of the same, opposite, or both sexes, especially a direction seen to be dictated by physiologic rather than sociologic forces.
. This was an innovative idea of which I am still enamored en·am·or  
tr.v. en·am·ored, en·am·or·ing, en·am·ors
To inspire with love; captivate: was enamored of the beautiful dancer; were enamored with the charming island.
.

The term gender is not a copyrighted term, and once the concept emerged, it was used by others in different ways. Robert Stoller and his psychoanalyatic group at UCLA UCLA University of California at Los Angeles
UCLA University Center for Learning Assistance (Illinois State University)
UCLA University of Carrollton, TX and Lower Addison, TX
 split role from identity, gender identity being interpsychic and gender role being behavioral and socially prescribed as well as socially and historically stereotyped. This resulted in a popular dictum that sex is what you are born with and gender is what you become. Sex is biology, gender is sociology (Stoller, 1968).

Even these nicely refined meanings of gender were lost when the feminist movement seized upon the term. Arguing that all notions of femininity and masculinity one sees on school playgrounds are socially constructed. Thorne stated that the feminist critics argued, "If boys and girls boys and girls

mercurialisannua.
 are different, they are not born, but made that way" (Thorne. 1993, p. 2). This is an extreme statement, fortunately now rejected by most, but before it was, the term gender, regarded as a more a politically correct politically correct Politically sensitive adjective Referring to language reflecting awareness and sensitivity to another person's physical, mental, cultural, or other disadvantages or deviations from a norm; a person is not mentally retarded, but  term, began to be used to avoid the biological term set in questionnaires. The result has been confusion: We now have to explain how we are using the term gender, and the term has lost much of its usefulness in scientific discussion. This substitution of the word gender for biological sex should serve as a sort of moral story indicating that it is not always possible to predict what others will do with your specific terminology once it is disseminated--something about which we should all be aware. What we need now is another term to express what Money so ably explained nearly half a century ago.

Researchers into sex come from a variety of disciplines and professions. Some come from disciplines that tend to emphasize a social constructionist con·struc·tion·ist  
n.
A person who construes a legal text or document in a specified way: a strict constructionist.
 perspective over biology. For the social constructionist, sex is an ever-changing psychosocial construct created in the symbolic social worlds that allow people to interact with each other. They believe that each individual will have a different set of experiences, creating a cognitive structure that will determine how any new information is internally processed. In short, each individual gives meaning to sexual and self-concepts through the complex interaction of external discourse and social relations with the existing power structure (Gagnon & Simon, 1973; Reis, 1986). It is also important to realize that those who claim to be social or behavioral scientists strongly believe in the predictive qualities of their work. I have always been struck with the problem faced by the believers in projective technique tests when Evelyn Hooker demonstrated to them that their tests could not distinguish persons who were homosexual from heterosexuals, something which they had strongly believed could be done (Hooker, 1957). As an outsider who is not an advocate of projective technique tests, I would have thought they might be able to fudge and explain away their failure to do so by claiming that Hooker did not use a representative sample or skewered its selection. Instead they accepted the test results demonstrating that homosexuals were little different from heterosexuals, thereby establishing a pscyhological basis for challenging the then current concepts of homosexuality. Such a simple experiment, when expert believers are involved, can force a lot of change, even if the instruments in which the experts believe are not as valid as they think.

Money, through his study of hermaphrodites Hermaphrodites

half-man, half-woman; offspring of Hermes and Aphrodite. [Gk. Myth.: Hall, 153]

See : Androgyny
 and their adjustment in life to their assigned sex role, came to believe that gender was to a considerable extent a psychosocial construct, although he did not ignore biological and other factors and always subscribed to a multivaried explanation. This led him and his colleagues to develop the concept of critical periods: periods at various stages in development from the embryo through early childhood during which critical gender happenings could significantly influence gender behavior. He was not certain when this might happen but increasingly felt it occurred both in the embryo and in early infancy, at the latest by the 18th month (Money, Hampson, & Hampson, 1955). It might be that Money was not originally as clear as he thought, because Lawrence Kohlberg cited him as saying that the sexual development of the normal adult is contingent on sex assignment at 3 or 4 years (Kohlberg, 1966), and others felt this was the case also. Quite clearly and unequivocally, however, Money early on finally settled on such critical periods ending at 18 months. Gender identity involves social situational and in-uterine biological forces and the existence of sex chromosomes-that is, XX or XY chromosomes--but that does not preclude the existence of other factors at work. How else can we explain the existence of transsexuality trans·sex·u·al  
n.
1. One who wishes to be considered by society as a member of the opposite sex.

2. One who has undergone a sex change.
, of transvestism transvestism: see homosexuality.
Transvestism
Klinger, Cpl.

dresses in women’s clothes to try to win discharge from the army. [Am. TV: M ° A ° S ° H in Terrace]
, or even homosexuality? But how does one gather evidence to document this assumption?

It was in this setting that the parents involved in the so-called John-Joan case called upon Money for help. By the time they had consulted Money, the twin who had suffered penile penile /pe·nile/ (pe´nil) of or pertaining to the penis.

pe·nile
adj.
Of or relating to the penis.



penile

of or pertaining to the penis.
 ablation while he and his brother were being circumcised at 7 months was 17 months old. After consulting Money, the parents began identifying the child as a girl, and surgery for removal of the testes testes
 or testicles

Male reproductive organs (see reproductive system). Humans have two oval-shaped testes 1.5–2 in. (4–5 cm) long that produce sperm and androgens (mainly testosterone), contained in a sac (scrotum) behind the penis.
 was performed several months later when the child was 23 months old.(1) Vaginoplasty vaginoplasty /vag·i·no·plas·ty/ (-plas?te) plastic surgery of the vagina.

vag·i·no·plas·ty
n.
Plastic surgery of the vagina. Also called colpoplasty.
 was to be delayed until puberty. Note that this gender change came close to the end of Money's critical period, and the castration castration, removal of the sex glands of an animal, i.e., testes in the male, or ovaries and often the uterus in the female. Castration of the female animal is commonly referred to as spaying.  took place beyond it. Money also emphasized that indoctrination in·doc·tri·nate  
tr.v. in·doc·tri·nat·ed, in·doc·tri·nat·ing, in·doc·tri·nates
1. To instruct in a body of doctrine or principles.

2.
 into the new role had to be ongoing and continuous. Money and Ehrhardt reported some 6 years after the surgery that the child was becoming clearly feminine and, though tomboyish, was adjusting well (Money & Ehrhardt, 1972). Later in the chapter, there was a carefully worded cautionary statement that the successful acceptance of sex or gender changes would only occur if the adults, especially those close to the individual, transmitted clear and unambiguous signals about the new identity (Money & Ehrhardt, 1972. p. 173), something that did not occur in this case. Ultimate success, as Money said in personal discussion of the case, could only be noted after puberty. Still, Money and Ehrhardt felt that with parental and other support, the gender change would be successful. The unfortunate aspect of this is that many readers did not catch the cautionary warning about the importance of parental certainty. Certainly Money and Ehrhardt did not give it prominence. The book had tremendous influence on physicians who, in their search for treatment for intersex children, ignored any warnings and instead quickly adopted the idea that human infants are psychosexually malleable at birth, thus justifying sex reassignment surgery For specialized articles on surgical procedures, see Sex reassignment surgery male-to-female and Sex reassignment surgery female-to-male.
Sex reassignment surgery (SRS), gender reassignment surgery, or sex-change operation
 at birth and even performing somewhat drastic surgery, even if it went contrary to chromosomal sex.

Not all sexologists agreed with Money's rosy prognosis. Milton Diamond was an early critic who hypothesized that the hermaphrodites from whom Money had drawn most of his early data might be receiving mixed biological signals that allowed them to conform to the assigned gender rather than change it, which they could do somewhat more easily than a nonhermaphrodite child. Many such individuals, in fact, wanted surgery to make them better conform to their assigned gender even if the chromosomal sex might be different. Diamond charged Money with de-emphasizing biology or nature, and overemphasizing nurture (Diamond, 1965). The problem with the twins as a scientific experiment is that they disappeared from the literature in the 1970s, and only rumors existed on what had happened. The last meeting Money had with them in 1978 was disastrous, and David (Brenda) ran from his office. The first notice that the case might be different than described came from a British Television presentation of the case in 1980. Money had refused to participate in the documentary although Diamond did. I should add that the British network made an agreement not to exhibit the program in North America, so for most Americans the failure was only a rumor. Unfortunately, Money failed to report the difficulties of the child to accept sex reassignment until much later, in part perhaps because, as he once said, the client refused to communicate with him. Undoubtedly he also felt there were too many issues involved, and that the media that dogged him were more interested in showing the primacy of biology over rearing and in polarizing the story rather than in giving information. The issue is further complicated by the fact that there was at least one other case of penis ablatio in Canada at about the same time, also resulting from a botched botch  
tr.v. botched, botch·ing, botch·es
1. To ruin through clumsiness.

2. To make or perform clumsily; bungle.

3. To repair or mend clumsily.

n.
1.
 circumcision circumcision (sûr'kəmsĭzh`ən), operation to remove the foreskin covering the glans of the penis. It dates back to prehistoric times and was widespread throughout the Middle East as a religious rite before it was introduced among the . In this case the new gender identity was accepted (Bradley, Oliver, Chernick, & Zucker, 1998). Some have pointed to this so-called successful case as a dubious success because the woman is a lesbian and drives an 18-wheel truck, but since I have a daughter who is a lesbian and drives an 18-wheel truck, I am not sure the criticism is valid. Personally, I think it would have been politically wiser for John to have been the first to reveal the changes taking place in the John-Joan case or to have emphasized the contradictory evidence early on rather than having someone else do it, but he did not and this will remain a blot on his career. But what do two cases, one favorable and one unfavorable, really prove? A single example does not prove or disprove disprove,
v to refute or to prove false by affirmative evidence to the contrary.
 a theory. It only emphasizes that there are a lot of factors at work.

This is also the conclusion of the most complete examination of the vast literature on the subject by Ken Zucker (1999). He concluded that both biological and psychosexual psychosexual /psy·cho·sex·u·al/ (-sek´shoo-al) pertaining to the mental or emotional aspects of sex.

psy·cho·sex·u·al
adj.
Of or relating to the mental and emotional aspects of sexuality.
 factors are involved and there is no easy answer and no easy solution. Zucker examined a number of known diagnoses for intersex children, including androgen insensitivity syndrome Androgen insensitivity syndrome (AIS, or "Androgen resistance syndrome") is a set of disorders of sexual differentiation that results from mutations of the gene encoding the androgen receptor. It has also been called androgen resistance in the medical literature. , congenital adrenal hyperplasia Congenital Adrenal Hyperplasia Definition

CAH is a genetic disorder characterized by a deficiency in the hormones cortisol and aldosterone and an over-production of the hormone androgen, which is present at birth and affects sexual development.
, 5 alpha-reductas deficiency, partial androgen insensitivity syndrome, micropenis syndrome, penile agensis (the penis fails to differentiate), cloacal exstrophy, and penis ablatio. He found there was a significant gender identity differentiation among the syndromes. Unfortunately, he also found that there had been a significant lack of follow-up in most of the cases. I can only conclude, as does Zucker, that there needs to be a lot more empirical inquiry and follow-up before we can arrive at definitive answers.

The issue of intersex children has been further complicated by the fact that the whole question of treatment has been politicized. Money became a major target of the newly formed Intersex Society of North America The Intersex Society of North America, founded in 1993 by Cheryl Chase, is an organisation formed to represent the interest of intersexuals in the USA: people whose bodies do not fit the accepted conventional ideas of "male" or "female".  (ISNA Isna (ĭs`nə) or Esna (ĕs`–), town (1986 pop. 43,055), central Egypt, on the Nile River. It is the center for an agricultural area that is irrigated by the Nile. ) because of his advocacy of neonatal treatment for some forms of hermaphroditism hermaphroditism

Condition of having both male and female reproductive organs (see reproductive system). It is normal in most flowering plants and in some invertebrate animals. True human hermaphrodites are extremely rare.
 (Money, 1968). A rival theory pushed by the ISNA advocates that except for minor surgical corrections, the decisions should be held in abeyance A lapse in succession during which there is no person in whom title is vested. In the law of estates, the condition of a freehold when there is no person in whom it is vested. In such cases the freehold has been said to be in nubibus (in the clouds), in pendenti  until the child at puberty can determine for himself or herself what kind of surgery is desired (Dreger, 1999). In short, it changed the playing field, and though the Society brought hemaphroditism out of the closet, it also at its extreme became rather shrill. The ISNA tends to ignore the fact that the gender in which an intersex child is brought up will undoubtedly influence the child's ultimate decision, since in our world it is always impossible to be a neuter neu·ter
adj.
1. Having undeveloped or imperfectly developed sexual organs.

2. Sexually undeveloped.

n.
A castrated animal.

v.
To castrate or spay.



neuter

1.
. The real need in my mind is in helping parents decide what to do with their infants, since society has not yet accepted the fact that there are males, females, and others, and both the medical community and the parents need some guidelines. Undoubtedly, major reconstructive surgery reconstructive surgery
n.
Plastic surgery.


reconstructive surgery,
n surgery to rebuild a structure for functional or esthetic reasons.
 should be post ported until puberty if possible, but chromosomal sex alone cannot be a guide. The best recommendation would not only be based on the diagnosis of the causal factor causal factor Medtalk A factor linked to the causation of a disease or health problem  of intersex but on the willingness of the parents to raise sexually ambiguous children. There is no easy answer, and in fact, I am not certain there is an absolute answer. Neither was Money, although he was made a bele noir for his advice for early intervention ear·ly intervention
n. Abbr. EI
A process of assessment and therapy provided to children, especially those younger than age 6, to facilitate normal cognitive and emotional development and to prevent developmental disability or delay.
 about which he made some qualifications. The problem is to communicate the options to the patents more effectively without influencing them and then to support them in their decision. Quite frankly, some parents of intersex children seem to be almost incapable of dealing with an intersexed child unless a gender is assigned and some surgery done. Undoubtedly mistakes will be made. This is all issue where the sexological community itself needs to be involved as do parent groups and medical professionals. Interestingly, even in the John-Joan case of penis ablation where a mistake was made, John (or David as is his real name) made the decision himself to revert to his chromosomal sex in his early teens and has became a fairly well adjusted male with children and a wife (Colapinto, 2000). He undoubtedly suffered from the attempts to change him, but the real suffering was caused by the physician who botched the circumcision, not by Money who was later sought out by the parents.

The problem with exploring new approaches or areas is that one becomes particularly vulnerable. For example, Money was innovative in the use of drugs for treatment of sex offenders and some paraphiles. While not all would agree with some aspects of the treatment (Tsang, 1995), some critics become almost irrational, a recent e-mail to me, for example, claimed that John was producing Depo-Provera under his own pharmaceutical brand. "Upjohn," and was guilty of both naming a condition and selling the "cure" (L. M. Downing, personal communication, April 16, 2003). The critic was totally unaware that Upjohn was a long established pharmaceutical company that was not named after John and had a long and respectable history with the use of Depo-Provera. Even when the misinformation mis·in·form  
tr.v. mis·in·formed, mis·in·form·ing, mis·in·forms
To provide with incorrect information.



mis
 she was disseminating was pointed out, the person still felt that somehow John had turned a commercially "unviable" treatment into an academic asset, whatever that might mean (L. M. Downing, personal communication, April 21, 2003). Some days Money just cannot win.

Money should also be remembered not only as a pioneer in his writings on gender, but as a pioneer in the establishment of transsexualism as a diagnostic category in the United States. In 1965, he joined with others to establish the Johns Hopkins Gender Identity Clinic, which began sex reassignment surgery in 1966 and in a sense gave the blessing of academia to what had been sensationalized in the press. In fact, the Johns Hopkins center became a media event, and the resultant publicity soon led to the establishment of a number of university affiliated gender clinics, all of which included learns of psychiatrists, psychologists, and surgeons. Unfortunately, in spite of Money's pioneering work, the Hopkins center ran into controversy with some of his colleagues there. Academia, as many of us know, is a place where bitter rivalries can flourish. In 1975, Paul McHugh, an opponent of transsexual surgery, became chairman of the psychiatry department at Johns Hopkins, and he was determined to end the practice, comparing it to the lobotomies of an earlier generation of psychiatry. John Meyer, the then-head of the clinic and no friend of Money's, agreed and closed it. Since Meyer allegedly did so on the basis of his own poorly conceived study--which had serious methodological flaws including a poor response rate, a lack of any real scale for post operative adjustment, and numerous other problems it seems to an outside viewer that the decision was a political one, perhaps aimed at Money by some of his academic rivals (Fleming, Steinman, & Bocknek, 1980: Meyer, 1979). No one, however, can lessen Money's importance in the field of transsexualism.

One of Money's pet projects was to make the terminology of sexology more scientific. In the past, many professionals as well as the public used terms like perverts, deviants, pathological, and other such words to describe individuals with different forms of sexual expression. Money, following the example of Steckel, began to categorize such individuals as having a paraphilia paraphilia /para·phil·ia/ (par?ah-fil´e-ah) a psychosexual disorder marked by sexual urges, fantasies, and behavior involving objects, suffering or humiliation, or children or other nonconsenting partners. . Through his influence, the term was ultimately adopted by the American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential world-wide. Its some 148,000 members are mainly American but some are international.  and finally used in the 3rd edition of the Diagnostic and Statistical Manual. The term paraphilia in English seems to be less judgmental judg·men·tal  
adj.
1. Of, relating to, or dependent on judgment: a judgmental error.

2. Inclined to make judgments, especially moral or personal ones:
 than others, and to the public it sounds more scientific. In fact, Money devoted much energy to finding new terms for old, familiar diagnoses. Certainly it made the discussion of sex sound more scientific.

Most importantly, Money has a tremendously impressive list of publications on almost every aspect of human sexuality, even including history. He was interested in methodology, in opening new areas for exploration, in educating the public at large, and in keeping his colleagues on their toes. He wrote books for a popular audience as well as scholarly articles for his peers.

In spite of his somewhat prickly personality, Money had a remarkable number of collaborators in his publications, many of them his students. Richard Green wrote me that his life would have been quite different had he not met John Money in 1957 when he went to Hopkins as a student. While still a student, be copublished two papers with Money (Green & Money. 1960, 1961) and has continued to publish in the field since that time. Interestingly, Green was first author on the publications as a student, something that often does not happen in cases of other professors and their student collaborators. In fact, Moneys students, who are too numerous to mention, have become extremely influential in the field of human sexuality for both professionals and the educated reading public. As a series editor of many of his more popular books, I often thought he had a hidden factory going. He was also the best grant getter of anyone in the sex field. I am properly envious.

Fulfilling the job of a teacher and scholar, Money also often acted as referee for various journal articles. I must admit that I hated to have him read any manuscript of mine because it came back marked up with what I often felt were unusually picky pick·y  
adj. pick·i·er, pick·i·est Informal
Excessively meticulous; fussy.


picky
Adjective

[pickier, pickiest] Brit, Austral & NZ
 comments. Though I recognized that he had broad based knowledge of the field, this did not prevent my occasional outbursts of anger at him. Still, I must admit that occasionally I found he gave me a different insight. However, I remain bruised. He could be and often was a very harsh critic.

Money was a hard man to convince to change once he made up his mind. I tried to get him to change the title of Venuses Penuses, a book for which I was general editor, but he was determined to keep the title. The title of the book to my mind had little relation to the subject matter, which dealt with philosophy of sex and sex research, but my arguments were to no avail. It was John's book and not mine, and I eventually abandoned my arguments. Not infrequently in our relations, he went his way and I went mine. One is advised not to argue with John.

Money often had rocky relations with some of his peers, as the case of the Johns Hopkins center might illustrate, but he also was often very concerned about the people he dealt with and protective of his students. His actions, however, were often misunderstood. Let me illustrate. He and I were both involved with the Erickson Education Foundation established by Reed Erickson, a transsexual trans·sex·u·al
n.
A person who strongly identifies with the opposite gender and who chooses to live as a member of the opposite gender or to become one by surgery.

adj.
1. Of or relating to such a person.

2.
 FTM FTM Free Throws Made (basketball)
FTM Family Tree Maker (Brøderbund)
FTM Female to Male Transsexual
FTM For The Moment
FTM Fair to Midland (band)
FTM Forgot to Mention
, whom we both felt to be a somewhat troubled person. John was visiting in Mazatlan, Mexico, at Erickson's mansion there when "Eric" had what might be termed a psychotic moment, perhaps as a result of a drug overdose Drug Overdose Definition

A drug overdose is the accidental or intentional use of a drug or medicine in an amount that is higher than is normally used.
. John, extremely concerned and finding little assistance in Mexico, somehow managed to charter a plane and have Erickson transported to Johns Hopkins for treatment. When Erickson recovered he was so angered over what John had innocently done that he broke with him. I never discussed the issue with John and I only have Erickson' side of the story. The point of the story is that John is a complex personality, both nurturing and critical a mother hen to some and a harsh critic to others, and either way he sometimes gets into trouble.

Since I am telling stories, I might as well tell how he broke his ankle trying to be a good Samaritan. He, I, my wife Bonnie, and Zelda Supplee were visiting a nude beach in Dubrovnik (as part of our research of the local scene) while attending an international conference on gender. The beach was full of rocks, and as we were walking Along, Zelda, who was about 5 feet tall and weighed well over 200 pounds, began to fall. John and I were quick to the rescue, but in trying to catch Zelda, John stumbled over a rock and Zelda fell on him. Few of us can say that we broke an ankle trying to help a friend.

Money was also extremely important to the SSSS. As many of you know he is a past president, and it was during his presidency that the SSSS first established an office for a part-time secretary, the office which grew into the present job. He began the reorganization of the Society, which Ira Reiss and I eventually completed. He also served a long term as associate editor of The Journal of Sex Research.

I could go on telling John stories, but I think that SSSS does great honor to itself as well as to Money by naming an award after him. In spite of the fact that he is controversial, sometimes deliberately so, I think he made extremely significant contributions to the field in the last half of the 20th century. He made sexology a far more scientific field than it had been. He brought a large number of students into the field, he helped the SSSS grow as a society, he raised the scholarship level in the field, and he contributed immeasurably to our information and data base in numerous areas of human sexuality. As our science progresses, others will continue to build upon his work, often modifying and perhaps occasionally rejecting parts, but this is the way of science. Our pioneers like John Money cannel can·nel  
n.
A bituminous coal that burns brightly with much smoke.



[Perhaps short for cannel coal, dialectal variant of candle coal (from its bright flame).]
 and should not be forgotten. While he might not be loved by all of us, he certainly is respected. Now that he is a long time senior citizen and seems somewhat vulnerable, we can even learn to love him. I commend the Eastern Region for naming an award after him. He clearly deserves it.

(1) Some say the parents had actually began identifying the child as a girl somewhat earlier, perhaps as early as 14 months of age, on the advice of others they had consulted.

REFERENCES

Bradley, S., Oliver, G., Chernick, A., & Zucker, K. J. (1998). Experiment of nurture: Ablatio penis at 2 months, sex reassignment at 7 months, and a psychosexal follow-up in young adulthood. Pediatrics, 102, 1-5.

Bullough, V. L. (Ed.) (1970), The scientific revolution. New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of
: Holt, Rinehart and Winston

Colapinto. J. (2000). As nature made him. New York: Harper-Collins.

Diamond, M. (1965). A critical evaluation of the ontogeny ontogeny: see biogenetic law.
Ontogeny

The developmental history of an organism from its origin to maturity. It starts with fertilization and ends with the attainment of an adult state, usually expressed in terms of both maximal body
 of human sexual behavior
This article is about sexual practices (i.e., physical sex). Broader aspects of sexual behaviour such as social and psychological sexual issues are covered in related articles such as human sexuality, heterosexuality, and homosexuality.
. Quarterly Review of Biology, 40. 147-175.

Dreger, A D. (1999). Intersex in the age of ethics. Hagerstown, MD: University Publishing Group

Fleming, M., Steinman, C., & Bocknek, B (1980). Methodological problems in assessing sex reassignment surgery: A reply to Meyer and Reter. Archives of Sexual Behavior Archives of Sexual Behavior is an academic sexology journal and the official publication of the International Academy of Sex Research.

Contributions consist of empirical research (both quantitative and qualitative), theoretical reviews and essays, clinical case
, 9, 451-456.

Fletcher, R. (1991). Intelligence, equality, character, and education. Inteligence, 15, 139-149.

Gagnon. J. H., & Simon, W. (1973). Sexual conduct: The social sources of human sexuality. Chicago: Aldine.

Gillie, O. (1976, October 24). Crucial data faked by eminent psychologist. The Sunday Times, pp. 1-2.

Green, R., & Money, J. (1960). Incongruous gender role: Nongenital manifestations in prepubertal prepubertal /pre·pu·ber·tal/ (-pu´ber-tal) before puberty; pertaining to the period of accelerated growth preceding gonadal maturity.  boys. Journal of Nervous and Mental Disease The Journal of Nervous and Mental Disease is a scholarly journal on psychopathology.

Founded in 1874, it is the world's oldest independent scientific monthly in the field of human behavior.
, 130, 160-167.

Green, R., & Money, J. (1961). Effeminacy Effeminacy
Blue Boy

Gainsborough painting depicting princely lad with sissyish overtones. [Br. Art.: Misc.]

Fauntleroy, Little Lord

title-inheriting, yellow-curled sissy in velvet. [Am. Lit.
 in prepubertal boys: Summary of eleven cases and recommendations for case management. Pediatrics, 27, 286-291.

Hooker, E. (1957). The adjustment of overt male homosexuals. Journal of Projective Techniques, 21, 18-31.

Hoolihan, E. (Ed.). (2001). An annotated catalogue of the Edward C. Atwater collections of American popular medicine and health reform Rochester, NY: University of Rochester The University of Rochester (UR) is a private, coeducational and nonsectarian research university located in Rochester, New York. The university is one of 62 elected members of the Association of American Universities.  Press.

Jones, J. A. (1997). Alfred Kinsey: A public/private life. New York: W. W. Norton.

Joynson, R. B. (1989). The Burt affair. London: Routledge.

Kohlberg, L. (1966). A cognitive developmental analysis of children's sex role concepts and attitudes. In E. E. Maccoby (Ed.), The Development of Sex Differences. Stanford. CA: Stanford University Press.

Meyer, J. (1979). Sex reassignment Archives of General Psychiatry Archives of General Psychiatry is a monthly professional medical journal published by the American Medical Association. Archives of General Psychiatry publishes original, peer-reviewed articles about psychiatry, mental health, behavioral science and related fields. , 36, 1010-1015.

Misiak, H. & Sexton, V. S. (1966). History of psychology: An overview, New York: Grune and Stratton.

Money, J. (1968). Sex errors of the body: Dilemmas, education, counseling. Baltimore: Johns Hopkins University Johns Hopkins University, mainly at Baltimore, Md. Johns Hopkins in 1867 had a group of his associates incorporated as the trustees of a university and a hospital, endowing each with $3.5 million. Daniel C.  Press.

Money, J. (1986) Venuses penuses. Buffalo, NY: Prometheus Books.

Money, J., & Ehrhardt, A. A. (1972) Man & woman, boy & girl. Baltimore: Johns Hopkins University Press.

Money, J., Hampson, J. G., & Hampson. J. L., (1955). Hermaphroditism: Recommendations concerning assignment of sex, change of sex, and psychological Management. Bulletin of the Johns Hopkins Hospital
See also: , , and
The Johns Hopkins Hospital is a teaching hospital in Baltimore, Maryland (USA). It was founded using money from a bequest by philanthropist Johns Hopkins.
, 97, 301-319.

Raines, T. (2002) Rising to the light: A portrait of Bruno Bettelheim. New York: Alfred A Knopf.

Reis. I. (1986). Journey into sexuality: An exploratory voyage. Englewood Cliffs, NJ: Prentice Hall.

Reisman, J. A., & Eichel, E. W. (1990). Kinsey, sex and fraud: The indoctrination of a people. Lafayette, LA: Lochinvar-Huntington House.

Stoller, R. J. (1968). Sex and gender. New York: Science House.

Thorne, B. (1993) Gender play: Girls and boys in school. New Brunswick, NJ: Rutgers University Press Rutgers University Press is a nonprofit academic publishing house, operating in Piscataway, New Jersey under the auspices of Rutgers University. The press was founded in 1936, and since that time has grown in size and in the scope of its publishing program. .

Tsang, D.C. (1995). Policing "perversions": Depo-Provera and John Money's new sexual order. Journal of Homosexuality The Journal of Homosexuality (ISSN 0091-8369) is a long-standing peer-reviewed academic journal (founding editor Charles Silverstein) published by The Haworth Press, Inc., in New York. , 28, 397-426.

Wiederman, M. W., & White, B. E. (2002). Handbook for conducting research on human sexuality. Mahwah, NJ: Lawrence Erlbaum Associates.

Zucker, K. J. (1999). Intersexuality intersexuality /in·ter·sex·u·al·i·ty/ (in?ter-sek?shoo-al´i-te)
1. hermaphroditism.

2. pseudohermaphroditism.

3. androgyny.
 and gender identity differentiation. Annual Review of Sea Research, 10, 1-69.

Manuscript accepted June 16, 2003

Vern L. Bullough, Ph.D., R.N., is a State University of New York (body) State University of New York - (SUNY) The public university system of New York State, USA, with campuses throughout the state.  Distinguished proffessor Emeritus in history and sociology, and Professor Emeritus at California State University, Northridge CSUN offers a variety of programs leading to bachelor's degrees in 61 fields and master's degrees in 42 fields. The university has over 150,000 alumni. It's also home to a summer musical theater/theater program known as TADW (TeenAge Drama Workshop) that leads teenagers through an  where he taught before going to Buffalo. While there, he was awarded the title of Outstanding Professor by the California State University System California State University System, coordinating agency established in 1960 by the merger of individual California state colleges, now consisting of 23 campuses. . He and his late wife, Bonnie Bullough, established the Center for Sex Research which houses the Bonnie and Vern Bullough collection of materials on all aspects of human Sexuality. Currently he teaches sexology as an adjunct professor in the nursing school at University of Southern California The U.S. News & World Report ranked USC 27th among all universities in the United States in its 2008 ranking of "America's Best Colleges", also designating it as one of the "most selective universities" for admitting 8,634 of the almost 34,000 who applied for freshman admission . He is also a fellow in the Medieval and Renaissance Center at UCLA. A former president of the Society for the Scientific Study of Sexuality (SSSS) and a fellow of the society, he was given the Distinguished Research Award by the SSSS as well by the Eastern Region, and he received the Kinsey Award from the Mid Continent. This paper was given as an address marking the establishment of the John Money award by the Eastern Region of the SSSS.

Address correspondence to Dr. Vern Bullough, 3304 West Sierra Dr., Westlake Village, CA 91362; e-mail: vbullough@adelphia.net.

Vern L. Bullough State University of New York and University of Southern California
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Author:Bullough, Vern L.
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Date:Aug 1, 2003
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